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南京医科大学学报（自然科学版） 第41卷第10期
·1480 · Journal of Nanjing Medical University（Natural Sciences） 2021年10月

·临床医学·

血清载脂蛋白A1和胆碱酯酶在妊娠期肝内胆汁淤积症诊断及

程度判定中的价值

南星宇 ，赵 军 ，张 婷 ，赵绍杰 ，董蕊锐 ，王 晶 ，邹 萍 ，叶宁珍 1
1
2
2*
2
1
2
2
南京医科大学附属无锡妇幼保健院产科，检验科，江苏 无锡 214002
1 2
［摘 要］ 目的：探讨血清载脂蛋白A1（apolipoprotein A1，APOA1）、胆碱酯酶（cholinesterase，CHE）在妊娠期肝内胆汁淤积症
（intrahepatic cholestasis of pregnancy，ICP）诊断及程度判定中的应用价值。方法：采用回顾性病例对照研究，选取100例ICP患
者和100例正常妊娠女性为研究对象。分析比较两组血清APOA1、CHE水平，采用受试者工作特征（receiver operating charac⁃
teristic，ROC）曲线分析两者对 ICP 诊断和疾病程度判定的价值。结果：ICP 组 APOA1、CHE 含量与正常对照组相比显著降低
（P＜0.05），其与总胆汁酸具有显著负相关性。APOA1与CHE 诊断ICP疾病的ROC 曲线下面积（area under the curve，AUC）分
别为0.871、0.782，APOA1与CHE对ICP疾病程度判定的AUC分别为0.843、0.773。两种标志物联合诊断ICP的AUC为0.909，
两种标志物联合检测对ICP疾病程度判定的AUC为0.891。结论：APOA1和CHE联合检测可以作为诊断ICP疾病和程度判定
的新型标志物，提高ICP疾病的诊断率。
［关键词］ 妊娠期肝内胆汁淤积症；载脂蛋白A1；胆碱酯酶；诊断标志物

［中图分类号］ R714.25 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）10⁃1480⁃05
doi：10.7655/NYDXBNS20211010

The value of apolipoprotein A1 and cholinesterase in the diagnosis and severity of
intrahepatic cholestasis of pregnancy
1 2* 2 1 2 2 2 1
NAN Xingyu ，ZHAO Jun ，ZHANG Ting ，ZHAO Shaojie ，DONG Ruirui ，WANG Jing ，ZOU Ping ，YE Ningzhen
1 Obstetrics Department，Clinical Laboratory，the Affiliated Wuxi Maternity and Child Health Care Hospital of
2
Nanjing Medical Univesity，Wuxi 214002，China

［Abstract］ Objective：To explore the application value of apolipoprotein A1（APOA1）and cholinesterase（CHE）in the diagnosis
and severity of intrahepatic cholestasis of pregnancy（ICP）. Methods：This retrospective case⁃control study was conducted with 100
ICP patients and 100 normal pregnant women. Protein molecular markers APOA1 and CHE were compared between two groups.
Results：APOA1 and CHE levels in the ICP group were significantly lower than those in the normal group（P＜0.05），the levels of two
markers were negatively associated with that of total bile acids. The area under the receiver operating characteristic（ROC）curves
（AUC）of APOA1 and CHE in diagnosis of ICP were 0.871 and 0.782，respectively，the AUC of APOA1 and CHE in severity of ICP
were 0.843 and 0.773，respectively. Multiple logistic regression analysis showed that a combination of the levels of the two markers
optimized the AUC to 0.909 and 0.891 in diagnosing ICP or evaluating the severity of ICP. Conclusion：Combined detection of APOA1
and CHE markers can be used as novel noninvasive biomarkers to evaluate the diagnosis and severity of ICP. The findings of this study
can improve the diagnosis rate of ICP disease.
［Key words］ intrahepatic cholestasis of pregnancy；apolipoprotein A1；cholinesterase；marker
［J Nanjing Med Univ，2021，41（10）：1480⁃1484］

妊娠期肝内胆汁淤积症（intrahepatic cholesta⁃
sis of pregnancy，ICP）是一种常见且严重的妊娠期并
［基金项目］ 国家自然科学基金面上项目（81671489）；江苏
省科技厅科技发展重大专项（BE2017628） 发症，通常发生在妊娠中、晚期，并在分娩后48 h内
∗ 消退。ICP 的主要发病特征是皮肤瘙痒、血清肝酶
通信作者（Corresponding author），E⁃mail：zhaojun3069@163.com