摘要
目的探讨胰岛素样生长因子结合蛋白3(IGFBP-3)、β-Klotho、血小板激活复合物-1(PAC-1)对妊娠期肝内胆汁淤积综合征(ICP)终止妊娠时机的指导价值。方法前瞻性选取2021年9月至2023年6月周口市妇幼保健院收治的249例ICP患者纳入研究,其中轻度122例,重度94例,极重度33例,根据胎儿结局分为不良组36例和良好组213例。比较不同病情程度患者的IGFBP-3、β-Klotho、PAC-1水平,采用Spearman相关系数分析IGFBP-3、β-Klotho、PAC-1与病情程度的相关性;比较不良组和良好组患者的临床资料及IGFBP-3、β-Klotho、PAC-1水平,采用多因素Logistic回归分析IGFBP-3、β-Klotho、PAC-1对胎儿结局的影响,采用受试者工作特征(ROC)曲线分析IGFBP-3、β-Klotho、PAC-1预测ICP胎儿结局的价值。结果IGFBP-3、β-Klotho水平随着病情的加重而降低,PAC-1水平则随着病情的加重而升高,差异均有统计学意义(P<0.05);Spearman相关系数分析结果显示,IGFBP-3、β-Klotho与病情程度呈负相关(r=-0.610、-0.645,P<0.05),PAC-1与病情程度呈正相关(r=0.709,P<0.05);不良组患者病情程度重于良好组,IGFBP-3、β-Klotho水平分别为(2.06±0.62)μg/L、(414.58±39.00)pg/mL,明显低于良好组的(3.19±0.75)μg/L、(482.50±36.41)pg/m L,PAC-1水平为(21.97±4.25)%,明显高于良好组的(11.34±3.00)%,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,IGFBP-3升高、β-Klotho升高是ICP胎儿结局的独立相关保护因素(P<0.05),PAC-1升高是其独立相关危险因素(P<0.05);ROC曲线分析结果显示,IGFBP-3、β-Klotho、PAC-1联合检测预测ICP胎儿结局的曲线下面积(AUC)为0.923(95%CI:0.882~0.953),预测价值优于各指标单独预测(P<0.05)。结论IGFBP-3、β-Klotho、PAC-1水平波动与ICP病情严重程度及胎儿结局有关,联合检测对胎儿结局具有一定预测价值,当IGFBP-3>2.43μg/L、β-Klotho>426.32 pg/mL、PAC-1<20.82%时,胎儿不良结局风险显著升高,临床可综合孕周、病情、既往史等情况权衡利弊,考虑终止妊娠时机,进而改善胎儿结局。
Objective To explore the guiding value of insulin-like growth factor binding protein-3(IGFBP-3),β-Klotho,and platelet-activating complex-1(PAC-1)in determining the timing of pregnancy termination for intrahepatic cholestasis of pregnancy(ICP).Methods A prospective study was conducted on 249 ICP patients admitted to Zhoukou Maternal and Child Health Hospital from September 2021 to June 2023,including 122 mild cases,94 severe cases,and 33 extremely severe cases.Based on fetal outcomes,the patients were divided into an adverse outcome group(36 cases)and a favorable outcome group(213 cases).The levels of IGFBP-3,β-Klotho,and PAC-1 were compared among patients with different disease severities.Spearman correlation analysis was used to assess the relationship between these markers and disease severity.Clinical data and marker levels were compared between the adverse and favorable outcome groups.Multivariate logistic regression was used to analyze the impact of IGFBP-3,β-Klotho,and PAC-1 on fetal outcomes.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of these markers for fetal outcomes in ICP.Results IGFBP-3 andβ-Klotho levels decreased with worsening disease severity,while PAC-1 levels increased,with statistically significant differences(P<0.05).Spearman analysis showed that IGFBP-3 andβ-Klotho were negatively correlated with disease severity(r=-0.610,-0.645,P<0.05),whereas PAC-1 was positively correlated with disease severity(r=0.709,P<0.05).The adverse outcome group had more severe disease compared to the favorable outcome group,with significantly lower IGFBP-3 level,lowerβ-Klotho level,and higher PAC-1 levels(P<0.05):IGFBP-3,(2.06±0.62)μg/L vs(3.19±0.75)μg/L;β-Klotho,(414.58±39.000)pg/mL vs(482.50±36.41)pg/mL;PAC-1,(21.97±4.25)%vs(11.34±3.00)%.Multivariate logistic regression indicated that elevated IGFBP-3 andβ-Klotho were independent protective factors for fetal outcomes(P<0.05),while elevated PAC-1 was an independent risk factor(P<0.05).ROC analysis revealed that the combined detection of IGFBP-3,β-Klotho,and PAC-1 had an area under the curve(AUC)of 0.923(95%CI:0.882-0.953),outperforming individual markers(P<0.05).Conclusion Fluctuations in IGFBP-3,β-Klotho,and PAC-1 levels are associated with ICP severity and fetal outcomes.Combined detection has predictive value for fetal outcomes.When IGFBP-3>2.43μg/L,β-Klotho>426.32 pg/mL,and PAC-1<20.82%,the risk of adverse fetal outcomes significantly increases.Clinicians may consider gestational age,disease severity,and medical history to weigh the risks and benefits,determining the optimal timing for pregnancy termination to improve fetal outcomes.
作者
朱晓雪
董丽涛
郑方园
ZHU Xiao-xue;DONG Li-tao;ZHENG Fang-yuan(Department of Obstetrics and Gynecology,Zhoukou Maternal and Child Health Hospital(Zhoukou Children's Hospital),Zhoukou 466000,Henan,CHINA)
出处
《海南医学》
2025年第11期1595-1600,共6页
Hainan Medical Journal
基金
2021年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20211057)。
