Division of Women and Children's Health, King's College London, London, UK.
Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
BJOG. 2019 Dec;126(13):1633-1640. doi: 10.1111/1471-0528.15926. Epub 2019 Sep 26.
To evaluate enzymatic total serum bile acid quantification as a monitoring strategy for women with intrahepatic cholestasis of pregnancy (ICP) treated with ursodeoxycholic acid (UDCA).
Cohort.
One UK university hospital.
29 ICP cases treated with UDCA.
Serial samples were collected prospectively throughout gestation. Total serum bile acids were measured enzymatically and individual bile acids by high-performance liquid chromatography-tandem mass spectrometry. Data were log-transformed and analysed with random effects generalised least square regression.
The relationship between enzymatic total bile acid measurements and individual bile acid concentrations after UDCA treatment.
In untreated women, cholic acid was the principal bile acid (51%) and UDCA concentrations were <0.5%, whereas UDCA constituted 60% (IQR 43-69) of serum bile acids following treatment and cholic acid fell to <20%. Changes in the total bile acid measurement reflected similar alterations in the concentrations of the pathologically elevated bile acids, e.g. a two-fold increase in enzymatic total bile acids is accompanied by approximately a two-fold increase in cholic acid and chenodeoxycholic acid at most UDCA doses (P < 0.001). Most of the effects of UDCA on cholic acid occur in the first week of treatment (60% relative reduction, P = 0.025, 95% CI 0.2-0.9, from 10 micromol/l (4.7-17.6) to 3.5 micromol/l (1.4-7.5).
Ursodeoxycholic acid becomes the main component of the bile acid measurement after treatment. Enzymatic total bile acid assays are good predictors of both cholic acid and chenodeoxycholic acid, the primary bile acids that are raised prior to treatment.
Ursodeoxycholic acid constitutes approximately 60% of the bile acid measurement and reduces pathological cholic acid in treated women.
评估酶法总血清胆汁酸定量检测作为熊去氧胆酸（UDCA）治疗妊娠肝内胆汁淤积症（ICP）女性的监测策略。
队列研究。
英国一所大学医院。
29 例接受 UDCA 治疗的 ICP 病例。
前瞻性采集整个孕期的系列样本。酶法检测总血清胆汁酸，高效液相色谱-串联质谱法检测各胆汁酸。数据经对数转换后，采用随机效应广义最小二乘回归进行分析。
UDCA 治疗后酶法总胆汁酸检测与各胆汁酸浓度的关系。
未治疗女性中，胆酸为主要胆汁酸（51%），UDCA 浓度<0.5%，而治疗后 UDCA 构成血清胆汁酸的 60%（IQR 43-69），胆酸降至<20%。总胆汁酸检测的变化反映了病理性升高的胆汁酸浓度的类似变化，例如酶法总胆汁酸增加两倍，同时胆酸和鹅脱氧胆酸增加约两倍（大多数 UDCA 剂量，P<0.001）。UDCA 对胆酸的大部分作用发生在治疗的第一周（相对减少 60%，P=0.025，95%CI 0.2-0.9，从 10μmol/L（4.7-17.6）降至 3.5μmol/L（1.4-7.5）。
治疗后 UDCA 成为胆汁酸检测的主要成分。酶法总胆汁酸检测能很好地预测治疗前升高的主要胆汁酸胆酸和鹅脱氧胆酸。
研究结果表明，熊去氧胆酸治疗后成为胆汁酸检测的主要成分，降低了治疗女性的病理性胆酸。
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