Exploration Of Serum HsCRP,PTX-3 And Lipid Levels In Patients With Intrahepatic Cholestasis During Pregnancy And Their Correlations

ObjectiveThe aim of this study is to detect the expression of high sensitivity C-reactive protein(hs CRP)and pentamerin-3(PTX-3)in the sera of patients with Intrahepatic cholestasis of pregnancy(ICP)by enzyme linked immunosorbent assay(ELISA).This study was conducted to determine the expression levels of hs CRP and Pentamerin-3(PTX-3)in the serum of patients with ICP,and to collect data on maternal lipid levels before the treatment of the disease through our GH medical record system.The study was conducted to understand the changes and correlations in the serum levels of inflammatory factors and lipoproteins in ICP patients and normal mothers.MethodsSixty-eight pregnant women were randomly selected to the obstetrics department of Gansu Provincial People’s Hospital between November 2021 and March 2022,including 34 pregnant women in the experimental group who were diagnosed with ICP and 34 pregnant women in the normal control group who had no specific abnormalities in the antenatal examination during the same period.The subjects were excluded from smoking,alcohol consumption,psychiatric disorders and other complications of pregnancy,and the pregnancy was a"spontaneous singleton conception",and no abnormalities such as fetal malformations were detected in clinical or laboratory examinations up to the current pregnancy.The participant group signed the"Informed Consent Form"in advance and agreed to cooperate throughout the procedure.The day before the gathering of blood samples,pregnant women in the experimental and control groups were instructed to fast for at least 8-12 hours after midnight on the day of specimen collection.10 ml of blood was routinely collected from the anterior elbow vein,injected into a sterile sodium heparin anticoagulation tube,mixed and allowed to stand,and then the serum was routinely centrifuged at 1500 rpm within 6 hours and extracted and numbered accurately.The levels of hs CRP and PTX-3 in the serum specimens were measured by double antibody sandwich ELISA.Total bile acid(TBA),low density lipoprotein(LDL),high density lipoprotein(HDL),alanine aminotransferase(ALT)and aspartate aminotransferase(ALT)were measured.Total cholesterol(TC)and total triglyceride(TG)levels were measured by our biochemistry laboratory and collected together with general laboratory data such as age,age of gestational,weight and BMI.The data were collated together with general laboratory data such as age,gestational age,body weight and BMI through the Harvest system of our hospital.SPSS 25.0 was used to perform statistical analysis of the data from this experiment.Measures were expressed as mean±standard deviation if they conformed to a normal distribution,otherwise they were expressed as median(interquartile spacing);two comparisons within groups for normally distributed data and chi-square were applied using the LSD-t test;if the principle of normality or chi-square was not met,multiple independent samples were used for within-group comparisons;Pearson correlation coefficients were used to compare correlations between indicators that met the normal distribution and variance chi-square,and Spearman rank correlation was used if they did not.We then used the Receiving Operating Characteristic curve(ROC curve)to explore the diagnostic value of each index as a diagnostic index for ICP and used stepwise regression for further analysis.P<0.05 was considered a statistically significant difference.Results1.The median(interquartile range)levels of hs CRP in the cholestasis group and normal group of mothers were 3.40(1.59)and 2.10(1.78)mg/dl,respectively.hs CRP levels in the cholestasis group of mothers were significantly higher than those in the normal group of mothers,with statistically significant differences(P<0.05);PTX-3 levels in the cholestasis group of mothers and normal group of mothers were 84.04(39.45)and 96.04(79.30)ng/ml,respectively.No statistically significant difference was found between the levels of PTX-3 in the cholestatic and normal groups of pregnant women(P=0.301).2.Expression levels of total bile acids and lipoprotein levels in pregnant women in the cholestasis group and in those in the normal group:TBA:16.47±9.86 vs.4.22±2.22μmol/L;ALT:17.5(13)vs.16(13.75)U/L;AST:12(9.75)vs.11(7)U/L;TC:5.26±1.57 vs.3.66±2.12 mmol/L;TG:4.23±4.84 vs.1.86±8.01 mmol/L;LDL:4.71±3.57 vs.2.19±1.04mg/dl;HDL:1.44(1.23)vs.2.45(1.13)mmol/L.The expression levels of TBA,TC,TG and LDL were higher in the cholestasis group than in the normal group(P<0.05),while the expression levels of HDL,AST and ALT were not significantly different between the two groups.3.In the cholestasis group,maternal TBA was significantly and positively correlated with hs CRP,TC,TG and LDL(r/rs=0.297,0.398,0.434,0.640 P<0.05);maternal hs CRP was significantly and positively correlated with TC,TG and LDL in the cholestasis group(r/rs=0.772,0.747,0.803 P<0.05);PTX-3 was significantly and positively correlated with HDL in the cholestasis group(rs=0.626 P<0.05).4.hs CRP ROC curve showed:AUC=0.766,95%CI:0.613-0.919,P<0.05,cut-off value:3.50mg/dl,sensitivity 74%,specificity 94%,Jorden index:0.675;TC ROC curve showed:AUC=0.779,95%CI:0.636-0.992,P<0.05,cut-off value:5.765 mmol/L,sensitivity 76%,specificity 96.3%,Jorden index:0.723;TG ROC curve:AUC=0.771,95%CI:0.622-0.920,P<0.05,cut-off value:3.66 mmol/L,sensitivity 75.3%,specificity 96.6%,Jorden index:0.719;LDL ROC curve:AUC=0.713,95%CI:0.553-0.872,P<0.05,cut-off value:3.710mmol/L,sensitivity 65%,specificity 90%,Jorden index:0.550.5.In the cholestasis group,maternal lipid TG and LDL levels and serum hs CRP levels showed a linear regression relationship with serum total bile acid levels,the regression curve was?=0.899+0.791*hs CRP+2.744*LDL-1.293*TG,R~2=0.594(P<0.01).Conclusions1.The expression level of hs CRP in the peripheral blood serum was higher in the cholestasis group than in the normal maternal group during the same period,and was significantly correlated with the change in blood bile acid level,suggesting that the development of intrahepatic cholestasis during pregnancy may be related to the onset and development of inflammatory response.2.The expression of TC,TG and LDL in the cholestasis group was higher than that of normal mothers during the same period,and was significantly correlated with changes in blood bile acid levels,suggesting that lipid metabolism may be involved in the development of intrahepatic cholestasis during pregnancy.3.The difference in PTX-3 expression level in peripheral blood between the cholestasis group and the normal maternal group was not statistically significant,but some studies found significant changes in PTX-3 in abnormal lipid metabolism disorders,guess PTX-3 may participate in lipid metabolism.4.During the development of intrahepatic cholestasis in pregnancy,there are complex changes in both inflammatory response and lipid metabolism,both of which may be involved and have direct or indirect effects on each other.