Diagnosis application value of serum glycocholic acid, total bile acid, alanine transarninase and thyroid stimulating hormone levels′ detection in intrahepatic cholestasis of pregnancy

doi:10.3877/cma.j.issn.1673-5250.2016.06.006

Objective

To investigate the clinical diagnosis value of serum glycocholic acid, total bile acid(TBA), alanine transarninase(ALT) and thyroid stimulating hormone(TSH) levels in intrahepatic cholestasis of pregnancy(ICP).

Methods

From January to December 2015, a total of 62 cases of ICP pregnant women(included in ICP group) and 1 160 healthy pregnant women at the same time in outpatient for antenatal examination(included in control group) in Tianmen First People′s Hospital of Hubei, were chosen as study objects.Detection serum glycocholic acid, TBA, ALT and TSH levels of all subjects.Compared the differences of 4 index levels above mentioned between two groups of pregnant women and parewise compared the 4 index between patients with different degrees of ICP by statistical method, also compared the difference of proportion of advanced age(≥35 years old) between two groups. There were no significant differences between two groups of pregnant women in general clinical data such as weight and gestational age, etc.(P>0.05).

Results

The serum glycocholic acid, TBA, ALT and TSH levels of ICP group patients were higher than those of control group, and the differences were statistically significant(P<0.05). The serum glycocholic acid content of mild ICP patients was lower than that of moderate ICP patients and higher than that of control group, and the differences were statistically significant(P<0.05). There were no significant differences between mild and moderate ICP patients or between mild ICP patients and control group in serum TBA, ALT and TSH levels(P>0.05). Serum glycocholic acid, TBA, ALT and TSH levels of mild ICP patients were lower than those of severe ICP patients, and the differences were statistically significant(P<0.05). The proportion of advanced age pregnant women of ICP group was higher than that of control group, and the difference was statistically significant(74.2% vs 34.2%, χ²= 195.87, P=0.002).

Conclusions

Serum glycocholic acid, TBA, ALT and TSH levels′ monitoring have significant value for the diagnosis of ICP. The detection of serum glycocholic acid content also can be used for the diagnosis of early mild ICP.

Key words: Glycocholic acid, Bile acids and salts, Alanine transaminase, Thyrotropin, Cholestasis, intrahepatic, Pregnant women

表1 ICP孕妇与健康孕妇之间及不同程度ICP患者两两之间血清甘胆酸、TBA、ALT及TSH水平比较(±s)

组别		例数	甘胆酸水平(mg/L)	TBA水平(μmol/L)	ALT水平(U/L)	TSH水平(mIU/L)
ICP组		62	54.2±8.3	37.4±6.1	105.8±12.3	5.3±1.9
?	重型	6	201.2±29.6	97.4±12.3	276.8±63.7	6.9±2.4
?	中型	36	51.2±12.3	36.4±6.1	95.8±12.3	5.9±1.6
?	轻型	20	15.6±1.1	18.3±2.7	49.6±7.4	3.2±0.9
对照组		1 160	1.6±0.6	8.3±1.1	29.6±2.4	1.8±0.9
t值^a		?	7.95	6.20	4.36	3.73
P值		?	0.036	0.041	0.042	0.044

表1 ICP孕妇与健康孕妇之间及不同程度ICP患者两两之间血清甘胆酸、TBA、ALT及TSH水平比较(±s)

组别		例数	甘胆酸水平(mg/L)	TBA水平(μmol/L)	ALT水平(U/L)	TSH水平(mIU/L)
ICP组		62	54.2±8.3	37.4±6.1	105.8±12.3	5.3±1.9
?	重型	6	201.2±29.6	97.4±12.3	276.8±63.7	6.9±2.4
?	中型	36	51.2±12.3	36.4±6.1	95.8±12.3	5.9±1.6
?	轻型	20	15.6±1.1	18.3±2.7	49.6±7.4	3.2±0.9
对照组		1 160	1.6±0.6	8.3±1.1	29.6±2.4	1.8±0.9
t值^a		?	7.95	6.20	4.36	3.73
P值		?	0.036	0.041	0.042	0.044

