关键词: 妊娠期肝内胆汁淤积症, 中性粒细胞/淋巴细胞比值, 可溶性血管细胞黏附因子-1, 胰岛素样生长因子结合蛋白3, 诊断效能

Abstract: Objective To investigate the value of serum neutrophil/lymphocyte ratio (NLR), soluble vascular cell adhesion factor-1 (sVCAM-1) and insulin-like growth factor binding protein 3 (IGFBP-3) in the diagnosis and prognosis of intrahepatic cholestasis during pregnancy (ICP). Methods A total of 83 pregnant women with ICP admitted from January 2019 to December 2021 were included in the observation group. They were divided into mild subgroup (n=34), moderate subgroup (n=30) and severe subgroup (n=19) according to serum TBA level. Based on pregnancy outcomes, they were further classified into good outcome subgroup (n=65) and poor outcome subgroup (n=18). Meanwhile, 35 healthy pregnant women who underwent prenatal checkups and delivery during the same period were included in the control group. The levels of NLR, SVCAM-1 and IGFBP-3 were compared between the observation group and the control group, as well as among the subsets of the observation group categorized by disease severity and different pregnancy outcomes. Pearson analysis was used to examine the correlation of NLR, sVCAM-1 and IGFBP-3 levels with serum ALT, TBil levels, fetal growth restriction (FGR) and postoperative blood loss. ROC curves were constructed to assess the diagnostic and prognostic efficacy of individual and combined measurements of NLR, sVCAM-1 and IGFBP-3 levels for ICP. Results The NLR and sVCAM-1 levels in the observation group were 3.76±0.85 and 769.50±69.53 pg/L respectively, which were significantly higher than those in the control group (1.82±0.49 and 423.29±48.37 pg/L respectively). Additionally, the IGFBP-3 level in the observation group was 4.38±0.72 μg/L. The differences were statistically significant (t=9.528, 15.947, 11.852, all P<0.05). The NLR and sVCAM-1 levels in the severe subgroup were 4.86±1.025 and 952.41±89.76 pg/L respectively, higher than those in both the moderate (3.90±0.85 and 734.65±67.53 pg/L) and mild subgroups(2.71±0.69 and 564.52±55.49 pg/L respectively). The IGFBP-3 level in the severe subgroup was 2.36±0.42 μg/L, lower than those in the moderate and mild subgroups (2.93±0.54 μg/L and 3.58±0.67 μg/L respectively), the differences were statistically significant (F=23.924, 36.571, 17.862, all P<0.05). The NLR and SVCAM-1 levels of the poor outcome subgroup were 4.95±1.05 and 971.46±92.35 pg/L respectively, which were higher than those of the good outcome subgroup (3.67±0.78 and 698.75±63.24 pg/L respectively). Moreover, the IGFBP-3 level in the poor outcome subgroup was 2.24±0.39 μg/L, significantly lower than the 3.12±0.58 μg/L observed in the good outcome subgroup, the differences were statistically significant (t=8.207, 7.853, 7.426, all P<0.05). Pearson analysis showed that in the observation group, NLR and sVCAM-1 were positively correlated with ALT, TBIL, and postoperative blood loss, and negatively correlated with FGR. IGFBP-3 was positively correlated with FGR, but negatively correlated with ALT, TBIL and postoperative blood loss (P<0.01). ROC curve revealed that the AUC values for the evaluation of ICP using NLR, sVCAM-1 and IGFBP-3 levels individually and in combination were 0.691, 0.638, 0.725 and 0.914, respectively. The sensitivity and specificity of combined detection were both higher than any single test, and the difference was statistically significant (P<0.01). Conclusion The combined detection of serum NLR, sVCAM-1 and IGFBP-3 levels has high clinical value in evaluating the severity and prognosis of ICP patients.

Key words: ICP, NLR, sVCAM-1, IGFBP - 3, Diagnostic performance