胎盘ABCB4表达与妊娠期肝内胆汁淤积症血液指标及妊娠结局相关性分析

Correlation analysis of placental ABCB4 expression with blood indicators and pregnancy outcomes in intrahepatic cholestasis of pregnancy

摘要:

目的 分析胎盘组织中ABCB4基因表达情况与妊娠期肝内胆汁淤积症（ICP）患者血液指标及妊娠结局的相关性。方法 该回顾性研究病例纳入时间为2021年1月至2022年12月，研究对象为河南科技大学第二附属医院112例ICP患者，根据临床妊娠结局不同，将60例伴不良妊娠结局的ICP患者列为预后不良组，将52例正常分娩的ICP患者列为预后良好组。比较两组患者的胎盘ABCB4阳性表达率、ABCB4 mRNA相对表达量及血清胆汁酸、肝功能指标，经Spearman相关性系数验证胎盘ABCB4表达情况与ICP患者血液指标的相关性；通过绘制受试者工作特征（ROC）曲线验证胎盘ABCB4表达情况对不良妊娠结局的预测效能。结果 经检测，预后不良组患者的ABCB4阳性表达率为85.00%（51/60），高于预后良好组73.08%（38/52），ABCB4 mRNA相对表达量为（7.75±2.31），低于预后良好组（9.03±2.49）（P<0.05）。预后不良组患者的胆汁酸水平为（55.25±10.31）mmol/L，谷草转氨酶（AST）水平为（88.39±10.47）U/L，谷丙转氨酶（ALT）水平为（85.11±10.61）U/L，均高于预后良好组［（48.24±10.47）mmol/L、（80.24±10.31）U/L、（78.45±10.17）U/L］（P<0.05）。经Spearman相关性系数检验，胎盘ABCB4阳性表达率会随胆汁酸、AST、ALT水平上升而不断升高，ABCB4 mRNA相对表达量会下降；经ROC曲线验证，ABCB4阳性表达率越高、ABCB4 mRNA相对表达量越低，ICP患者发生不良妊娠结局的风险越高。结论 ICP患者的胎盘ABCB4阳性表达率会明显升高，ABCB4 mRNA相对表达量会明显下降，ABCB4阳性表达率与患者血液指标、不良妊娠结局发生率正相关，ABCB4 mRNA相对表达量与患者血液指标、不良妊娠结局发生率负相关。

Abstract:

Objective To analyze the correlation between the expression of ABCB4 gene in placental tissue and blood indicators and pregnancy outcomes in intrahepatic cholestasis of pregnancy (ICP) patients.Methods This article is a retrospective study, with cases included from January 2021 to December 2022. The study subjects were 112 ICP patients. According to different clinical pregnancy outcomes, 60 ICP patients with adverse pregnancy outcomes were classified as the poor prognosis group, and 52 ICP patients with normal delivery were classified as the good prognosis group. The placental ABCB4 positive expression rate, ABCB4 mRNA relative expression level, serum bile acid, and liver function indicators of the two groups of patients were compared. The correlation between placental ABCB4 expression and blood indicators in ICP patients was verified by Spearman correlation coefficient. The predictive efficacy of ABCB4 expression in placenta for adverse pregnancy outcomes was verified by plotting ROC.Results After testing, the positive expression rate of ABCB4 in patients with poor prognosis was 85.00% (51/60), which was higher than 73.08% (38/52) in the group with good prognosis. The relative expression level of ABCB4 mRNA was 7.75±2.31, and lower than that in the group with good prognosis 9.03±2.49 (P<0.05). The bile acid levels of patients with poor prognosis were 55.25±10.31 mmol/L, AST levels were 88.39±10.47 U/L, and ALT levels were 85.11±10.61 U/L, which were higher than those of patients with good prognosis (48.24±10.47 mmol/L, 80.24±10.31 U/L, 78.45±10.17 U/L) (P<0.05). According to Spearman correlation coefficient test, the positive expression rate of ABCB4 in the placenta continuously increases with the increase of bile acid, AST, and ALT levels, while the relative expression level of ABCB4 mRNA decreases. According to the ROC curve validation, the higher the positive expression rate of ABCB4 and the lower the relative expression level of ABCB4 mRNA, the higher the risk of adverse pregnancy outcomes in ICP patients.Conclusion The positive expression rate of ABCB4 in the placenta of ICP patients will significantly increase, and the relative expression level of ABCB4 mRNA will significantly decrease. The positive expression rate of ABCB4 is positively correlated with the patient's blood indicators and the incidence of adverse pregnancy outcomes, while the relative expression level of ABCB4 mRNA is negatively correlated with the patient's blood indicators and the incidence of adverse pregnancy outcomes.