背景:妊娠肝内胆汁淤积症(ICP)对母亲和未出生的孩子都是一种罕见但严重的并发症。诊断主要基于升高的血清胆汁酸水平。在一个大型ICP队列中,我们在这里使用瞬时弹性成像(TE)详细研究肝脏硬度(LS),现在广泛用于在几分钟内非侵入性筛查肝硬化。
目的:专门探讨与无并发症妊娠的对照组相比,ICP女性的大队列中的LS。
方法:使用TE(Fibroscan,回声,巴黎,法国)在2010年至2020年之间。在17个案例中,LS可以在产后测量。对照组为分娩前450名妇女和分娩后38名无并发症妊娠妇女。常规实验室,还测量了胆汁酸和凋亡标志物caspase裂解的细胞角蛋白18片段(M30)的水平。
结果:患有ICP的女性转氨酶明显升高,但γ-谷氨酰转移酶(GGT)正常。与对照组在6.2±2.3kPa时相比,平均LS在7.3±3.0kPa时显著增加(P<0.0001)。两组产后LS均显著下降,但ICP仍较高(5.8±1.7kPavs4.2±0.9kPa,P<0.0001),分别。在ICP中,LS与胆汁酸和M30的水平高度显着相关,但与转氨酶无关。在ICP组中,GGT与GGT没有相关性,甚至在分娩后显着增加。胆汁酸主要与肝细胞凋亡标志物M30、LS和丙氨酸氨基转移酶水平相关,天冬氨酸转氨酶,和胆红素.在多变量分析中,LS仍然是与胆汁酸升高独立相关的唯一参数。
结论:结论:LS在ICP中显著升高,这最可能是由于毒性胆汁酸积累和肝细胞凋亡。与传统的实验室标记物相关,LS提供了额外的非侵入性信息,以快速识别处于ICP风险的女性。
BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a rare but severe complication for both the mother and the unborn child. The diagnosis is primarily based on elevated serum levels of bile acids. In a large ICP cohort, we here study in detail liver stiffness (LS) using transient elastography (TE), now widely used to non-invasively screen for liver cirrhosis within minutes.
OBJECTIVE: To specifically explore LS in a large cohort of women with ICP compared to a control group with uncomplicated pregnancy.
METHODS: LS and hepatic steatosis marker controlled attenuation parameter (CAP) were measured in 100 pregnant women with ICP using TE (Fibroscan, Echosens, Paris, France) between 2010 and 2020. In 17 cases, LS could be measured postpartum. 450 women before and 38 women after delivery with uncomplicated pregnancy served as control group. Routine laboratory, levels of bile acids and apoptosis marker caspase-cleaved cytokeratin 18 fragment (M30) were also measured.
RESULTS: Women with ICP had significantly elevated transaminases but normal gamma-glutamyl transferase (GGT). Mean LS was significantly increased at 7.3 ± 3.0 kPa compared to the control group at 6.2 ± 2.3 kPa (P < 0.0001). Postpartum LS decreased significantly in both groups but was still higher in ICP (5.8 ± 1.7 kPa vs 4.2 ± 0.9 kPa, P < 0.0001), respectively. In ICP, LS was highly significantly correlated with levels of bile acids and M30 but not transaminases. No correlation was seen with GGT that even increased significantly after delivery in the ICP group. Bile acids were mostly correlated with the liver apoptosis marker M30, LS and levels of alanine aminotransferase, aspartate aminotransferase, and bilirubin. In multivariate analysis, LS remained the sole parameter that was independently associated with elevated bile acids.
CONCLUSIONS: In conclusion, LS is significantly elevated in ICP which is most likely due to toxic bile acid accumulation and hepatocyte apoptosis. In association with conventional laboratory markers, LS provides additional non-invasive information to rapidly identify women at risk for ICP.