妊娠肝内胆汁淤积症患者血清中sVCAM-1及IL-6的测定及意义
摘要 目的 探讨可溶性血管细胞粘附分子1（soluble vascular cell adhesion molecule-l, sVCAM-1）及白细胞介素-6（interleukin-6,IL-6）在妊娠肝内胆汁淤积症（Intrahepatic cholestasis of pregnancy ,ICP）发病中的作用。方法 测定49例孕妇血清中sVCAM-1、IL-6水平，其中正常妊娠组15例，ICP组34例，包括轻度14例，重度20例。用酶联免疫吸附法（ELISA）测定sVCAM-1，用放射免疫法（RIA）测定IL-6。结果 重度ICP患者血中sVCAM-1、IL-6水平均显著高于正常妊娠组（P<0.01），轻度ICP患者与正常妊娠组相比，虽无统计学差异，但有升高趋势，ICP组产后各项指标下降与正常妊娠组无显著性差异（P>0.05）。IL-6与sVCAM-1呈正相关（r=0.435,P<0.01）。结论 ICP患者粘附分子的异常表达可能是ICP发病机制的一个重要环节。IL-6可诱导sVCAM-1的表达。
关键词 妊娠肝内胆汁淤积症，血管细胞粘附分子-1，白细胞介素-6。
The changes and significance of sVCAM-1、IL-6in serum of patients with intrahepatic cholestasis of pregnancy(ICP). Fang Caiyun , Fang xiaomei ,Zhao Yajuan. Department of Obstetrics and Gynecology , Taihe Hospital of Yunyang Medical College, Hubei Shiyan ,442000,China..
[Abstract] Objective To investigate circulating levels of soluble vascular cell adhesion molecule-l( sVCAM-1) and Interleukin-6 (IL-6) in the peripheral of intrahepatic cholestasis of pregnancy(ICP). To reveal the pathogenesis of ICP. Methods Maternal serum sVCAM-1 and IL-6 were determined in 49 women which 15 were normal pregnant women and 34 with ICP. The later were grouped into 14 women with mild, 20 with severe ICP. sVCAM-1 was measured by ELISA and IL-6 by RIA. Results The levels of serum sVCAM-1 and IL-6 were significantly elevated in women with severe ICP compared with control subjects(P<0.01),and the markedly decreased to normal 5 day after delively (P>0.05). The IL-6 levels were positively correlated with sVCAM-1(r=0.435,P<0.01). Conclusion Elevated levels of sVCAM-1 indicate that a primary endothelial cell dysfunction play an important role in the pathogensis of ICP. Elevated sVCAM-1 were associated with IL-6 levels increase.
[Key words] Intrahepatic cholestasis of pregnancy(ICP) sVCAM-1, IL-6
妊娠肝内胆汁淤积症（Intrahepatic cholestasis of pregnancy ,ICP）是发生于妊娠中晚期以皮肤瘙痒、黄疸，产后症状迅速消失为特征的妊娠期并发症，因易引起胎儿窘迫、早产、死胎、死产而被列为高危妊娠之一。但病因目前仍不明确，最近国内外大量研究表明，ICP的发生与免疫功能的改变有关[1]。可溶性血管细胞粘附分子1(soluble vascular cell adhesion molecule-l,sVCAM-1)的含量改变是抗免疫反应的结果。而白细胞介素6(Interleukin-6 ,IL-6)及肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)等作为刺激因子，可诱导粘附分子异常表达，本研究通过测定ICP患者血清中可溶性血管细胞粘附分子-1，白细胞介素-6水平作自身对照及与正常妊娠组对照，以探讨二者在ICP发病中的作用。
1 资料与方法
1.1 研究对象 选择2006年1月—2007年9月在我院收治ICP患者34例（ICP组）：其中轻度ICP14例、重度20例，ICP的诊断参照文献[2]，临床分度标准[3]（1）轻度：血清胆红素<21umol/L，直接胆红素<6umol/L，血清丙氨酸氨基转移酶（ALT）<250u/L，血清天冬氨酸氨基转移酶（AST）<250u/L。（2）重度：血清胆红素>21umol/L，直接胆红素>6umol/L，ALT>250u/L，AST>250u/L。平均年龄（26.94±2.74）岁，平均孕周（35.13±1.02）周。正常孕妇15例，正常妊娠组平均年龄（27.93±3.86）岁，平均孕周（39.34±0.96）周。所有研究对象排除合并妊娠期高血压疾病、糖尿病、肾病、原发性高血压、肝炎、贫血、胆石症等疾病。由于细胞因子（如IL-8,IL-6等）可能与分娩发动有关，为排除此干扰因素，所有病例均在临产前行剖宫产术。
