沈林萍 李艳 仝玉丽

【摘要】 目的：分析妊娠期肝內胆汁淤积症（ICP）孕妇外周血及脐带血中鸢尾素变化和相关性。方法：选取2017年11月-2019年11月于本院进行治疗的84例ICP患者，依据疾病严重程度将其分成轻症组（n=50）以及重症组（n=34）。另选取同期于本院进行孕期保健的60例正常孕妇为健康组。采集两组空腹上臂静脉血样本，产后3 min内采集脐静脉血样本，分别进行血清鸢尾素水平检测。比较三组临床相关指标;比较三组外周血及脐静脉血鸢尾素水平;分析临床相关指标与ICP孕妇外周血及脐静脉中鸢尾素水平的相关性;比较三组胎盘合体结节面密度与绒毛间隙面密度。结果：轻症组新生儿体重以及甘油三酯（TG）水平均低于健康组，谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转移酶（GGT）以及总胆汁酸水平均高于健康组（P<0.05）。重症组妊娠周期、新生儿体重、高密度脂蛋白胆固醇（HDL-C）以及同型半胱氨酸（Hcy）水平均低于健康组与轻症组，TG、低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）、ALT、AST、碱性磷酸酶（ALP）、GGT、总胆汁酸、直接胆红素、总胆红素以及肌酐水平均高于健康组与轻症组，且尿素水平低于轻症组（P<0.05）。三组脐静脉血中鸢尾素水平均低于外周血（P<0.05）。健康组与轻症组外周血与脐静脉血中鸢尾素水平均低于重症组（P<0.05）。健康组外周血中鸢尾素水平与脐静脉血中鸢尾素水平呈正相关（r=0.406，P=0.044）。轻症组与重症组外周血中鸢尾素水平与脐静脉血中鸢尾素水平均呈正相关（r=0.401、0.412，P=0.037、0.048）。ICP孕妇外周血中鸢尾素水平与脐静脉血中鸢尾素水平呈正相关（r=0.212，P=0.038）。ICP孕妇外周血与脐静脉血中鸢尾素水平与脐动脉S/D值、TG、TC、LDL-C、ALT、AST、ALP、GGT、总胆汁酸、直接胆红素以及总胆红素均呈正相关（P<0.05）;脐静脉血中鸢尾素水平与新生儿出生体重呈负相关（P<0.05）。轻症组与重症组合体结节面密度均高于健康组，绒毛间隙面密度均低于健康组（P<0.05）。轻症组合体结节面密度低于重症组，绒毛膜间隙面密度高于重症组（P<0.05）。结论：脐静脉血中鸢尾素水平明显低于外周血;ICP孕妇外周血以及脐静脉血鸢尾素水平均高于健康孕妇，推测鸢尾素可能在ICP病理生理过程中起到一定作用;ICP孕妇胎儿出生体重下降可能与鸢尾素在能量和脂肪代谢方面作用有关;通过观察外周血与脐静脉血中鸢尾素水平，可为判断ICP严重程度提供一定参考价值。

【关键词】 妊娠期肝内胆汁淤积症 鸢尾素 脐静脉血 外周血 孕妇

Changes and Correlation Analysis of Irisin in Peripheral Blood and Umbilical Vein Blood of Pregnant Women with Intrahepatic Cholestasis of Pregnancy/SHEN Linping， LI Yan， TONG Yuli. //Medical Innovation of China， 2021， 18（10）： 0-023

