The Value Of Blood Routine Inflammatory Markers In The Diagnosis And Prognosis Of Intrahepatic Cholestasis During Pregnancy

BackgroundIntrahepatic cholestasis of pregnancy is a special disease of pregnancy characterized by itching accompanied by elevated bile acids.The inflammatory response plays an important role in the pathophysiological mechanism of intrahepatic cholestasis of pregnancy.Recently,several studies have reported that blood inflammatory markers have certain value for ICP diagnosis and prognosis,but the results are controversial.ObjectiveCombined with retrospective case-control experiments and meta-analysis,the value of conventional inflammatory markers in the diagnosis and prognosis of ICP was evaluated.Research ContentThe research consists of two parts.In the first part,the ICP cases diagnosed by the Department of Gastroenterology and Obstetrics and Gynecology were collected retrospectively from the establishment of the Jiahe System of the Zhongshan Hospital affiliated to Xiamen University to January 2019.Clinical data were collected from both outpatients and inpatients,including:age,gestational age,aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(ALP),glutamyl tra ns peptidase(GGT),white blood cells Count,neutrophil count,lymphocyte count,platelet count,red blood cell distribution width(RDW),hemoglobin,mean platelet volume(MPV),hematocrit(HCT),neutrophil to lymphocyte ratio(NLR),Platelet to lymphocyte ratio(PLR),the number of premature births,etc.Data statistical processing was performed using SPSS20 software,and the ROC curve was used to evaluate the predictive value of each index for ICP diagnosis,disease severity assessment and preterm birth complications.The second part obtains the research on the diagnosis and prognosis value of ICP by using the search medical database.The search results are screened strictly according to the inclusion and exclusion criteria,and the NOS score scale(Newcastle-Ottawa Scale)is included.The literature is evaluated for quality.A meta-analysis of the included data was performed using RevMan 5.3 and a conclusion was reached.ResultA total of 130 ICP patients were collected through the hospital system,including 29 in the severe group,101 in the mild group,and 80 in the normal delivery.Compared with the control group,the age,neutrophils,lymphocytes,MPV,ALP,AST,NLR were significantly higher in the ICP group than in the control group,and the platelets were lower than the control group,and statistically significant;There was no statistical difference between the two groups in blood inflammatory markers.The results of ROC curve analysis showed that MPV,platelet and NLR had certain diagnostic value for ICP.The area under the ROC curve was 0.95±0.01(95%CI:0.92?0.97,P<0.01)and 0.64±0.04(95%CI:0.56 to 0.72,P<0.01),0.80±0.03(95%CI:0.73 to 0.87,P<0.01).Further analysis of the difference between the ICP mild group and the severe group showed that compared with mild ICP patients,the gestational age of patients with severe ICP was smaller,and there was a statistically significant difference between the two;and age,all blood routine inflammation markers There is no difference in the group.Compared with the ICP normal delivery group,the levels of bile acid and transaminase in the ICP preterm group were higher,and the difference was statistically significant;there was no significant difference in age and blood inflammatory markers.The ROC curve was used to analyze the predictive value of bile acid and transaminase for ICP premature delivery.The results showed that TBA,AST and ALT had certain value for predicting ICP premature birth;the area under ROC curve was 0.63±0.06(95%CI:0.51?0.75,P=0.03),0.67 ± 0.06(95%CI:0.56?0.78,P<0.01),0.65 ± 0.08(95%CI:95%CI:0.52?0.81,P<0.01,P<0.01).The meta-analysis included 8 articles in the study,including 1491 patients,including 879 in the ICP group and 612 in the control group.According to the NOS scale,the quality of the literature was evaluated.All the studies were more than 6 points,and the quality of the literature was high.The meta-analysis results suggest that MPV and NLR are valuable for ICP diagnosis,but not valuable for disease severity assessment;PLR,platelet,and RDW are priceless for ICP diagnosis and disease severity assessment.ConclusionThe routine inflammatory markers NLR and MPV have good accuracy in ICP diagnosis.However,the current evidence indicates that blood inflammatory markers are of no value in assessing the severity of ICP disease;bile acid and transaminase levels may have predictive value for ICP concurrent preterm birth However,due to the differences in clinical measurement instruments,the research population is relatively limited,the defects of retrospective research itself,the inclusion of too few literatures,the possible publication bias,the meta-analysis heterogeneity and the inability to eliminate,etc.Future large-sample,high-quality clinical studies are supported.