血清PTX3、SULT2A1、AFABP预测妊娠期肝内胆汁淤积症价值及其危险因素分析

摘要/Abstract

摘要： 目的探讨血清正五聚蛋白3(PTX3)、硫酸基转移酶2A1(SULT2A1)、清脂肪细胞型脂肪酸结合蛋白(AFABP)在预测妊娠期肝内胆汁淤积症的价值,分析其危险因素。方法从2020年8月—2023年8月常州市妇幼保健院选取100例妊娠期肝内胆汁淤积症患者纳入观察组,对照组纳入90例健康孕妇,进行两组患者基本资料的收集,并进行血清PTX3、SULT2A1、AFABP水平检测,利用多因素Logistic回归分析妊娠期肝内胆汁淤积症的危险因素,通过受试者操作特征(ROC)曲线评估血清PTX3、SULT2A1和AFABP的联合检测在预测妊娠期肝内胆汁淤积症中的价值。结果观察组ALT(79.24±5.78)U/L、AST(58.62±5.21)U/L、ALP(206.79±32.58)U/L、TBA(44.76±4.89)μmol/L、GGT(36.76±4.13)U/L、TBil(12.56±2.38)μmol/L、DBil(5.92±1.45)μmol/L水平较对照组(18.45±3.24)U/L、(20.38±3.36)U/L、(174.54±27.61)U/L、(5.01±1.02)μmol/L、(18.22±3.18)U/L、(10.49±2.15)μmol/L、(3.29±0.87)μmol/L高,差异有统计学意义(t=88.082、59.389、7.318、75.631、34.387、6.265、14.952,P<0.05);妊娠期肝内胆汁淤积症的危险因素包括ICP家族史、乙肝病毒感染史、双胎及以上、妊娠期高血压、自身免疫性疾病(P<0.05);观察组PTX3(4.93±1.28)μg/L、AFABP(35.24±9.24)μmol/L水平高于对照组(3.27±1.02)μg/L、(21.22±7.45)μmol/L,SULT2A1(28.74±7.87)μg/L水平低于对照组(43.26±9.12)μg/L(P<0.05);ROC分析显示,血清PTX3、SULT2A1、AFABP水平、联合检测在妊娠期肝内胆汁淤积症中的预测灵敏度分别为68.0%、80.0%、83.0%、95.0%,特异度分别为87.8%、85.6%、83.3%、92.2%,AUC分别为0.845、0.889、0.891、0.972。结论联合检测血清PTX3、SULT2A1、AFABP水平在预测妊娠期肝内胆汁淤积症方面显示出高灵敏度和特异度,为早期诊断和治疗提供了关键证据。

关键词: 妊娠期肝内胆汁淤积症, 正五聚蛋白3, 硫酸基转移酶2A1, 清脂肪细胞型脂肪酸结合蛋白

Abstract: Objective To evaluate the predictive value of serum Pentraxin 3 (PTX3), Sulfotransferase 2A1 (SULT2A1), and Adipocyte Fatty Acid Binding Protein (AFABP) for Intrahepatic Cholestasis of Pregnancy (ICP) and analyze its associated risk factors.Methods From August 2020 to August 2023, 100 patients with ICP treated at Changzhou Maternal and Child Health Hospital were included in the observation group, and 90 healthy pregnant women were included in the control group. Data were collected for both groups, and serum levels of PTX3, SULT2A1, and AFABP were measured. Multifactorial Logistic regression was performed to identify risk factors for ICP, and the predictive value of combined serum PTX3, SULT2A1, and AFABP levels was evaluated using Receiver Operating Characteristic (ROC) curves.Results The observation group showed significantly higher levels of ALT (79.24±5.78 U/L), AST (58.62±5.21 U/L), ALP (206.79±32.58 U/L), TBA (44.76±4.89 μmol/L), GGT (36.76±4.13 U/L), TBil (12.56±2.38 μmol/L), and DBil (5.92±1.45 μmol/L) compared to the control group (18.45±3.24 U/L, 20.38±3.36 U/L, 174.54±27.61 U/L, 5.01±1.02 μmol/L, 18.22±3.18 U/L, 10.49±2.15 μmol/L, 3.29±0.87 μmol/L; t=88.082, 59.389, 7.318, 75.631, 34.387, 6.265, 14.952, P<0.05). Risk factors for ICP included family history of ICP, hepatitis B virus infection, multiple pregnancies, gestational hypertension, and autoimmune diseases (P<0.05). In the observation group, serum levels of PTX3 (4.93±1.28 μg/L) and AFABP (35.24±9.24 μmol/L) were higher, while SULT2A1 (28.74±7.87 μg/L) was lower compared to the control group (3.27±1.02 μg/L, 21.22±7.45 μmol/L, 43.26±9.12 μg/L respectively; P<0.05). ROC analysis revealed that the sensitivity and specificity of serum PTX3, SULT2A1, AFABP levels, and their combined detection for predicting ICP were 68.0%, 80.0%, 83.0%, 95.0%, and 87.8%, 85.6%, 83.3%, 92.2% respectively, with AUCs of 0.845, 0.889, 0.891, 0.972.Conclusion Combined measurement of serum PTX3, SULT2A1, and AFABP levels demonstrates high sensitivity and specificity in predicting ICP, providing valuable support for early diagnosis and intervention.

Key words: Intrahepatic cholestasis of pregnancy, Pentraxin 3, Sulfotransferase 2A1, Adipocyte fatty acid binding protein

沈佳雷, 曹克旦, 王芳. 血清PTX3、SULT2A1、AFABP预测妊娠期肝内胆汁淤积症价值及其危险因素分析[J]. 肝脏, 2024, 29(12): 1553-1557.

SHEN Jia-lei, CAO Ke-dan, WANG Fang. Serum PTX3, SULT2A1 and AFABP as predictive biomarkers for intrahepatic cholestasis of pregnancy: analysis of associated risk factors[J]. Chinese Hepatolgy, 2024, 29(12): 1553-1557.

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