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目的探讨总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(γ-GGT)和总胆汁酸(TBA)早期诊断妊娠期肝内胆汁淤积症(ICP)及评价ICP严重程度的价值。方法依据ICP诊断标准,纳入2013年6月-2016年6月妇产科住院的100例ICP患者(ICP组)和80例非ICP患者(对照组);依据ICP分度标准,进一步将ICP患者分为轻度ICP组(45例)和重度ICP组(55例)。检测患者血清TBIL、DBIL、ALT、AST、γ-GGT和TBA水平并进行统计学分析。结果与对照组相比,ICP组患者血清TBIL、DBIL、ALT、AST、γ-GGT和TBA水平均明显升高(均P<0.01)。与轻度ICP组相比,重度ICP组患者血清TBIL、DBIL、ALT、AST、γ-GGT和TBA水平均明显升高(P<0.01)。ROC分析显示:TBA≥13.45μmol/L时有助于早期诊断ICP;TBA与ALT、AST联合检测诊断重度ICP的敏感度和Youden指数高于单一检测。结论检测血清TBIL、DBIL、ALT、AST、γ-GGT和TBA水平有助于早期诊断ICP,以TBA最具应用价值;与单一检测相比,TBA与ALT、AST联合检测更有助于早期预测ICP的严重程度。
Objective To investigate the effects of total bilirubin, DBIL, ALT, AST, γ- GGT) and total bile acid (TBA) early diagnosis of intrahepatic cholestasis of pregnancy (ICP) and evaluation of the severity of ICP value. Methods According to ICP diagnostic criteria, 100 ICP patients (ICP group) and 80 non-ICP patients (control group) were enrolled in the department of obstetrics and gynecology from June 2013 to June 2016. According to ICP standard, ICP patients Divided into mild ICP group (45 cases) and severe ICP group (55 cases). Patients’ serum TBIL, DBIL, ALT, AST, γ-GGT and TBA levels were measured and statistically analyzed. Results Compared with the control group, the serum levels of TBIL, DBIL, ALT, AST, γ-GGT and TBA in ICP group were significantly increased (all P <0.01). Serum levels of TBIL, DBIL, ALT, AST, γ-GGT and TBA were significantly higher in patients with severe ICP than those in mild ICP (P <0.01). ROC analysis showed that the TBA≥13.45μmol / L was helpful for the early diagnosis of ICP. The sensitivity and Youden index of combined detection of TBA and ALT and AST in severe ICP were higher than those of single detection. Conclusion The detection of serum TBIL, DBIL, ALT, AST, γ-GGT and TBA levels are helpful for the early diagnosis of ICP and the most useful value for TBA. Compared with single detection, TBA and ALT and AST detection are more helpful for early prediction ICP severity.