维生素D、MPV与ICP孕妇病情严重程度关系及对新生儿结局的预测效能

Relationship between vitamin D, MPV and severity of ICP in pregnant women and their predictive values for neonatal outcomes

摘要

目的 探究维生素D(VitD)、平均血小板体积(MPV)与妊娠期肝内胆汁淤积症(ICP)孕妇病情严重程度关系及对新生儿结局的预测效能。方法 选取2022年1月至2023年12月在内江市第一人民医院产科分娩确诊为ICP的180例患者为ICP组,同期选取120例正常妊娠孕妇为对照组.检测并比较两组血清25羟基维生素D[25(OH)D]、MPV水平,比较不同病情严重程度ICP孕妇血清25(OH)D和MPV水平,统计并比较两组新生儿不良结局发生情况.采用Logistic回归模型分析ICP孕妇不良新生儿结局的危险因素,采用受试者工作特征(ROC)曲线分析25(OH)D、MPV单独及联合对ICP孕妇不良新生儿结局的预测效能。结果 相较于对照组,ICP组孕妇血清25(OH)D水平降低,MPV水平升高,差异有统计学意义(t值分别为-16.781、20.125,P<0.05);轻度组、重度组、极重度组孕妇血清25(OH)D水平逐渐降低,MPV水平逐渐升高,差异有统计学意义(F值分别为33.672、33.761,P<0.05);多因素Logistic回归分析结果显示,总胆汁酸>40μmol/L、发病时间≤28周、MPV升高是ICP孕妇不良新生儿结局的危险因素(OR值分别为2.220、1.912、1.709,P<0.05),25(OH)D升高是保护因素(OR=0.608,P<0.05);ROC曲线结果显示,血清25(OH)D、MPV单独及联合预测ICP孕妇不良新生儿结局的AUC(95%CI)分别为0.773(0.700~0.845)、0.876(0.817~0.935)、0.910(0.862~0.958),两者联合的预测效能优于单一检测(Z值分别为3.068、0.794,P<0.05)。结论 ICP孕妇维生素D不足、平均血小板体积增大与病情加重及新生儿不良结局显著相关,两项指标联测有助于预测ICP孕妇新生儿不良结局.

Abstract

Objective To explore relationship between vitamin D, mean platelet volume (MPV), and severity of intrahepatic cholestasis of pregnancy (ICP) in pregnant women, and analyze their predictive values for neonatal outcomes. Methods 180 patients who were diagnosed as ICP and delivered in Department of Obstetrics, The First People's Hospital of Neijiang City from January 2022 to December 2023 were selected as ICP group, and 120 normal pregnant women who received regular prenatal examination in our hospital in the same period were selected as control group. Serum 25 hydroxyvitamin D [25(OH)D] level and MPV of the pregnant women in the two groups were detected and compared between the ICP group and the control group. The serum 25(OH)D level and MPV of the pregnant women with different severity of ICP were compared among the mild ICP group, the severe ICP group and extremely severe ICP group. The incidences of adverse neonatal outcomes were summed up and compared between the ICP group and the control group. Logistic regression model was used to analyze risk factors for adverse neonatal outcomes in the ICP pregnant women. Receiver operating characteristic (ROC) curve was used to analyze predictive values of single 25(OH)D and single MPV alone, and combination of 25(OH)D and MPV for adverse neonatal outcomes in the ICP pregnant women. Results Compared with the control group, the ICP pregnant women had lower serum 25(OH)D level and higher MPV level, and there were with statistically significant differences (t=-16.781 and 20.125 respectively, both P<0.05). The serum 25(OH)D level of the ICP pregnant women in the mild ICP group, severe ICP group and extremely severe ICP group gradually decreased, while the MPV level gradually increased, and there were statistically significant differences (F=33.672 and 33.761 respectively, both P<0.05). Multiple Logistic regression analysis showed that total bile acids >40μmol/L, ICP onset time ≤28 weeks, and elevated MPV were risk factors for adverse neonatal outcomes in the ICP pregnant women (OR=2.220, 1.912 and 1.709 respectively, all P<0.05), while elevated 25(OH)D was a protective factor (OR=0.608, P<0.05). The ROC curve analysis showed that the AUCs (95%CI) of single serum 25(OH)D and single MPV alone and combination of the two indexes for predicting adverse neonatal outcomes in the ICP pregnant women were 0.773 (0.700-0.845), 0.876 (0.817-0.935), and 0.910 (0.862-0.958) respectively. The combined predictive efficacy of the two indexes was better than those of single detection of the two index (Z=3.068, P=0.002; Z=0.794, P=0.427). Conclusion Insufficient vitamin D and increased MPV in the ICP pregnant women are significantly correlated with worsening of the condition and adverse neonatal outcomes. The combination of these two indexes can help predict adverse neonatal outcomes in the ICP pregnant women.

关键词

25羟基维生素D / 平均血小板体积 / 妊娠期肝内胆汁淤积症 / 病情严重程度 / 新生儿结局 / 预测效能

Key words

25 hydroxyvitamin D / mean platelet volume / intrahepatic cholestasis of pregnancy / severity of disease / neonatal outcome / predictive efficacy

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基金资助

四川省医学(青年创新)科研课题(Q20103)