Kozic Jennifer R, Benton Samantha J, Hutcheon Jennifer A, Payne Beth A, Magee Laura A, von Dadelszen Peter
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; The CFRI Reproduction and Healthy Pregnancy Cluster, University of British Columbia, Vancouver BC.
J Obstet Gynaecol Can. 2011 Oct;33(10):995-1004. doi: 10.1016/S1701-2163(16)35048-4.
To evaluate whether (1) the absolute magnitude of liver function test values, (2) the percentage change in liver function test values over time, or (3) the rate of change in liver function test values over time predicts adverse maternal outcomes in women with preeclampsia.
We used data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study, a prospective multicentre cohort study assessing predictors of adverse maternal outcomes in women with preeclampsia. Women with at least one liver function test performed at the time of hospital admission were included. Liver functions were tested by serum concentrations of aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), albumin, total bilirubin, and the international normalized prothrombin time ratio. Parameters investigated were absolute levels, change within 48 hours of hospital admission, change from admission to delivery or outcome, and rate of change from admission to delivery or outcome of each liver function test. The ability of these parameters to predict adverse outcomes was assessed using logistic regression analyses and by calculating the receiver operating characteristic (ROC) area under the curve (AUC).
Of the 2008 women, 1056 (53%) had at least one abnormal liver function test result. The odds of having an adverse maternal outcome were higher in women with any abnormal liver function test than in women with normal results. When test results were stratified into quartiles, women with results in the highest quartile (lowest quartile for albumin) were at higher risk of adverse outcomes than women in the lowest quartile for all parameters (highest for albumin). The absolute magnitude of AST, ALT, and LDH predicted adverse maternal outcomes (AST: ROC AUC 0.73 [95% CI 0.67 to 0.97]; ALT: ROC AUC 0.73 [95% CI 0.67 to 0.79]; LDH: ROC AUC 0.74 [95% CI 0.68 to 0.81]). Neither change of liver function test results, within 48 hours of admission or from admission to delivery or outcome, nor rate of change were predictive.
We found abnormal liver function test results to be associated with an increased risk for adverse maternal outcomes. Levels of AST, ALT, and LDH were found to be modestly predictive of these outcomes.
评估（1）肝功能测试值的绝对大小，（2）肝功能测试值随时间的百分比变化，或（3）肝功能测试值随时间的变化率是否可预测子痫前期女性的不良孕产妇结局。
我们使用了PIERS（子痫前期风险综合评估）研究的数据，这是一项前瞻性多中心队列研究，评估子痫前期女性不良孕产妇结局的预测因素。纳入了在入院时至少进行过一次肝功能测试的女性。通过检测血清天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、乳酸脱氢酶（LDH）、白蛋白、总胆红素和国际标准化凝血酶原时间比值来评估肝功能。研究的参数包括各肝功能测试的绝对水平、入院48小时内的变化、入院至分娩或结局的变化以及入院至分娩或结局的变化率。使用逻辑回归分析并通过计算曲线下的受试者操作特征（ROC）面积（AUC）来评估这些参数预测不良结局的能力。
在2008名女性中，1056名（53%）至少有一项肝功能测试结果异常。肝功能测试结果异常的女性发生不良孕产妇结局的几率高于结果正常的女性。当将测试结果分为四分位数时，所有参数处于最高四分位数（白蛋白为最低四分位数）的女性发生不良结局的风险高于处于最低四分位数（白蛋白为最高四分位数）的女性。AST、ALT和LDH的绝对大小可预测不良孕产妇结局（AST：ROC AUC 0.73 [95% CI 0.67至0.97]；ALT：ROC AUC 0.73 [95% CI 0.67至0.79]；LDH：ROC AUC 0.74 [95% CI 0.68至0.81]）。入院48小时内或入院至分娩或结局时肝功能测试结果的变化以及变化率均无预测性。
我们发现肝功能测试结果异常与不良孕产妇结局风险增加相关。AST、ALT和LDH水平对这些结局有一定的预测性。
