Expression And Clinical Significance Of Caspase3 And XIAP In Placenta Of Patients With Intrahepatic Cholestasis Of Pregnancy

Objective:To study the relationship between cysteine aspastic acid-specific protease3(Caspase3),X-linked inhibitor of apoptosis protein(XIAP)and intrahepatic cholestasis of pregnancy(ICP),and to provide new ideas for the prevention,treatment and prediction of pregnancy outcome of ICP.Methods:In this prospective study,20 severe ICP patients,20 mild ICP patients and20 normal singleton pregnancies delivered at the Second Clinical Medical College of Three Gorges University from January 2018 to June 2019 were selected as the study objects,which were divided into severe ICP group,mild ICP group and control group.General data of all pregnant women were collected.Elbow vein blood was collected from all pregnant women in a fasting state one day before the operation,and umbilical vein blood was collected during cesarean section.Enzyme linked immunosorbent assay(ELISA)was used to detect totol bile acid(TBA),almanine aminotransferase(ALT),aspartate transaminase(AST),total bilirubin(TBIL)in serum and umbilical vein blood.Placental tissue was taken within 10 minutes after delivery.The expression of Caspase3 and XIAP in placental tissues were detected by immunohistochemistry.SPSS17.0 was used to analyze the results.Results:(1)General information:There were no significant differences in age,pregnancy and parity among the three groups of pregnant women.The incidence of Meconium stained amniotic fluid(MSAF)and fetal distress among pregnant women in each group were statistically significant(P<0.01),and that in severe ICP group was higher than that in mild ICP group and control group(P<0.0167).Compared with the control group,the birth weight of newborns in severe and mild ICP group were lower,the one minute Apgar score and gestational week of newborns in severe ICP group was significantly lower than that of mild ICP group and control group(P<0.05).(2)Biochemical indicators:serum TBA,ALT and AST in severe and mild ICP were higher than those in control group,TBA in severe ICP group was higher compared with mild group(P<0.05).Umbilical vein blood TBA in severe ICP group was higher than that in mild ICP group and control group(P<0.05).Serum and umbilical vein blood TBA were positively correlated(r=0.366,P<0.01).(3)Immunohistochemical results showed that Caspase3 was expressed in the placental trophoblasts of three groups of pregnant women,mainly in the cytoplasm.The protein expression level was analyzed by immunohistochemical integration method,and the average optical densidy(AOD)value was determined by image analysis software.For the expression level of Caspase3,severe ICP group showed significantly high results as compared with both mild ICP group and control group,while the expression level in mild ICP group was higher than that in control group,the difference was statistically significant(P<0.0167).The AOD value of Caspase3 in severe ICP group was higher than that in mild ICP group and control group,and a higher value of AOD was found in mild ICP group,as compared to control group(P<0.05).XIAP was expressed in the placental trophoblasts of three groups of pregnant women,mainly in the cytoplasm.The protein expression level was analyzed by immunohistochemical integration method,and the average optical densidy(AOD)value was determined by image analysis software.For the expression level of XIAP,severe ICP group showed significantly low results as compared with both mild ICP group and control group,while the expression level in mild ICP group was lower than that in control group,the difference was statistically significant(P<0.0167).The AOD value of XIAP in severe ICP group was lower than that in mild ICP group and control group,and a lower value of AOD was found in mild ICP group,as compared to control group(P<0.05).The protein expression levels of Caspase3 and XIAP in placenta tissue were negatively correlated(r_s=-0.770,P<0.05),and the AOD values of both were negatively correlated(r=-0.599,P<0.05).Conclusion:(1)The expression levels of Caspase3 and XIAP in placental trophoblasts were related to the severity of ICP.The severity of ICP increased with the increase of expression of Caspase3 and the decrease of expression of XIAP in placenta.(2)The expression of Caspase3 and XIAP in placental trophoblasts of ICP patients is negatively correlated,suggesting that Caspase3 and XIAP may interact in the occurrence and development of ICP.