HBV感染孕妇早期胆汁酸谱检测在妊娠期肝内胆汁淤积症诊断中的应用

Early detection of bile acid profiles for diagnosing intrahepatic cholestasis in HBV-infected pregnant women

目的探讨HBV感染孕妇早期胆汁酸谱检测在妊娠期肝内胆汁淤积症(ICP)诊断中的应用价值。方法回顾性分析2020年1月—2022年12月无锡市妇幼保健院收治的186例HBV感染孕妇,根据ICP诊断标准将其分为单纯HBV组(124例)和HBV并发ICP组(62例),收集两组孕妇一般资料及妊娠早期围保肝生化指标和胆汁酸谱检测结果,采用单因素分析、多因素logistic回归分析HBV感染孕妇并发ICP的主要影响因素,ROC曲线分析预测诊断效能。结果与HBV组比,HBV并发ICP组AST[(46.60±38.98)U/L比(30.97±31.49)U/L,P=0.004]、ALT[(50.80±36.81)U/L比(40.32±29.45)U/L,P=0.037]、DBil[(6.07±2.34)μmol/L比(4.73±1.83)μmol/L,P<0.001]、TBA[(16.98±2.48)μmol/L比(6.01±2.34)μmol/L,P=0.010]明显升高,CA[(0.59±0.49)μmol/L比(0.40±0.34)μmol/L,P=0.007]、GCA[(2.41±1.04)μmol/L比(1.52±0.70)μmol/L,P<0.001]、GDCA[(0.92±0.35)μmol/L比(0.67±0.37)μmol/L,P<0.001]、GCDCA[(2.14±0.89)μmol/L比(1.67±0.56)μmol/L,P<0.001]也升高,且AST、DBil、GCA、GDCA、GCDCA为HBV并发ICP的主要危险因素(P<0.05);AST、DBil、GCA对HBV并发ICP诊断价值较高(分别AUC 0.747、0.725、0.761);GCDCA、GDCA的诊断价值一般(AUC 0.667、0.688)。结论胆汁酸谱GCA、GCDCA、GDCA亚型升高及AST、DBil升高均是HBV感染孕妇并发ICP发生的主要危险因素,且GCA的预测诊断价值最高,临床应结合肝功能指标综合诊断。

Objective To evaluate the diagnostic value of early preggnancy bile acid profiling in detecting intrahepatic cholestasis of pregnancy(ICP)among pregnant women infected with the hepatitis B virus(HBV).Methods Between January 2020 and December 2022,a retrospective analysis was conducted on 186 pregnant women with HBV infection admitted to our hospital.Based on the diagnostic criteria for ICP,participants were categorized into two groups:those with HBV infection alone(124 cases)and those with HBV infection complicated by ICP group(62 cases).We collected and compared the general demographic information,peri-protective liver function indices,and early pregnancy bile acid profiles between the two groups.Through univariate and multivariate logistic regression analyses,we identified the primary factors influencing the occurrence of ICP in HBV-infected pregnant women.Additionally,the fiagnostic efficacy for ICP was evaluated using ROC curve analysis.Results In the comparative analysis between the HBV-alone group and the HBV plus ICP group,significant differences were observed in several biochemical parameters.AST levels were notably higher in the HBV plus ICP group[(46.60±38.98)U/L]compared to the HBV-alone group[(30.97±31.49)U/L,P=0.004].Similarly,ALT[(50.80±36.81)U/L vs(40.32±29.45)U/L,P=0.0037],DBil[(6.07±2.34)μmol/L vs(4.73±1.83)μmol/L,P<0.001],and TBA[(16.98±2.48)μmol/L vs(6.01±2.34)μmol/L,P=0.010]were significantly elevated in the HBV plus ICP group.Concentrations of cholic acid(CA),(glycocholic acid)GCA,glycodeoxrycholic acid(GDCA),glycochenodeoxycholic acid(GCDCA)also showed significant increases,with P-values of 0.007,<0.001,<0.001,and<0.001,respectively.Multivariate analysis identified AST,DBil,GCA,GDCA,and GCDCA as major risk factors for the development of ICP in HBV-infected pregnant women(P<0.05).Among these,AST,DBil and GCA demonstrated higher diagnostic values for HBV-complicated ICP with AUCs of 0.747,0.725 and 0.761,respectively.The diagnostic efficiency of GCDCA and GDCA was moderate,with AUC values of 0.667 and 0.688.Conclusion The study identifies the elevation of GCA,GCDCA,GDCA subtypes in the bile acid profile,along with increases in AST and DBil,as principal risk factors for ICP in HBV-infected pregnant women.Notably,GCA emerges as the biomarker with the highest predictive diagnostic value for ICP.These findings underscore the importance of integrating liver function tests with bile acid spectrum analysis in the clinical diagnosis of ICP among this patient population.