血清HIF-1α、HO-1和sFlt-1对妊娠期肝内胆汁淤积症患者胎儿宫内缺氧的诊断价值OACSTPCD

Objective To investigate the diagnostic value of serum hypoxia inducible factor 1α(HIF-1α),heme oxygenase-1(HO-1)and soluble vascular endothelial growth factor receptor-1(sFlt-1)levels for fetal intrauterine hypoxia in the patients with intrahepatic cholestasis of pregnancy(ICP).Methods A total of 148 ICP patients diagnosed and treated in this hospital from January 2020 to December 2022 were selected as the ICP group.Sixty-six normal pregnant women in this hospital during the same period were selected as the nor-mal pregnancy group.The changes of serum HIF-1α,HO-1 and sFlt-1 levels were observed in the two groups,the influencing factors of intrauterine hypoxia were investigated,and the relationship between serum HIF-1α,HO-1 and sFlt-1 levels with the severity in the patients with ICP was analyzed,as well as the efficiency of HIF-1α,HO-1 and sFlt-1 in diagnosing intrauterine hypoxia in ICP patients was analyzed.The ICP patients were divided into the intrauterine hypoxia group and non-intrauterine hypoxia group according to whether in-trauterine hypoxia occurred,and the differences of clinical indexes between the two groups were compared.Re-sults The serum HIF-1 and sFlt-1 levels in the ICP group were significantly higher than those in the normal pregnancy group(P＜0.01),moreover which increased with the increase of ICP severity(P＜0.01),while se-rum HO-1 level was significantly lower than that in the normal pregnancy group(P＜0.01),and which de-creased with the increase of ICP severity(P＜0.01).In the intrauterine hypoxia group,the direct bilirubin,in-direct bilirubin,total bile acid,glycocholic acid,HIF-1 and sFlt-1 levels were significantly higher than those in the non-intrauterine hypoxia group(P＜0.01),while the prothrombin time and activated partial thromboplas-tin time were longer than those in the non-intrauterine hypoxia group(P＜0.01),while the serum HO-1 level was significantly lower than that in the non-intrauterine hypoxia group(P＜0.01).The multifactorial Logistic regression analysis showed that the increase of direct bilirubin,HIF-1α and sFlt-1 levels,and the decrease of HO-1 level were the independent risk factors for intrauterine hypoxia(P＜0.05).The serum HIF-1,HO-1 and sFlt-1 levels for diagnosing intrauterine hypoxia in ICP patients had the higher diagnostic efficiency.The sensitivity and specificity of their combined detection were 96.8％and 88.4％respectively,and the area under the curve(AUC)was 0.969,which was significantly greater than that of single index HIF-1(Z=3.294,P＜0.001),HO-1(Z=4.841,P＜0.001)and sFlt-1(Z=3.602,P＜0.001),while there was no statistically sig-nificant difference in AUC among the three indexes(P＞0.05).Conclusion HIF-1,HO-1 and sFlt-1 are the indexes reflecting the severity degree and intrauterine hypoxia in the patients with ICP,and their combined de-tection is beneficial to improve the diagnostic efficiency of fetal intrauterine hypoxia.