血清自分泌运动因子、甲壳质酶蛋白40与妊娠期肝内胆汁淤积症患者辅助性T细胞17/调节性T细胞失衡和妊娠结局的关系研究

Study on the relationship between the serum autocrine motility factor,chitinase protein 40,helper T cell 17/regulatory T cell imbalance and the pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy

目的探讨血清自分泌运动因子(ATX)、甲壳质酶蛋白40(YKL-40)与妊娠期肝内胆汁淤积症(ICP)患者辅助性T细胞17(Th17)/调节性T细胞(Treg)失衡和妊娠结局的关系。方法选取2017年8月至2022年8月宝鸡市妇幼保健院收治的ICP患者178例作为观察组,根据患者病情严重程度分为轻度组(n=126)和重度组(n=52);且患者根据妊娠结局分为正常妊娠组(n=128)和不良妊娠组(n=50)。另选同期健康孕妇80例作为对照组。检测血清ATX、YKL-40水平并计算Th17/Treg比值。采用Pearson相关性分析血清ATX、YKL-40与Th17/Treg的关系。采用多因素Logistic回归分析ICP患者不良妊娠结局的危险因素。结果重度组ATX、YKL-40、Th17、Th17/Treg高于对照组和轻度组,且轻度组高于对照组(P<0.05);重度组Treg水平低于对照组和轻度组,且轻度组低于对照组(P<0.05)。Pearson相关性分析显示,ATX、YKL-40与Th17/Treg均呈现显著正相关(P<0.05)。多因素Logistic回归分析结果显示,高Th17/Treg、高YKL40、高ATX、高TBA、高TBil为ICP患者不良妊娠结局的独立危险因素(P<0.05)。结论血清ATX、YKL-40与ICP患者Th17/Treg失衡相关,高TBil、高TBA、高ATX、高YKL40、高Th17/Treg为ICP患者不良妊娠结局的独立危险因素。

Objective To explore the relationship between the serum autotaxin(ATX),chitinase protein-40(YKL-40)and the T helper cell 17(Th17)/regulatory T cell(Treg)imbalance as well as the pregnancy outcome in patients with intrahepatic cholestasis of pregnancy(ICP).Methods One hundred and seventy-eight ICP patients admitted to our hospital from August 2017 to August 2022 were enrolled in an observation group.The patients were divided into a mild group(n=126)and a severe group(n=52)according to the severity of the patient's condition.The patients were further divided into a normal pregnancy group(n=128)and an adverse pregnancy group(n=50)base on the pregnancy outcome.Another 80 healthy pregnant women were selected as a control group.The levels of serum ATX and YKL-40 were detected and the ratio of Th17/Treg was calculated.The relationship between the serum ATX,YKL-40 and the Th17/Treg was analyzed by using Pearson correlation analysis.The risk factors of adverse pregnancy outcomes in the ICP patients were analyzed by multivariate logistic regression analysis.Results The levels of ATX,YKL-40,Th17 and Th17/Treg in the severe group were higher than those in the control group and the mild group,and the mild group were higher than those of the control group(P<0.05).The levels of Treg in the severe group was lower than that in the control group and the mild group,and the mild group was lower than that of the control group(P<0.05).Pearson correlation analysis showed that ATX and YKL-40 were positively correlated with Th17/Treg(P<0.05).Multivariate logistic regression analysis showed that high Th17/Treg,high YK-4O,high ATX,high TBA and high TBil were independent risk factors for adverse pregnancy outcomes in the ICP patients(P<0.05).Conclusions Serum ATX and YKL-40 are associated with Th17/Treg imbalance in ICP patients.High TBil,high TBA,high ATX,high YKL-40 and high Th17/Treg are independent risk factors for adverse pregnancy outcomes in ICP patients.