Abstract: Objective To investigate the clinical significance of serum matrix metalloproteinase-9 (MMP-9), adipocytic fatty acid-binding protein (AFABP) and placental growth factor receptor (PLGF) levels in assessing the severity of intrahepatic cholestasis of pregnancy (ICP).Methods From January 2020 to June 2022, 70 pregnant women diagnosed with ICP were selected as the observation group, while 40 healthy pregnant womenfrom the same period as the control group. Serum levels of MMP-9, AFABP, PLGF, alanine aminotransferase (ALT), albumin (Alb), total bilirubin (TBil), total bile acid (TBA) and glycholic acid (CG) were detected. The severity of pruritis was evaluated using the Ribalta score. According to TBA and TBil levels, the participants were divided into mild(n=31) , moderate(n=24) and severe(n=15)group. Based on the presence or absence of FGR, they were further classified into non-combined FGR(n=57) and combined FGR(n=13) subgroups. We compared levels of ALT, Alb, CG, MMP-9, AFABP and PLGF between the observation and control groups, and among the subgroups with different disease severities and FGR status within the observation. Pearson correlation was used to analyze the relationship between levels of MMP-9, AFABP , PLGF, ALT, Alb, CG and the Ribalta score. The effectiveness of single and combined detection was evaluated using ROC analysis.Results In the observation group, the levels of ALT, CG, MMP-9 and AFABP were 150.43±13.65 U/L, 17.52±4.28 mg/L, 786.38±62.85 ng/mL, 35.80±6.47 μg/L, respectively. The PLGF level in the observation group was 1.47±0.39 ng/mL, siginificantly lower than the control group`s levels(36.74±5.28 U/L, 1.86±0.37 mg/L, 542.71±48.93 ng/mL, 21.38±4.65 μg/L) (t=12.056, 19.825, 10.734, 9.428, 8.529, all P<0.05). Within the observation groups, the moderate to severe subgroup had higher MMP-9 and AFABP levels(852.86±70.25 ng/mL and 41.09±8.13 μg/L, respectively) than the moderate and mild subgroups(773.90±61.49 ng/mL, 36.47±6.70 μg/L, 680.47±53.42 ng/mL, 30.82±5.34 μg/L, respectively). The severe subgroup had a lower PLGF level(1.15±0.29 ng/mL) compared to the moderate and mild subgroups(1.43±0.38 ng/mL and 1.76±0.45 ng/mL, respectively), with these differences being statistically significant (F=24.825, 38.764, 28.492, all P<0.05). Moreover, In the observation group, the FGR subgroup had higher MMP-9 and AFABP levels(863.78±72.54 ng/mL and 41.37±8.26 μg/L, respectively), and a lower PLGF level(1.13±0.28 ng/mL) compared to the non-FGR subgroup (735.64±58.91 ng/mL, 33.61±6.25 μg/L and 1.61±0.42 ng/mL, respectively), with these differences also being, statistically significant (t=8.736, 9.872, 9.034, all P<0.05). Pearson analysis showed that the levels of MMP-9 and AFABP were positively correlated with ALT, CG and Ribalta scores in the observation group, while,PLGF levels had a negatively correlation(P<0.01). ROC analysis revealed that the AUC for MMP-9, AFABP and PLGF, both individually and combined were 0.684, 0.753, 0.709 and 0.921, respectively. The sensitivity and specificity of combined detection surpassed those of any single detection (P<0.01).Conclusion Simultaneously assessing serum levels of MMP-9, AFABP and PLGF offer significant clinical utility in determining the severity of ICP and the incidence of FGR.

Key words: The ICP, FGR, MMP-9, AFABP, PLGF, Test value