妊娠肝内胆汁淤积症发病前血小板参数及炎症标志物变化分析。
Analysis of changes in platelet parameters and inflammatory markers in intrahepatic cholestasis of pregnancy before disease development.
作者信息
Shen Cong, Hu Wenshi, Wu Tiantian, Wang Gaigai, Qiao Longwei, Gao Tingting
机构信息
State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University Suzhou 215002, Jiangsu, China.
Department of Laboratory Medicine, School of Medicine, Jiangsu University Zhenjiang 212013, Jiangsu, China.
出版信息
Am J Transl Res. 2024 Dec 15;16(12):7448-7457. doi: 10.62347/OWXV5949. eCollection 2024.
BACKGROUND
Intrahepatic cholestasis of pregnancy (ICP) is the most common liver condition during pregnancy, associated with adverse outcomes for both mother and fetus. While inflammatory markers are important predictors in oncology and cardiovascular disease, their role in ICP remains unclear. This study investigates changes in platelet parameters and blood-derived inflammatory markers around the onset of ICP and evaluates their potential as independent risk factors.
METHODS
This retrospective study analyzed inflammatory markers, including the Neutrophil-to-Lymphocyte Ratio (NLR), Derived NLR (dNLR), Monocyte-to-Lymphocyte Ratio (MLR), Neutrophil-Monocyte-to-Lymphocyte Ratio (NMLR), Systemic Inflammation Response Index (SIRI), and Systemic Immune-Inflammation Index (SII) along with variations in platelet parameters in 49 ICP patients and 250 healthy controls during late pregnancy, specifically at disease onset. Additionally, changes in these parameters were assessed among the same 49 ICP patients compared to 1439 healthy controls during early pregnancy.
RESULTS
During an episode of ICP, individuals exhibited increased platelet parameters, including PCT, P-LCR, PDW and MPV, compared to those with uncomplicated pregnancies. The levels of WBC, NEUT, NLR, dNLR, NMLR, SIRI, and SII were also elevated in the ICP group relative to the control group. Prior to disease onset, platelet parameters such as PCT and PDW, along with inflammatory markers including NEUT, NLR, NMLR, SIRI, and SII, were significantly higher in ICP patients. Additionally, a notable increase in HGB, HCT, MCV, MCH, and RDW-CV was observed in the ICP group, while MCHC was decreased. Logistic regression analysis identified MCV, PDW and SII as risk factors for developing ICP.
CONCLUSIONS
PCT, PDW, NEUT, NLR, NMLR, SIRI, and SII levels were significantly elevated both before and during the progression of ICP. Notably, MCV, PDW, and SII were identified as independent risk factors, representing new predictive indicators for the development of ICP.
背景
妊娠期肝内胆汁淤积症（ICP）是孕期最常见的肝脏疾病，与母婴不良结局相关。虽然炎症标志物在肿瘤学和心血管疾病中是重要的预测指标，但其在ICP中的作用仍不明确。本研究调查了ICP发病前后血小板参数和血液来源炎症标志物的变化，并评估它们作为独立危险因素的可能性。
方法
这项回顾性研究分析了49例ICP患者和250例健康对照在妊娠晚期（特别是疾病发作时）的炎症标志物，包括中性粒细胞与淋巴细胞比值（NLR）、衍生NLR（dNLR）、单核细胞与淋巴细胞比值（MLR）、中性粒细胞 - 单核细胞与淋巴细胞比值（NMLR）、全身炎症反应指数（SIRI）和全身免疫炎症指数（SII），以及血小板参数的变化。此外，还评估了这49例ICP患者与1439例健康对照在妊娠早期这些参数的变化。
结果
在ICP发作期间，与未合并并发症的妊娠患者相比，个体的血小板参数升高，包括血小板压积（PCT）、血小板大细胞比率（P-LCR）、血小板分布宽度（PDW）和平均血小板体积（MPV）。与对照组相比，ICP组的白细胞（WBC）、中性粒细胞（NEUT）、NLR、dNLR、NMLR、SIRI和SII水平也升高。在疾病发作前，ICP患者的血小板参数如PCT和PDW，以及炎症标志物如NEUT、NLR、NMLR、SIRI和SII显著更高。此外，ICP组观察到血红蛋白（HGB）、红细胞压积（HCT）、平均红细胞体积（MCV）、平均红细胞血红蛋白含量（MCH）和红细胞体积分布宽度变异系数（RDW-CV）显著增加，而平均红细胞血红蛋白浓度（MCHC）降低。逻辑回归分析确定MCV、PDW和SII为发生ICP的危险因素。
结论
在ICP进展之前和期间，PCT、PDW、NEUT、NLR、NMLR、SIRI和SII水平均显著升高。值得注意的是，MCV、PDW和SII被确定为独立危险因素，代表了ICP发生的新预测指标。
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