Page 78 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第41卷第6期
·856 · Journal of Nanjing Medical University（Natural Sciences） 2021年6月

·临床医学·

胆汁酸谱在诊断妊娠期肝内胆汁淤积症和高胆汁酸血症中的

价值

孙 宁，钟天鹰 ，陈亚军，陈 辰，陈 晨
*
南京医科大学附属妇产医院检验科，江苏 南京 210004

［摘 要］ 目的：探讨胆汁酸谱在诊断妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）和无症状高胆汁酸血
症（asymptomatic hypercholanemia of pregnancy，AHP）中的价值。方法：选取正常妊娠者100例、ICP患者60例、AHP患者30例，
采用高效液相色谱串联质谱（high performance liquid chromatography tandem mass spectrometry，HPLC⁃MS/MS）分析各组胆汁酸
含量，并通过建立正交偏最小二乘判别分析（orthogonal projections to latent structures，OPLS⁃DA）模型，寻找ICP 组和AHP 组差
异性的胆汁酸。利用受试者工作特征（receiver operating characteristic，ROC）曲线分析两者差异性胆汁酸以及联合指标的诊断
效能。结果：15种胆汁酸中，除鹅脱氧胆酸（chenodeoxycholic acid，CDCA）外，其余胆汁酸的含量在3组间差异均有统计学意义
（P＜0.05）；通过OPLS⁃DA模型找到ICP组和AHP组差异性的胆汁酸为牛磺结合型胆酸（taurocholic acid，TCA）、牛磺结合型鹅
脱氧胆酸（taurochenodeoxycholic acid，TCDCA）、甘氨结合型胆酸（glycocholic acid，GCA）、甘氨结合型鹅脱氧胆酸（glycohenode⁃
oxycholic acid，GCDCA）、牛磺结合型熊脱氧胆酸（tauroursodeoxycholic acid，TUDCA）。ROC结果显示，TCA的诊断效能最高，曲
线下面积（area under curve，AUC）为 0.808，联合 TCA、TCDCA、GCA、GCDCA、TUDCA 诊断 ICP 的效能更高，AUC 为 0.967，灵敏
度为90.6%，特异度为98.0%。结论：ICP和AHP的胆汁酸谱有差异，利用OPLS⁃DA模型找到的差异性胆汁酸可以作为两者鉴
别诊断的一种重要方法。
［关键词］ 胆汁酸谱；妊娠期肝内胆汁淤积症；无症状高胆汁酸血症；高效液相色谱串联质谱

［中图分类号］ R714.255 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）06⁃856⁃07
doi：10.7655/NYDXBNS20210610

The value of bile acid profile in diagnosis of intrahepatic cholestasis of pregnancy and
asymptomatic hypercholanemia of pregnancy

*
SUN Ning，ZHONG Tianying ，CHEN Yajun，CHEN Chen，CHEN Chen
Department of Clinical Laboratory，Obstetrics and Gynecology Hospital of Nanjing Medical University，Nanjing
210004，China

［Abstract］ Objective：This study aims to investigate the value of bile acid profile in diagnosis of intrahepatic cholestasis of
pregnancy（ICP）and asymptomatic hypercholanemia of pregnancy（AHP）. Methods：Total 100 cases of normal pregnancy，60 cases of
ICP and 30 cases of AHP were selected. The content of bile acid in each group was analyzed by high performance liquid
chromatography tandem mass spectrometry（HPLC⁃MS/MS）. In addition，the orthogonal projections to latent structures（OPLS⁃DA）
model was developed to explore the differences of bile acids between the ICP and AHP groups. The diagnostic effiency of the
differential bile acids and the combined indicators was analyzed by receiver operating characteristic（ROC）curves. Results：Except for
chenodeoxycholic acid（CDCA），the contents of 15 kinds of bile acids among the three groups were statistically significant（P < 0.05）.
According to the OPLS ⁃ DA model，the differential bile acids in ICP group and AHP group were taurocholic acid（TCA），
taurochenodeoxycholic acid（TCDCA），glycocholic acid（GCA），glycohenodeoxycholic acid（GCDCA），tauroursodeoxycholic acid
（TUDCA）. ROC results showed that TCA had the highest diagnostic efficiency with area under curve（AUC）of 0.808. The combination
of TCA，TCDCA，GCDCA and TUDCA was more effective in the diagnosis of ICP. The AUC was 0.967，the sensitivity was 90.6%，and

［基金项目］ 江苏省卫生健康委医学科研项目（K2019015）
∗
通信作者（Corresponding author），E⁃mail：13851875320@163.com