Division of Reproduction and Endocrinology, King's College London, London, UK.
Am J Gastroenterol. 2010 Mar;105(3):585-95. doi: 10.1038/ajg.2009.633. Epub 2009 Nov 10.
Increased maternal serum bile acids are implicated in intrahepatic cholestasis of pregnancy. Individual bile acid profiles and their relationship with disease progression, however, remain unknown. The purpose of this prospective study was to determine the temporal changes in bile acids in normal pregnancy and in pregnancies complicated with intrahepatic cholestasis of pregnancy and pruritus gravidarum.
A validated method for the evaluation of 15 bile acids (conjugated and unconjugated) in a single serum sample was developed using high-performance liquid chromatography/mass spectrometry (HPLC-MS) with an electrospray interface. Bile acid concentrations were assessed in samples (16 weeks of gestation to 4 weeks postpartum) from women with, or who later developed, intrahepatic cholestasis of pregnancy (n=63) and were compared with those from normal pregnant women (n=26) and from women with pruritus gravidarum (n=43).
Intrahepatic cholestasis of pregnancy was associated with a predominant increase in cholic acid conjugated with taurine and glycine, from 24 weeks of pregnancy. Ursodeoxycholic acid (UDCA) treatment (> or =21 days, n=15) significantly reduced serum taurocholic and taurodeoxycholic acid concentrations (P<0.01). Bile acid profiles were similar in normal pregnancy and pregnancy associated with pruritus gravidarum.
The bile acid profiles and effects of treatment by UDCA implicate a role for taurine-conjugated bile acids in the syndrome of intrahepatic cholestasis of pregnancy. [corrected] With regard to individual bile acid profiles, pruritus gravidarum is a disorder quite distinct from intrahepatic cholestasis of pregnancy.
母体血清胆汁酸升高与妊娠肝内胆汁淤积症有关。然而，个体胆汁酸谱及其与疾病进展的关系尚不清楚。本前瞻性研究旨在确定正常妊娠和妊娠肝内胆汁淤积症及妊娠瘙痒症中胆汁酸的时间变化。
采用高效液相色谱/质谱联用（HPLC-MS），用电喷雾接口建立了一种评估 15 种胆汁酸（结合型和非结合型）的验证方法。评估了患有妊娠肝内胆汁淤积症（n=63）或以后发生妊娠肝内胆汁淤积症的女性（n=63）和正常孕妇（n=26）及妊娠瘙痒症女性（n=43）的样本（妊娠 16 周至产后 4 周）中的胆汁酸浓度。
妊娠肝内胆汁淤积症与胆酸与牛磺酸和甘氨酸结合物从 24 孕周开始的主要增加相关。熊去氧胆酸（UDCA）治疗（>或=21 天，n=15）显著降低了血清牛磺胆酸和牛磺脱氧胆酸浓度（P<0.01）。正常妊娠和妊娠瘙痒症中胆汁酸谱相似。
UDCA 治疗的胆汁酸谱和作用提示牛磺酸结合胆汁酸在妊娠肝内胆汁淤积症综合征中起作用。[已更正]就个体胆汁酸谱而言，妊娠瘙痒症是一种与妊娠肝内胆汁淤积症完全不同的疾病。