[Abstract] Objective： To analyze the changes and correlation of irisin in peripheral blood and umbilical vein blood of pregnant women with intrahepatic cholestasis of pregnancy （ICP）. Method： A total of 84 ICP patients treated in our hospital from November 2017 to November 2019 were selected. They were divided into mild group （n=50） and severe group （n=34） according to the severity of the disease. Another 60 cases of normal pregnant women received pregnancy care in our hospital during the same period were selected as the healthy group. Fasting upper arm venous blood samples were collected from both groups， and umbilical vein blood samples were collected within 3 min after delivery to detect serum irisin level， respectively. The clinical related indexes were compared among the three groups. The irisin levels in peripheral blood and umbilical vein blood were compared among the three groups. The correlation between clinical related indexes and irisin levels in peripheral blood and umbilical vein blood of ICP pregnant women was analyzed. The area density of placental syncytial nodule and intervillous space were compared among the three groups. Result： The neonatal weight and triglyceride （TG） levels in the mild group were lower than those in the healthy group， and the levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， γ-glutamyltransferase （GGT） and total bile acid in the mild group were higher than those in the healthy group （P<0.05）. The gestational cycle， neonatal weight， high density lipoprotein cholesterol （HDL-C） and homocysteine （Hcy） levels of the severe group were lower than those of the healthy group and the mild group， while the levels of TG， low density lipoprotein cholesterol （LDL-C）， total cholesterol （TC）， ALT， AST， alkaline phosphatase （ALP）， GGT， total bile acid， direct bilirubin， total bilirubin and creatinine of the severe group were higher than those of the healthy group， the level of urea of the severe group was lower than that of the mild group （P<0.05）. The levels of irisin in umbilical vein blood of the three groups were lower than those in peripheral blood （P<0.05）. The levels of irisin in peripheral blood and umbilical venous blood in the healthy group and the mild group were lower than those in the severe group （P<0.05）. The level of irisin in peripheral blood was positively correlated with that in umbilical vein blood in the healthy group （r=0.406， P=0.044）. The levels of irisin in peripheral blood were positively correlated with the levels of irisin in umbilical vein blood in both mild and severe groups （r=0.401， 0.412， P=0.037， 0.048）. The level of irisin in peripheral blood of ICP pregnant women was positively correlated with the level of irisin in umbilical vein blood （r=0.212， P=0.038）. The levels of irisin in peripheral blood and umbilical vein blood of ICP pregnant women were positively correlated with the S/D value， TG， TC， LDL-C， ALT， AST， ALP， GGT， total bile acid， direct bilirubin and total bilirubin （P<0.05）. There was a negative correlation between irisin level in umbilical vein blood and birth weight （P<0.05）. The area density of syncytial nodule of both the mild group and the severe group was higher than that of the healthy group， and the intervillous space area density was lower than that of the healthy group （P<0.05）. The area density of syncytial nodule of the mild group was lower than that of the severe group， and the intervillous space area density was higher than that of the severe group （P<0.05）. Conclusion： The level of irisin in umbilical vein blood is significantly lower than that in peripheral blood. The levels of irisin in peripheral blood and umbilical vein blood of pregnant women with ICP are higher than those of healthy pregnant women， suggesting that irisin may play a role in the pathophysiological process of ICP. The decrease of fetal birth weight in ICP pregnant women may be related to the role of irisin in energy and fat metabolism. By observing the level of irisin in peripheral blood and umbilical venous blood， it can provide some reference value for judging the severity of ICP.

[Key words] Intrahepatic cholestasis of pregnancy Irisin Umbilical vein blood Peripheral blood Pregnant women

First-authors address： Heze Municipal Hospital， Heze 274000， China

doi：10.3969/j.issn.1674-4985.2021.10.005

妊娠期肝内胆汁淤积症（ICP）属于妊娠中、晚期特有的并发症之一，孕妇可出现胆汁酸水平升高、皮肤瘙痒等表现，并且对胎儿影响较大，容易出现难以预测的胎儿突然死亡，对胎儿生命安全产生不利影响[1]。通常在孕妇分娩后症状即可改善，但当其口服激素类避孕药或再次妊娠时，疾病极易复发[2]。当前，临床对于ICP发病机制以及引起围产儿不良妊娠结局的机制尚未完全明确，同时受到遗传、环境等因素影响，限制临床ICP治疗药物的发展，当前临床缺乏安全且疗效确切、适合妊娠期使用的治疗药物，因此一定程度上限制ICP治疗效果的提升[3]。……