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Abstract：
UNASSIGNED: To determine the association between lipid metabolism and intrahepatic cholestasis of pregnancy (ICP), and explore the value of maternal alanine aminotransferase/aspartate aminotransferase (ALT/AST) and high-density lipoprotein (HDL) in predicting adverse neonatal outcomes in women with ICP.
UNASSIGNED: A total of 147 pregnant women with ICP admitted to The Fourth Hospital of Shijiazhuang and 120 normal pregnant women in the same period were selected in this study. The Mann-Whitney U test and Chi-square tests were used to compare the differences in clinical data. Multivariate logistic regression was used to analyze the relationship between ALT/AST and the occurrence of adverse pregnancy outcomes in patients with ICP. The combined predictive value of ALT/AST and HDL was determined by receiver operating characteristic (ROC) curve analysis.
UNASSIGNED: Among 147 women with ICP, 122 women had total bile acid (TBA) levels of 10-39.9 µmol/L, and 25 had TBA ≥ 40 µmol/L. There was significantly lower gestational age in patients with severe ICP than in those with mild and control groups (all p < 0.05), and the weight of newborns in the maternal ICP group was significantly lower than in the control group (p < 0.05). Increasing TBA levels was associated with higher AST, ALT, ALT/AST, and lower HDL level (all p < 0.05). Meanwhile, higher levels of ALT/AST was positively associated with neonatal hyperbilirubinemia [adjusted odds ratio (AOR) = 4.019, 95% CI [1.757-9.194, p = 0.001] and cardiac injury [AOR = 3.500, 95% CI [1.535-7.987], p = 0.003]. HDL was a significant protective factor for neonatal hyperbilirubinemia and cardiac injury [AOR = 0.315, 95% CI [0.126-0.788], p = 0.014; AOR = 0.134 (0.039-0.461), p = 0.001]. The area under the ROC curve (AUC) for prediction of neonatal hyperbilirubinemia by ALT/AST combined with HDL was 0.668 [95% CI [56.3-77.3%], p = 0.002], and the sensitivity and specificity were 47.1% and 84.0%, respectively. To predict neonatal cardiac injury, the AUC value was 0.668 [95% CI [56.4-77.1%], p = 0.002], with sensitivity and specificity were 41.2% and 87.1%, respectively.
UNASSIGNED: The levels of higher ALT/AST and lower HDL were significantly associated with the risk of ICP-related adverse neonatal outcomes. Moreover, ALT/AST combined with HDL has moderate clinical value in predicting the adverse outcomes of neonatal hyperbilirubinemia and cardiac injury.
UNASSIGNED: A total of 147 pregnant women with ICP admitted to The Fourth Hospital of Shijiazhuang and 120 normal pregnant women in the same period were selected in this study. The Mann-Whitney U test and Chi-square tests were used to compare the differences in clinical data. Multivariate logistic regression was used to analyze the relationship between ALT/AST and the occurrence of adverse pregnancy outcomes in patients with ICP. The combined predictive value of ALT/AST and HDL was determined by receiver operating characteristic (ROC) curve analysis.
UNASSIGNED: Among 147 women with ICP, 122 women had total bile acid (TBA) levels of 10-39.9 µmol/L, and 25 had TBA ≥ 40 µmol/L. There was significantly lower gestational age in patients with severe ICP than in those with mild and control groups (all p < 0.05), and the weight of newborns in the maternal ICP group was significantly lower than in the control group (p < 0.05). Increasing TBA levels was associated with higher AST, ALT, ALT/AST, and lower HDL level (all p < 0.05). Meanwhile, higher levels of ALT/AST was positively associated with neonatal hyperbilirubinemia [adjusted odds ratio (AOR) = 4.019, 95% CI [1.757-9.194, p = 0.001] and cardiac injury [AOR = 3.500, 95% CI [1.535-7.987], p = 0.003]. HDL was a significant protective factor for neonatal hyperbilirubinemia and cardiac injury [AOR = 0.315, 95% CI [0.126-0.788], p = 0.014; AOR = 0.134 (0.039-0.461), p = 0.001]. The area under the ROC curve (AUC) for prediction of neonatal hyperbilirubinemia by ALT/AST combined with HDL was 0.668 [95% CI [56.3-77.3%], p = 0.002], and the sensitivity and specificity were 47.1% and 84.0%, respectively. To predict neonatal cardiac injury, the AUC value was 0.668 [95% CI [56.4-77.1%], p = 0.002], with sensitivity and specificity were 41.2% and 87.1%, respectively.
