妊娠期肝内胆汁淤积症患者血清GDF15、GP73与病情严重程度及妊娠结局的相关性-东南大学学报医学版

妊娠期肝内胆汁淤积症患者血清GDF15、GP73与病情严重程度及妊娠结局的相关性

单位：西北妇女儿童医院医学检验中心, 陕西西安 710061

关键词：妊娠期肝内胆汁淤积症生长分化因子15 高尔基体蛋白73 病情程度妊娠结局相关性

分类号：R714.255

出版年·卷·期（页码）：2025·44·第二期（272-278）

摘要：

目的:探索妊娠期肝内胆汁淤积症(ICP)患者血清生长分化因子15(GDF15)、高尔基体蛋白73(GP73)与病情严重程度及妊娠结局的相关性。方法:选取2023年1月至12月于本院治疗的ICP患者150例作为研究组,根据病情程度分为轻度组(83例)和重度组(67例),根据妊娠结局分为结局良好组(96例)和结局不良组(54例);选择同期健康检查产妇79例作为对照组。使用ELISA法检测妊娠中期血清GDF15和GP73水平;空腹血糖、白蛋白、总胆红素(TBIL)、直接胆红素(DBIL)、总胆汁酸(TBA)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)和γ-谷氨酰转移酶(GGT)等指标使用生化分析仪测定;通过Pearson相关分析探讨ICP患者血清GDF15和GP73水平与各项血清指标的相关性;应用Logistic回归分析评估ICP患者妊娠结局不良的影响因素;绘制ROC曲线评估血清GDF15和GP73对ICP患者妊娠结局不良的预测效能。结果:研究组的糖尿病比例及血清GGT、TBA、ALT、AST、TBIL、DBIL、GDF15、GP73水平明显高于对照组(P<0.05);结局不良组血清GDF15、GP73、GGT、TBA、ALT、AST、TBIL、DBIL水平及糖尿病比例明显高于结局良好组(P＜0.05)。GDF15和GP73与GGT、TBA、ALT、AST、TBIL、DBIL均呈正相关(均P＜0.001);重度组血清GDF15、GP73水平明显高于轻度组(P＜0.001);结局不良组血清GDF15和GP73水平明显高于结局良好组(P＜0.05)。Logistic回归分析显示,GDF15、GP73、TBA、ALT、AST和TBIL为ICP患者妊娠结局不良的危险因素(P＜0.05);ROC曲线分析显示,血清GDF15和GP73预测ICP患者妊娠结局不良的AUC为0.875、0.869,二者联合预测的AUC为0.951,明显高于GDF15(Z=2.295,P=0.022)和GP73(Z=2.476,P=0.013)单独预测。结论:ICP患者血清GDF15和GP73水平明显升高,其水平与病情程度及妊娠结局密切相关,联合检测对ICP妊娠结局不良有一定的预测价值。

Objective: To explore the correlation between serum growth differentiation factor 15(GDF15) and Golgi protein 73(GP73) levels with the severity of intrahepatic cholestasis of pregnancy(ICP) and pregnancy outcomes. Methods: A total of 150 ICP patients treated in our hospital from January to December 2023 were included as the study group. These patients were assigned into the mild group(83 cases) and the severe group(67 cases) based on the severity of disease, and assigned into good outcome group(96 cases) and poor outcome group(54 cases) based on pregnancy outcomes. Meanwhile, A total of 79 healthy pregnancy women were selected as the control group. ELISA method was applied to detect serum GDF15 and GP73 levels in two groups during mid pregnancy. Fully automated biochemical analyzer was applied to detect fasting blood glucose, albumin, total bile acids(TBA), alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL), direct bilirubin(DBIL) and gamma-glutamyl transferase(GGT). Pearson correlation were applied to analyze the correlation between serum GDF15, GP73 levels and serological indicators. To analyze the interfering factors of adverse pregnancy outcomes in ICP patients, the Logistic regression analysis was selected. ROC curve analysis was applied to analyze the predictive value of serum GDF15 and GP73 for adverse pregnancy outcomes. Results: Compared with the control group, the proportion of diabetes and levels of GGT, TBA, ALT, AST, TBIL, DBIL, GDF15 and GP73 in the study group were significantly increased(P<0.05). Serum levels of GDF15, GP73, GGT, TBA, ALT, AST, TBIL, DBIL and diabetes ratio in the poor outcome group were significantly higher than those in the good outcome group(P<0.05). GDF15 and GP73 were positively correlated with GGT, TBA, ALT, AST, TBIL, and DBIL(all P<0.001). The levels of serum GDF15 and GP73 in the severe group were obviously higher than those in the mild group(P<0.001). The levels of serum GDF15 and GP73 in the poor outcome group were significantly higher than those in the good outcome group(P<0.05). The results of Logistic analysis showed that GDF15, GP73, TBA, ALT, AST, and TBIL were risk factors for poor pregnancy outcomes in ICP patients(P<0.05). ROC curve analysis showed that the AUC for predicting poor pregnancy outcomes in ICP patients using serum GDF15 and GP73 was 0.875 and 0.869, respectively, the AUC of the combined of the two was 0.951, which was obviously higher than that of GDF15 alone(Z=2.295, P=0.022) and GP73 alone(Z=2.476, P=0.013). Conclusion: The levels of serum GDF15 and GP73 in ICP patients are obviously elevated, and their levels are closely related to the severity of the disease and pregnancy outcomes. Combined detection has certain predictive value for adverse pregnancy outcomes in ICP patients.

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