Objective To investigate the clinical significance of four coagulation parameters, the D-dimer and antiphospholipid antibody detection in pregnant women with intrahepatic cholestasis of pregnancy (ICP).
Methods Eighty pregnant women with ICP were selected as case group, and another 80 healthy pregnant women were selected as control group. The case group was divided into mild ICP group (n=51) and severe ICP group (n=29) according to the severity of the disease. Plasma prothrombin time (PT), activated partial thrombin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer, serum anticardiolipin antibody (ACA), antibody against β2 glycoprotein Ⅰ (anti-β2GP Ⅰ) and normalized ratio of lupus anticoagulant (LA) were compared among different groups. Values of FIB, D-dimer, ACA, anti-β2GP Ⅰ and normalized ratio of LA in predicating adverse pregnancy outcomes were evaluated by receiver operating characteristic (ROC) curve.
Results Before delivery, the plasma FIB and D-dimer levels in the mild ICP group and the severe ICP group were significantly higher than those in the control group, and these indexes in the severe ICP group were also significantly higher than those in the mild ICP group (P < 0.05). Before delivery, the serum ACA, anti-β2GP Ⅰ and normalized ratio of LA in the mild ICP group and the severe ICP group were significantly higher than those in the control group, and these indexes in the severe ICP group were also significantly higher than those in the mild ICP group (P < 0.05). The cesarean section rate and the incidence rate of fetal intrauterine growth restriction in the case group were significantly higher than those in the control group (P < 0.05); among the 80 pregnant women with ICP, 32 cases had adverse pregnancy outcomes, and the levels of plasma FIB, D-dimer, serum ACA, anti-β2GP Ⅰ and normalized ratio of LA in the bad pregnancy group were significantly higher than those in the good pregnancy group (P < 0.05). When plasma FIB was greater than 4.520 g/L, the area under the curve (AUC) for predicting adverse pregnancy outcomes in the ICP pregnant women was 0.757, with a sensitivity of 71.9% and a specificity of 84.4%; when plasma D-dimer was greater than 1.860 mg/L, the AUC was 0.828, with a sensitivity of 78.1% and a specificity of 81.3%; when serum ACA was greater than 7.915 mU/mL, the AUC was 0.774, with a sensitivity of 81.3% and a specificity of 75.0%; when serum anti-β2GP Ⅰ was greater than 6.085 mU/mL, the AUC was 0.875, with a sensitivity of 87.5% and a specificity of 68.8%; when normalized ratio of LA was greater than 1.305, the AUC was 0.809, with a sensitivity of 84.4% and a specificity of 71.3%.
Conclusions There are abnormal conditions of coagulation, fibrinolysis and immunity in pregnant women with ICP during delivery, and the degree of abnormality is related to the severity of ICP. The detection of FIB, D-dimer and antiphospholipid antibody has positive significance for predicting the pregnancy outcomes of the pregnant women with ICP.
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