妊娠期肝内胆汁淤积症患者脂质代谢特征与胆汁酸代谢以及胎盘缺氧损伤的相关性研究

摘要

目的:妊娠期肝内胆汁淤积症(ICP)患者脂质代谢特征与胆汁酸代谢以及胎盘缺氧损伤的相关性.方法:收集在本院产科产检和分娩的ICP孕妇和健康孕妇,分别作为ICP组和对照组.测定孕20、24、28、32、36周时血清中脂质代谢以及胆汁酸代谢指标;分娩后测定胎盘中线粒体损伤分子的表达量.结果:两组孕妇孕20周时血清中TC、LDL-C、HDL-C的含量无差异,ICP孕妇孕24、28、32、36周时血清中TC、LDL-C的含量均显著高于对照组,HDL-C的含量显著低于对照组;两组孕妇孕20、24、28周时血清中TBA、ALT、AST的含量无差异,ICP孕妇孕32周、36周时血清中TBA、ALT、AST的含量均显著高于对照组;ICP组孕妇胎盘组织中CCO、ATP酶、SDH、Bcl-2的蛋白表达量显著低于对照组,Bax、Caspase-3的蛋白表达量显著高于对照组.孕24、28、32、36周时血清中LDL-C的含量与孕32周、36周时血清中TBA、ALT、AST的含量以及胎盘组织中Bax、Caspase-3的蛋白表达量呈正相关,与胎盘组织中CCO、ATP酶、SDH、Bcl-2的蛋白表达量呈负相关.结论:孕中期脂质代谢特征能够早期预测ICP的发生风险并评估胆汁酸代谢的异常程度、胎盘缺氧损伤的程度.%Objective: To study the correlation of lipid metabolism characteristics with bile acid metabolism and placental hypoxia injury in patients with intrahepatic cholestasis of pregnancy (ICP).Methods: ICP pregnant women and healthy pregnant women who received antenatal care and delivered in Obstetrics Department of Panzhihua Maternal and Child Health Care Hospital between May 2013 and October 2016 were collected and included in ICP group and control group respectively.Serum lipid metabolism and bile acid metabolism indexes were measured at 20 weeks, 24 weeks, 28 weeks, 32 weeks and 36 weeks of gestation;mitochondria damage molecule expression levels in placenta were determined after childbirth.Results: Serum TC, LDL-C and HDL-C levels were not different between two groups of pregnant women at 20 weeks of gestation, and serum TC and LDL-C levels of ICP group at 24 weeks, 28 weeks, 32 weeks and 36 weeks of gestation were significantly higher than those of control group while HDL-C levels were significantly lower than those of control group;serum TBA, ALT and AST levels were not different between two groups of pregnant women at 20 weeks, 24 weeks and 28 weeks of gestation, and serum TBA, ALT and AST levels of ICP group at 32 weeks and 36 weeks of gestation were significantly higher than those of control group;CCO, ATP synthase, SDH and Bcl-2 protein expression in placenta tissue of ICP group were significantly lower than those of control group while Bax and Caspase-3 protein expression were significantly higher than those of control group.Serum LDL-C levels at 24 weeks, 28 weeks, 32 weeks and 36 weeks of gestation were positively correlated with TBA, ALT and AST levels in serum as well as Bax and Caspase-3 protein expression in placental tissue, and negatively correlated with CCO, ATP synthase, SDH and Bcl-2 protein expression in placental tissue.Conclusions: Midtrimester lipid metabolism characteristics can early predict the risk of ICP and evaluate the abnormal degree of bile acid metabolism and the placental hypoxia injury.