Joutsiniemi Titta, Leino Riitta, Timonen Susanna, Pulkki Kari, Ekblad Ulla
Department of Obstetrics and Gynaecology, Turku University Central Hospital, Turku, Finland.
Acta Obstet Gynecol Scand. 2008;87(12):1280-4. doi: 10.1080/00016340802468316.
To evaluate and compare plasma glutathione S-transferase alpha (GSTA) concentrations in the third trimester of pregnancy in patients with intrahepatic cholestasis of pregnancy (ICP) and in healthy pregnant women.
Non-randomized clinical study.
Maternity unit and Department of Clinical Chemistry, Turku University Central Hospital, Turku, Finland.
Twenty-seven women with ICP and 49 healthy pregnant women.
GSTA concentrations were assessed in plasma samples in the third trimester of pregnancy using an enzyme-linked immunoassay (HEPKIT Alpha, Biotrin, Sinsheim-Reihen, Germany).
Plasma GSTA, serum alanine and bile acid concentrations were compared between study and control group. Correlation between plasma GSTA levels and serum alanine aminotransferase and bile acid levels in the ICP patients were tested by Spearman correlation coefficients. Main perinatal outcome was compared between the groups.
GSTA concentration in the control group was 1.62 microg/l (range: 0.25-6.1). In the ICP patients, the mean plasma GSTA concentration was 51.0 microg/l (range: 2.1-183.5), the mean serum alanine aminotransferase concentration was 145.70 U/l (range: 6-393) and the mean bile acid concentration was 19.2 micromol/l (range: 3-63). There was a statistically significant correlation in ICP patients between plasma GSTA concentration and serum alanine aminotransferase concentration (r=0.694, p=0.0001), but not with serum bile acid concentration. Nor was there any statistically significant correlation between gestational weeks and plasma GSTA concentration in the study group.
Plasma GSTA measurements may provide a more sensitive and specific diagnostic tool for diagnosis of ICP than the evaluation of transaminases or bile acid concentrations alone. Further studies are needed to evaluate the role of GSTA in the follow-up of patients with ICP and its prognostic value for threatening fetal distress in patients with ICP.
评估并比较妊娠肝内胆汁淤积症（ICP）患者与健康孕妇妊娠晚期血浆谷胱甘肽S-转移酶α（GSTA）浓度。
非随机临床研究。
芬兰图尔库大学中心医院妇产科及临床化学科。
27例ICP患者和49例健康孕妇。
采用酶联免疫分析法（HEPKIT Alpha，Biotrin，德国辛斯海姆-赖亨）检测妊娠晚期血浆样本中的GSTA浓度。
比较研究组与对照组的血浆GSTA、血清丙氨酸和胆汁酸浓度。通过Spearman相关系数检验ICP患者血浆GSTA水平与血清丙氨酸转氨酶及胆汁酸水平之间的相关性。比较两组的主要围产期结局。
对照组GSTA浓度为1.62μg/L（范围：0.25 - 6.1）。ICP患者血浆GSTA平均浓度为51.0μg/L（范围：2.1 - 183.5），血清丙氨酸转氨酶平均浓度为145.70 U/L（范围：6 - 393），胆汁酸平均浓度为19.2μmol/L（范围：3 - 63）。ICP患者血浆GSTA浓度与血清丙氨酸转氨酶浓度之间存在统计学显著相关性（r = 0.694，p = 0.0001），但与血清胆汁酸浓度无相关性。研究组孕周与血浆GSTA浓度之间也无统计学显著相关性。
与单独评估转氨酶或胆汁酸浓度相比，血浆GSTA检测可能为ICP诊断提供更敏感、特异的诊断工具。需要进一步研究评估GSTA在ICP患者随访中的作用及其对ICP患者胎儿窘迫威胁的预后价值。
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