Lawlor Megan L, Critchfield Agatha S
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.
Case Rep Obstet Gynecol. 2016;2016:4963283. doi: 10.1155/2016/4963283. Epub 2016 Nov 6.
Intrahepatic cholestasis of pregnancy (ICP) is a complication of pregnancy resulting in elevation of serum bile acid levels. ICP is often associated with underlying liver disease, including hepatitis C. Bile acids in relationship to the acute infection of hepatitis C virus have not yet been delineated in the literature. A 26-year-old gravida 4 para 2103 with dichorionic, diamniotic twin gestation and history of intravenous drug abuse developed ICP in the setting of acute hepatitis C infection. In addition to clinical symptoms of pruritus and right upper quadrant pain, she developed severe elevation in bile acids, 239 micromol/L, and transaminitis aspartate aminotransferase 1033 U/L, and alanine aminotransferase 448 U/L. She received ursodeoxycholic acid and antenatal testing was performed. Patient delivered vaginally at 33-week gestation following preterm rupture of membranes. Neonates were admitted to NICU and had uncomplicated neonatal courses. In the setting of ICP with significant transaminitis and severe elevation of bile acids, consideration of acute viral hepatitis is important, especially considering the worsening opioid epidemic and concurrent increase in intravenous drug use in the United States. Further study is needed regarding the acute form of HCV infection and its effect on ICP and associated bile acids.
妊娠期肝内胆汁淤积症（ICP）是一种妊娠并发症，可导致血清胆汁酸水平升高。ICP常与包括丙型肝炎在内的潜在肝脏疾病相关。文献中尚未阐明胆汁酸与丙型肝炎病毒急性感染之间的关系。一名26岁、孕4产2103、双绒毛膜双羊膜囊双胎妊娠且有静脉药物滥用史的孕妇，在急性丙型肝炎感染的情况下发生了ICP。除了瘙痒和右上腹疼痛的临床症状外，她的胆汁酸严重升高至239微摩尔/升，转氨酶也升高，天冬氨酸转氨酶为1033单位/升，丙氨酸转氨酶为448单位/升。她接受了熊去氧胆酸治疗并进行了产前检查。患者在孕33周胎膜早破后经阴道分娩。新生儿入住新生儿重症监护病房，新生儿病程顺利。在伴有显著转氨酶升高和胆汁酸严重升高的ICP情况下，考虑急性病毒性肝炎很重要，尤其是考虑到美国日益严重的阿片类药物流行以及静脉药物使用的同时增加。关于丙型肝炎病毒感染的急性形式及其对ICP和相关胆汁酸的影响，还需要进一步研究。
