超声下脐血流参数联合血清ACTA、MDA、SOD诊断妊娠期肝内胆汁淤积症患者胎儿窘迫的价值

Evaluating ultrasonic cord blood flow and serum activin A,malondialdehyde and superoxide dismutase for diagnosing fetal distress in intrahepatic cholestasis of pregnancy

目的探讨超声下脐血流参数联合血清激活素A(ACTA)、丙二醛(MDA)、超氧化物歧化酶(SOD)用于妊娠期肝内胆汁淤积症(ICP)患者胎儿窘迫(FD)诊断的价值。方法将鸡西鸡矿医院2020年10月—2022年10月收治的106例ICP孕妇纳入研究,按照分娩结局将其分为FD组(45例)与非FD组(61例)。两组均于分娩前进行超声及血清学检查,比较两组收缩末期最大血流速度(S)/舒张末期最大血流速度(D)、阻力指数(RI)、搏动指数(PI)、ACTA、MDA、SOD水平;通过ROC曲线分析S/D、RI、ACTA、MDA、SOD诊断ICP患者发生FD的价值;以一致性分析S/D、RI联合ACTA、MDA、SOD诊断ICP患者发生FD的价值。结果FD组PI水平[(0.56±0.14)]与非FD组PI水平[(0.60±0.13)]组间比较差异无统计学意义(P>0.05);FD组S/D、RI、ACTA、MDA水平[(3.08±0.53)、(0.66±0.14)、(0.46±0.14)pg/L、(4.27±0.62)μmol/L]明显高于非FD组[(2.57±0.61)、(0.45±0.11)、(0.32±0.10)pg/L、(3.38±0.57)μmol/L],FD组SOD水平[(33.96±3.87)kU/L]明显低于非FD组[(44.75±4.61)kU/L](P<0.05)。ROC分析显示S/D、RI、ACTA、MDA、SOD能够诊断ICP患者发生FD,曲线下面积为0.730、0.800、0.784、0.837、0.884,均有P<0.05,最佳截断值为2.635、0.505、0.395 pg/L、3.850μmol/L、39.480 kU/L,敏感度为0.884、0.800、0.711、0.733、0.778。经一致性分析,S/D、RI联合ACTA、MDA、SOD诊断ICP患者发生FD的灵敏度为0.911,特异度为0.967,准确率为0.943,Kappa=0.883。结论脐血流S/D、RI及ACTA、MDA、SOD均可用于ICP患者FD的诊断,且联合诊断的价值更高。

Objective To investigate the diagnostic efficacy of ultrasonic cord blood flow parameters alongside serum activin A(ActA),malondialdehyde(MDA)and superoxide dismutase(SOD)levels for detecting fetal distress(FD)in patients with intrahepatic cholestasis of pregnancy(ICP).Methods Between October 2020 and October 2022,our hospitall enrolled 106 pregnant women diagnosed with ICP.These participants were categorized based on childbirth outcomes into a FD group(45 cases)and a non-FD group(61 cases).Prior to delivery,all subjects underwent ultrasonography and serological assessments.This study compared the levels of end-systolic maximum blood velocity(S)/end-diastolic maximum blood velocity(D),resistance index(RI),pulsation index(PI),ActA,MDA and SOD between the two groups.The diagnostic utility of S/D,RI,ActA,MDA and SOD for FD in ICP patients were evaluated using ROC curve analysis.Additionally,the combined diagnostic accuracy of S/D,RI,ActA,MDA and SOD was assessed for consistency.Results No significant difference was observed in the PI levels between the FD group[(0.56±0.14)]and the non-FD group[(0.60±0.13)](P>0.05).However,the FD group showed significantly higher levels of S/D,RI,ActA and MDA[(3.08±0.53),(0.66±0.14),(0.46±0.14)pg/L,(4.27±0.62)μmol/L respectively]compared to the non-FD group[(2.57±0.61),(0.45±0.11),(0.32±0.10)pg/L,(3.38±0.57)μmol/L respectively].Conversely,SOD levels were significantly lower in the FD group[(33.96±3.87)kU/L]than in the non-FD group[(44.75±4.61)kU/L,P<0.05].ROC curve analysis confirmed the diagnostic capability of S/D,RI,ActA,MDA and SOD in detecting FD,with areas under the curve of 0.730,0.800,0.784,0.837 and 0.884 respectively,all significant(P<0.05).The optimal cut-off values for these markers were 2.635,0.505,0.395 pg/L,3.850μmol/L,and 39.480 kU/L respectively,with sensitivities of 0.884,0.800,0.711,0.733,and 0.778.Consistency analysis showed that combining S/D,RI,ActA,MDA and SOD improved diagnostic sensitivity,specificity,accuracy,and Kappa to 0.911,0.967,0.943 and 0.883,respectively.Conclusion The diagnostic parameters of umbilical cord blood flow,specifically the S/D,RI,along with serum markers ActA,MDA,and SOD,are effective in identifying FD in patients with ICP.The combined use of these markers significantly enhances diagnostic accuracy.