Serum Bile Acid Profiles Of Intrahepatic Cholestasis Of Pregnancy And Analyze Perinatal Outcomes

Objective: To investigate the characteristics of serum bile acid profiles of pregnant women with intrahepatic cholestasis of pregnancy and to analyze perinatal outcomes.Methods: 144 case of ICP patient,50 case of cholelithiasis patient,and 50 case of hepatitis B virus patient were collected from the First Affiliated Hospital of Chongqing Medical University,and 50 case of normal pregnant women were chosen as the control group.Divide ICP patients into 4 groups according to serum total bile acid(TBA),direct bilirubin(DBIL)and alanine aminotransferase(ALT).Apply the High performance liquid chromatography-mass spectrometry/mass spectrometry to detect the 15 kinds serum bile acid profiles of all the cases.The serum bile acid profiles include lithocholic acid(LCA),deoxycholic acid(DCA),chenodeoxycholic acid(CDCA),cholic acid(CA),ursodeoxycholic acid(UDCA),gychocholic acid(GLCA),gychodeoxycholic acid(GDCA),gychochenodeoxycholic acid(GCDCA),gychocholic acid(GCA),gychoursooxycholic acid(GUDCA),taurolithocholic acid(TLCA),taurodeoxycholic acid(TDCA),taurochenodeoxycholic acid(TCDCA)and tuarocholic acid(TCA),taurochenodeoxycholic acid(TUDCA).The PLS-DA was used to compare the difference of bile acid profiles among groups,and the perinatal outcomes of pregnant women in every group were analyzed.Results :(1)The differential serum bile acid profiles of the ICP groups and normal pregnant women were DCA,TCDCA,TCA,GDCA and GLCA The concentrations of TCA and TCDCA were the highest in the group ICP1,and the concentrations of DCA,GDCA and GLCA were the highest in the ICP3 group.(2)The differential bile acid profiles between group ICP4 and normal pregnant women were UDCA,GUDCA,TUDCA,GCA and GLCA.All the differential serum bile acid profiles concentration of group ICP4 were much higher than that of normal pregnant women.The differential serum bile acid profiles between group ICP4 and group ICP1 was TCDCA,TCA,DCA,GCA,GCDCA,TUDCA,TDCA and GUDCA.Only DCA concentration in group ICP4 was significantly higher than that in group ICP1,the other differential bile acid profiles of group ICP1 were significantly higher than that in group ICP4.The differential serum bile acid profiles between group ICP4 and the cholelithiasis were UDCA,CDCA,TUDCA and GCDCA.The concentrations of UDCA and TUDCA in the ICP4 were higher than those in the cholelithiasis,and the concentrations of CDCA and GCDCA were lower than those in the cholelithiasis.The differential serum bile acid profiles between group ICP4 and the hepatitis B virus were GCDCA,CDCA,TCDCA,TCA,GCA,GUDCA,UDCA and TUDCA,and the above concentrations were all lower in the ICP4 group than in the hepatitis B virus.(3)The differential serum bile acid profiles between group ICP3 and normal pregnant women group were GUDCA,LCA,GLCA,UDCA,TUDCA,CDCA and TLCA.Above of the concentration were higher in ICP3 group than in normal pregnant women group.The differential serum bile acid profiles between group ICP3 and group ICP1 were DCA,GDCA,LCA,GLCA,GCDCA and TCDCA.Only the concentration of TCDCAwas higher in group ICP1 than in group ICP3,the rest were higher in group ICP3 than in group ICP1.The differential serum bile acid profiles between group ICP3 group and the cholelithiasis were UDCA,LCA,TUDCA and GUDCA,the above bile acids concentrations were all higher in the group ICP3 than in the cholelithiasis.The differential serum bile acid profiles between group ICP3 and the hepatitis B virus were CA,TDCA,TLCA,GCDCA,TCDCA,TCA,CDCA and GDCA.The concentrations of DCA,GDCA,TDCA were higher in the group ICP3 than in the cholelithiasis,while the concentrations of CDCA,GCDCA,TCDCA were lower in the group ICP3 than in the cholelithiasis.(4)The differential serum bile acid profiles between group ICP1 and the normal pregnant women were TCDCA,TCA,GCA,GCDCA,TUDCA and GUDCA.The above bile acids concentrations were all higher in the group ICP1 than in the normal pregnant women.The differential serum bile acid profiles between group ICP1 and cholelithiasis were TUDCA,UDCA,TCA,CDCA,GUDCA,DCA,CA and GCDCA.The differential serum bile acid profiles between the group ICP1 and the hepatitis B virus were GCDCA,GCA,CDCA,TCDCA and TDCA,among which only the concentration of TDCA in the ICP1 was higher than that in the hepatitis B virus,the other differential bile acids in the group ICP1 were lower than that in the hepatitis B virus.(5)Group ICP1 presented significant higher rate of meconium-stained amniotic fluid,preterm delivery and cesarean section when compared to group ICP2.Group ICP3 presented significant higher rate of meconium-stained amniotic fluid and preterm delivery when compared to the normal pregnant women,but when compared to group ICP1,the rate of meconium-stained amniotic fluid,premature delivery cases and cesarean section cases were much significantly lower.And There was no significantdifference of perinatal outcomes between ICP3 group and ICP2 group.Group ICP4 presented significant higher rate of meconium-stained amniotic fluid,preterm delivery and cesarean section when compared to the normal pregnant women,but when compared to group ICP1,the rate of meconium-stained amniotic fluid,premature delivery neonatal asphyxia and cesarean section were much significantly lower.And There was no significant difference of perinatal outcomes between ICP4 group and ICP2 group.Conclusion : The characteristic bile acid profiles of ICP pregnant women are CDCA,UDCA,GLCA,GCDCA,GCA,GUDCA,TCDCA,TCA and TUDCA,which are significant for the diagnosis and differential diagnosis of ICP subtypes;Hypercholanemia of pregnancy and pregnancy-specific abnormal liver enzyme are belong to the ICP subtypes and should be paid particular attention in clinical practices.