妊娠期肝内胆汁淤积症患者血清LXRα、SREBP⁃1c水平与不良妊娠结局的关系

Relationship between serum LXRαand SREBP⁃1c levels and adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy

目的探讨妊娠期肝内胆汁淤积症(ICP)患者血清肝X受体α(LXRα)、胆固醇调节元件结合蛋白⁃1c(SREBP⁃1c)水平与不良妊娠结局的关系。方法选取2020年5月至2023年10月西北妇女儿童医院收治的116例ICP患者,根据患者不同妊娠结局设妊娠结局不良组(n=35)与妊娠结局良好组(n=81)。对比两组血清LXRα、SREBP⁃1c水平,采用受试者工作特性(ROC)曲线评价血清LXRα、SREBP⁃1c对ICP患者发生不良妊娠结局的评估价值,采用多因素logistic回归分析探讨ICP患者妊娠结局的影响因素。结果妊娠结局不良组患者血清LXRα水平低于妊娠结局良好组、SREBP⁃1c水平高于妊娠结局良好组,差异有统计学意义(P<0.05)。血清LXRα、SREBP⁃1c以及两者联合检测评估ICP患者发生不良妊娠结局的AUC(95%CI)分别为0.804(0.759~0.854),0.759(0.714~0.807),0.910(0.865~0.956)。妊娠结局不良组患者年龄≥35岁比例、胆汁酸≥40μmol/L比例、ICP家族史比例高于妊娠结局良好组,差异有统计学意义(P<0.05)。多因素回归分析显示,年龄≥35岁(OR=2.361,95%CI:1.196~4.660),胆汁酸水平≥40μmol/L(OR=3.010,95%CI:1.332~6.803),血清LXRα<11.04μg/mL(OR=4.375,95%CI:2.221~8.621),血清SREBP⁃1c≥12.97μg/L(OR=2.951,95%CI:1.579~5.514)是ICP患者发生不良妊娠结局的影响因素(P<0.05)。结论ICP患者血清LXRα水平降低、SREBP⁃1c水平升高与其不良妊娠结局密切相关,临床可早期监测两指标表达水平以降低不良妊娠结局的发生。

Objective To investigate the relationship between serum levels of liver X receptorα(LXRα),cholesterol regulatory element binding protein⁃1c(SREBP⁃1c)and adverse pregnancy outcomes in cases with intrahepatic cholestasis of pregnancy(ICP).Methods 116 ICP patients admitted to Northwest Women's and Children's Hospital from May 2020 to October 2023 were selected.Two groups were established on their pregnancy outcomes:a group with poor pregnancy outcomes(n=35)and a group with good pregnancy outcomes(n=81).The levels of serum LXRαand SREBP⁃1c were compared between the two groups to evaluate their value in assessing adverse pregnancy outcomes in ICP patients using receiver operating characteristic(ROC)curves.Additionally,multiple logistic regression analysis was conducted to explore the influencing factors of pregnancy outcomes in ICP patients.Results The serum LXRαlevel in the adverse pregnancy outcome group was lower than that in the good pregnancy outcome group,and the serum SREBP⁃1c level was higher than that in the good pregnancy outcome group,the difference is statistically significant(P<0.05).The AUC(95%CI)of serum LXRα,SREBP⁃1c,and their combined detection for evaluating adverse pregnancy outcomes in ICP patients were 0.804(0.759~0.854),0.759(0.714~0.807),and 0.910(0.865~0.956),respectively.The proportion of individuals aged≥35 years old,with bile acid levels≥40μmol/L,and family history of ICP in the adverse pregnancy outcome group were higher than those in the good pregnancy outcome group,and the difference is statistically significant(P<0.05).Age≥35 years(OR=2.361,95%CI:1.196-4.660),bile acid level≥40μmol/L(OR=3.010,95%CI:1.332-6.803),serum LXRα<11.04μg/mL(OR=4.375,95%CI:2.221-8.621),serum SBP⁃1C≥12.97μg/L(OR=2.951,95%CI:1.579~5.514)were identified as influencing factors for adverse pregnancy outcomes in ICP cases(P<0.05).Conclusion The decrease in serum LXRαlevels and the increase in SREBP⁃1c levels in ICP cases are closely related to adverse pregnancy outcomes.Monitoring the expression levels of these two indicators early on can help reduce the occurrence of adverse pregnancy outcomes.