[1]	袁鹏. 妊娠期肝内胆汁淤积症临床治疗体会[J]. 中外医学研究，2013，11(35)：45-46.
[2]	Rook M, Vargas J, Caughey A，et al. Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort[J]．PLoS One，2012，7(3)：e28343.
[3]	Pata O, Vardarel E, Ozcan A，et al.Intrahepatic cholestasis of pregnancy: correlation of preterm delivery with bile acids[J]．Turk J Gastroenterol，2011, 22(6)：602-605.
[4]	刘玲忠．妊娠肝内胆汁淤积症196例分析[J]. 实用预防医学，2010，17(1)：86-87.
[5]	林一，王厚照. 120例ICP患者血清中CG、TBA与TSH水平变化分析[J]．中国优生与遗传杂志，2014，22(11)：128-129.
[6]	刘金涛. 血清总胆汁酸检测在妊娠期肝内胆汁淤积症中的临床应用价值[J]. 检验医学，2015，30(5)：541-544.
[7]	叶娟华，陈智明. 不同分型ICP患者生化指标及围生结局分析[J]. 北华大学学报：自然科学版，2013，14(6)：683-686.
[8]	徐珊珊. 妊娠期肝内胆汁淤积症分型诊断与治疗的意义[J]. 实用临床医学，2006，7(5)：107-109.
[9]	曹泽毅．中华妇产科学.3版[M]. 北京：人民卫生出版社，2014：531-533.
[10]	左万兴. 妊娠期肝内胆汁淤积症[J]．国际妇产科学杂志，1995，22(6)：323-326.
[11]	吴希静，胡志军，朱前. 某地区5 089例中晚期妊娠妇女血清甘胆酸分析[J]. 检验医学与临床，2013，10(18)：2368-2369，2371.
[12]	吴味辛. 妊娠期肝内胆汁淤积症[J]．中国实用妇科与产科杂志，1990，6(5)：231.
[13]	顾星. 血清甘胆酸值在评估妊娠期肝内胆汁淤积症严重性中的价值[J]. 现代中西医结合杂志，2010，19(32)：4166.
[14]	陈江丽，王晓东，邢爱耘，等．胆汁酸对体外培养的胎盘组织促肾上腺皮质激素释放激素分泌水平的影响[J]．华西医学，2012，14(8)：359-361.
[15]	熊国润．血清TBA测定在诊断妊娠期肝内胆汁淤积症的价值[J]．检验医学与临床，2011，8(7)：844-845.
[16]	刘剑文，伍丹，黄英，等．血清甘胆酸测定在妊娠期肝内胆汁淤积症诊断中的意义[J]. 中国临床研究，2010，23(10)：885-886.
[17]	杨文惠．子痫前期患者血清瘦素及总胆汁酸变化[J]．中国误诊学杂志，2010，10(16)：3842.
[18]	郑铁生，鄢盛恺．临床生物化学检验.2版[M]．北京：中国医药科技出版社，2010：273.
[19]	刘佳，侯莉莉．妊娠肝内胆汁淤积症发生的分子机制研究进展[J]．现代生物医学进展，2011，11(23)：4539-4541.
[20]	Pineda G，Aguayo J，Ribalta J，et al. Thyroid function tests in normal pregnant women(third trimester)and in pregnant women with pregnancy cholestasis or with acute hepatitis[J]．Rev Med Chil，2000，128(1)：35-43.
[21]	吴跃军，顾洪璋. 妊娠期肝内胆汁淤积症患者甲状腺激素检测的临床意义[J]. 数理医药学杂志，2004，17(1)：27.
[22]	赵常志，魏红璐，谢建渝．妊娠期肝内胆汁淤积症生物检测指标的作用及临床意义[J]. 检验医学与临床，2009，6(7)：518-519.

[1]	Rong Huang, Ziyu Liang, Wenjin Qi. Expression and significance of NLRP3 inflammasome in serum of pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 540-548.
[2]	Xiaofei Li, Hongli Liu, Qiuling Shi, Jing Tian, Li Li, Hongbo Qi, Xin Luo. A prospective randomized controlled study of low intensity focused ultrasound uterine involution treatment for prevention and treatment of postpartum hemorrhage in natural childbirth women[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 534-539.
[3]	Fanying Zeng, Jie Ruan, Xinghui Liu, Guolin He. Current status of perinatal medicine advances under the new reproductive situation and coping strategies in prenatal care[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 519-524.
[4]	Ziyang Liu, Jianjian Cui, Yin Zhao. Current research status on obstetric disseminated intravascular coagulation and its scoring system[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 511-518.
[5]	Xialin Li, Fang He. Risk assessment and early warning system for postpartum hemorrhage[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 498-503.
[6]	Jingyu Qian, Mingming Zheng. Interpretation of the Italian guidelines on non-invasive and invasive prenatal diagnosis：executive summary of recommendations for practice the Italian Society for Obstetrics and Gynecology（SIGO）[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 486-492.
[7]	Xia He, Rong Huang, Wenjin Qi. High-throughput sequencing study on the abundance of placenta and fetal membrane flora in pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 549-555.
[8]	Jiangyan Xie, Yafei Wang, Fang He. Pregnancy complicated with thrombotic thrombocytopenic purpura：two cases report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 556-563.
[9]	Tingting Xu, Yongchi Zhan, Xiaodong Wang, Xiaodong Wang. Perinatal outcomes of fetomaternal hemorrhage syndrome pregnant women with sinusoidal fetal heart tracing[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 382-389.
[10]	Jiali Du, Rui Bao, Chunhong Qiao, Wei Han. Construction of a prediction model for adverse pregnancy outcomes after emergency cervical cerclage in pregnant women with cervical incompetence during the second trimester[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 403-409.
[11]	Xiaoyan Han, Hua Yang. Relationship between low level of serum placental growth factor in the second trimester pregnancy women and adverse fetal prognosis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 398-402.
[12]	Juan Tan, Jianxin Tan, Binbin Shao, Yan Wang, Zhengfeng Xu. Current research status on non-invasive prenatal testing for fetal with single gene inheritance diseases[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(03): 245-250.
[13]	Saijun Jia, Ying Zhang, Jiayi Wan. Pregnancy outcomes in pregnant women with subclinical hypothyroidism[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 140-147.
[14]	Jing Han, Shaolong Hao, Hua Kang. Retrospective analysis of clinical features of single-center thyroid carcinoma patients in Beijing[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 490-493.
[15]	Xiaorong Peng, Wei Mo, Qin Li, Yaqin Wu, Lan Li. Knowledge, attitude and practice of venous thromboembolism prevention and influencing factors among pregnant women[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2024, 12(03): 274-280.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export