Reyes H
Department of Medicine, University of Chile School of Medicine, Santiago.
Gastroenterol Clin North Am. 1992 Dec;21(4):905-21.
A mild form of intrahepatic cholestasis is an infrequent complication of pregnancy, with a spontaneous cure almost immediately after delivery and that often recurs in future pregnancies. Pruritus alters maternal well-being, and a subclinical steatorrhea may impair the patient's nutritional status; otherwise, it is a mild disease in the mother, and no maternal mortality has been attributed to it. In contrast, cholestasis of pregnancy is often identified as a risk of increased perinatal morbidity and mortality. The cause of cholestasis of pregnancy is unknown. A hereditary predisposition seems to induce in the maternal liver an abnormal reaction to female sex hormones, but some still unidentified environmental (possibly dietary) factor could also be involved in the pathogenesis of the disease. Pruritus, but not the biochemical alterations, can be alleviated by the use of cholestyramine, silymarin, or epomediol. Ursodeoxycholic acid has been beneficial in pruritus and in liver function tests; an improvement in fetal prognosis should be evaluated in future controlled studies.
轻度肝内胆汁淤积是妊娠罕见的并发症，产后几乎可立即自愈，且在未来妊娠中常复发。瘙痒会影响母亲的健康，亚临床脂肪泻可能损害患者的营养状况；否则，对母亲来说这是一种轻症疾病，尚无孕产妇死亡归因于此。相比之下，妊娠胆汁淤积症常被视为围产期发病率和死亡率增加的风险因素。妊娠胆汁淤积症的病因不明。遗传易感性似乎会使母体肝脏对女性性激素产生异常反应，但某些尚未明确的环境因素（可能是饮食因素）也可能参与该疾病的发病机制。使用消胆胺、水飞蓟宾或依泊二醇可缓解瘙痒，但无法改善生化指标异常。熊去氧胆酸对瘙痒和肝功能检查有益；未来的对照研究应评估其对胎儿预后的改善情况。
