关键词:

妊娠期肝内胆汁淤积症, 胎儿窘迫, Th1细胞因子, Th2细胞因子

Abstract:

Objective　To explore the effect of Th1/Th2 cell balance on fetal intrauterine distress in patients with intrahepatic cholestasis of pregnancy (ICP), and provide reference for clinical prevention of fetal intrauterine distress. Methods　A total of 96 ICP patients admitted to Xi'an People's Hospital from January 2023 to January 2024 were selected as the case group, including 62 primiparas and 34 multiparas, aged (28.46±4.20) years, with a gestational age of (33.70±2.34) weeks. Another 96 healthy pregnant women during the same period were selected as the control group, including 66 primiparas and 30 multiparas, aged (27.60±4.12) years, with a gestational age of (32.85±2.42) weeks. The case group was subdivided into an occurrence group and a non-occurrence group based on whether fetal intrauterine distress had occurred. The levels of Th1 cytokines [tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ)] and Th2 cytokine [interleukin (IL) -4] were detected by enzyme-linked immunosorbent assay (ELISA), and IFN-γ/IL-4 and TNF-α/IL-4 were calculated. The differences in TNF-α, IFN-γ, IL-4, IFN-γ/IL-4, and TNF-α/IL-4 were compared between the case group and the control group, as well as between the occurrence group and the non-occurrence group. Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of fetal intrauterine distress in ICP patients. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive value of Th1/Th2 cytokines for fetal intrauterine distress in ICP patients. Independent sample t test and χ² test were used. Results　The levels of TNF-α, IFN-γ, IFN-γ/IL-4, and TNF-α/IL-4 in the case group were higher than those in the control group [(102.31±18.33) ng/L vs. (64.20±12.62) ng/L, (166.78±32.33) ng/L vs. (138.39±28.10) ng/L, (3.36±0.22) vs. (1.15±0.12), (2.06±0.12) vs. (0.53±0.08)], but the level of IL-4 was lower than that in the control group [(49.57±16.32) ng/L vs. (120.54±20.36) ng/L], with statistically significant differences (t=16.779, 6.494, 86.407, 103.943, and 26.649, all P<0.001). Among the 96 ICP patients, 22 cases (22.92%) experienced fetal intrauterine distress, including 8 cases of acute fetal distress and 14 cases of chronic fetal distress. The levels of total serum bile acids, total serum bilirubin, TNF-α, IFN-γ, IFN-γ/IL-4, and TNF-α/IL-4 in the occurrence group were higher than those in the non-occurrence group, but the level of IL-4 was lower than that in the non-occurrence group, with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that total serum bile acids, TNF-α, IFN-γ, IL-4, IFN-γ/IL-4, and TNF-α/IL-4 were independent influencing factors for the occurrence of fetal distress in ICP patients (all P<0.05). The ROC curve was drawn, it was found that the areas under the curves (AUCs) of TNF-α, IFN-γ, and IL-4 in predicting fetal distress in ICP patients were all >0.70, and the AUCs of IFN-γ/IL-4 and TNF-α/IL-4 in predicting fetal distress were both >0.85. Conclusion　The shift of Th1/Th2 balance towards Th1 in ICP patients affects the risk of fetal intrauterine distress, and detecting IFN-γ/IL-4 and TNF-α/IL-4 helps to predict fetal intrauterine distress.

Key words:

Intrahepatic cholestasis of pregnancy, Fetal intrauterine distress, Th1 cytokines, Th2 cytokines