UNASSIGNED: The levels of higher ALT/AST and lower HDL were significantly associated with the risk of ICP-related adverse neonatal outcomes. Moreover, ALT/AST combined with HDL has moderate clinical value in predicting the adverse outcomes of neonatal hyperbilirubinemia and cardiac injury.
摘要：
■为了确定脂质代谢与妊娠期肝内胆汁淤积症（ICP）之间的关系，并探讨母体丙氨酸氨基转移酶/天冬氨酸氨基转移酶（ALT/AST）和高密度脂蛋白（HDL）在预测ICP妇女不良新生儿结局中的价值。
■本研究选取石家庄市第四医院收治的147例ICP孕妇和同期120例正常孕妇。采用Mann-WhitneyU检验和卡方检验比较临床资料的差异。采用多因素logistic回归分析ALT/AST与ICP患者不良妊娠结局发生的关系。通过受试者工作特征（ROC）曲线分析确定ALT/AST和HDL的组合预测值。
■在147名患有ICP的女性中，122名妇女的总胆汁酸（TBA）水平为10-39.9µmol/L，25的TBA≥40μmol/L重度ICP患者的孕龄明显低于轻度ICP组和对照组（均p<0.05）。且母体ICP组新生儿体重明显低于对照组(p<0.05)。增加TBA水平与较高的AST相关，ALT,ALT/AST,和较低的HDL水平（所有p<0.05）。同时,ALT/AST水平升高与新生儿高胆红素血症[校正比值比(AOR)=4.019,95%CI[1.757-9.194,p=0.001]和心脏损伤[AOR=3.500,95%CI[1.535-7.987]呈正相关,p=0.003]。HDL是新生儿高胆红素血症和心脏损伤的重要保护因素[AOR=0.315，95％CI[0.126-0.788]，p=0.014；AOR=0.134（0.039-0.461），p=0.001]。ALT/AST联合HDL预测新生儿高胆红素血症的ROC曲线下面积(AUC)为0.668[95%CI[56.3-77.3%],p=0.002],敏感性和特异性分别为47.1%和84.0%,分别。预测新生儿心脏损伤，AUC值为0.668[95%CI[56.4-77.1%]，p=0.002],敏感性和特异性分别为41.2%和87.1%，分别。
■较高的ALT/AST水平和较低的HDL水平与ICP相关的不良新生儿结局的风险显著相关。此外，ALT/AST联合HDL对预测新生儿高胆红素血症及心脏损伤的不良结局具有中等临床价值。
■本研究选取石家庄市第四医院收治的147例ICP孕妇和同期120例正常孕妇。采用Mann-WhitneyU检验和卡方检验比较临床资料的差异。采用多因素logistic回归分析ALT/AST与ICP患者不良妊娠结局发生的关系。通过受试者工作特征（ROC）曲线分析确定ALT/AST和HDL的组合预测值。
■在147名患有ICP的女性中，122名妇女的总胆汁酸（TBA）水平为10-39.9µmol/L，25的TBA≥40μmol/L重度ICP患者的孕龄明显低于轻度ICP组和对照组（均p<0.05）。且母体ICP组新生儿体重明显低于对照组(p<0.05)。增加TBA水平与较高的AST相关，ALT,ALT/AST,和较低的HDL水平（所有p<0.05）。同时,ALT/AST水平升高与新生儿高胆红素血症[校正比值比(AOR)=4.019,95%CI[1.757-9.194,p=0.001]和心脏损伤[AOR=3.500,95%CI[1.535-7.987]呈正相关,p=0.003]。HDL是新生儿高胆红素血症和心脏损伤的重要保护因素[AOR=0.315，95％CI[0.126-0.788]，p=0.014；AOR=0.134（0.039-0.461），p=0.001]。ALT/AST联合HDL预测新生儿高胆红素血症的ROC曲线下面积(AUC)为0.668[95%CI[56.3-77.3%],p=0.002],敏感性和特异性分别为47.1%和84.0%,分别。预测新生儿心脏损伤，AUC值为0.668[95%CI[56.4-77.1%]，p=0.002],敏感性和特异性分别为41.2%和87.1%，分别。
■较高的ALT/AST水平和较低的HDL水平与ICP相关的不良新生儿结局的风险显著相关。此外，ALT/AST联合HDL对预测新生儿高胆红素血症及心脏损伤的不良结局具有中等临床价值。
