Wong H Y, Tan J Y L, Lim C C
Gastroenterology Unit, Department of General Medicine, Tan Tock Seng Hospital, Singapore.
Ann Acad Med Singap. 2004 Mar;33(2):204-8.
The causes of abnormal liver function tests in pregnancy are varied and may or may not be pregnancy-related. Often, the diagnosis can be difficult. This study looked at the causes of deranged liver function tests in obstetric patients with significant symptoms and signs.
Data from 50 cases of abnormal liver function tests in pregnant patients, who presented from 1998 to 2001, were analysed. Their presenting symptoms included persistent vomiting (48%), pruritus (14%), jaundice (26%), upper abdominal discomfort (24%) and hypertension (46%).
Pregnancy-related causes accounted for 84% of the abnormal liver function tests. Abnormal liver function tests occurred more frequently in the first (34%) and third (58%) trimesters than in the second trimester (8%). Hyperemesis gravidarum (94%) and partial haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome (31%) were the commonest causes in the first and third trimesters respectively. Hepatitis B flare resulted in 2 maternal deaths. Seven patients with pre-eclampsia toxaemia, acute fatty liver of pregnancy or partial/complete HELLP syndrome had their liver function tests measured sequentially before and after delivery. All of them showed rapid improvement postpartum with their alanine aminotransferase (ALT) dropping 50% within 3 days.
The majority of patients with abnormal liver function tests had a cause related to pregnancy, and pregnancy-related causes in the third trimester improved rapidly postpartum. Hepatitis B flare was a significant non-obstetric cause leading to maternal mortality. This diagnosis must therefore be considered in ethnic groups where the incidence of chronic hepatitis B infection is high, especially in chronic hepatitis B carriers with suspected pregnancy-related disease who deteriorate postpartum.
孕期肝功能检查异常的原因多种多样，可能与妊娠有关，也可能无关。通常，诊断可能会很困难。本研究探讨了有明显症状和体征的产科患者肝功能检查异常的原因。
分析了1998年至2001年期间50例妊娠患者肝功能检查异常的数据。她们的主要症状包括持续性呕吐（48%）、瘙痒（14%）、黄疸（26%）、上腹部不适（24%）和高血压（46%）。
与妊娠相关的原因占肝功能检查异常的84%。肝功能检查异常在孕早期（34%）和孕晚期（58%）比孕中期（8%）更常见。妊娠剧吐（94%）和部分溶血、肝酶升高及血小板减少（HELLP）综合征（31%）分别是孕早期和孕晚期最常见的原因。乙型肝炎发作导致2例孕产妇死亡。7例先兆子痫毒血症、妊娠急性脂肪肝或部分/完全性HELLP综合征患者在分娩前后分别进行了肝功能检查。所有患者产后均迅速好转，丙氨酸转氨酶（ALT）在3天内下降了50%。
大多数肝功能检查异常的患者病因与妊娠有关，孕晚期与妊娠相关的病因产后迅速改善。乙型肝炎发作是导致孕产妇死亡的重要非产科原因。因此，在慢性乙型肝炎感染发病率高的种族群体中，尤其是在疑似患有与妊娠相关疾病且产后病情恶化的慢性乙型肝炎携带者中，必须考虑这一诊断。
