与硫唑嘌呤相关的妊娠肝内胆汁淤积症：病例系列。
Intrahepatic cholestasis of pregnancy associated with azathioprine: A case series.
机构信息
Obstetrics and Gynecology Department, Armand-Trousseau Hospital, Paris, France.
Obstetrics and Gynecology Department, Armand-Trousseau Hospital, Paris, France; Sorbonne Université, Paris, France.
出版信息
J Gynecol Obstet Hum Reprod. 2021 Apr;50(4):102083. doi: 10.1016/j.jogoh.2021.102083. Epub 2021 Feb 15.
BACKGROUND
Intrahepatic cholestasis of pregnancy (ICP) is characterised by otherwise unexplained maternal pruritus, increased serum bile acid concentration over 10 μmol/L and spontaneous relief of symptoms and liver abnormalities after delivery. It occurs most frequently during the third trimester and is usually not induced by medication. Besides, azathioprine is recommended as first-line immunosuppressant in patients with steroid-dependent inflammatory bowel disease and is allowed during pregnancy, in order to stabilize maternal disease.
METHODS
We reviewed all cases of ICP between 2010 and 2018 in two French perinatal centers.
RESULTS
We encountered eight pregnancies complicated by atypical ICP among patients treated with azathioprine. ICP associated with azathioprine appears to be biologically more severe and to occur earlier than "standard" ICP. Furthermore, clinical and biochemical abnormalities related to ICP disappear when azathioprine is discontinued. Azathioprine safety should be reconsidered and practitioners advised to discuss discontinuing this drug as soon as ICP diagnosis is established.
背景
妊娠肝内胆汁淤积症（ICP）的特征是无其他原因的孕妇瘙痒、血清胆汁酸浓度超过 10μmol/L，分娩后症状和肝脏异常自行缓解。它最常发生在妊娠晚期，通常不是药物引起的。此外，对于依赖激素的炎症性肠病患者，硫唑嘌呤被推荐为一线免疫抑制剂，且可在怀孕期间使用，以稳定母体疾病。
方法
我们回顾了 2010 年至 2018 年在法国两家围产期中心的所有 ICP 病例。
结果
我们发现有 8 例在使用硫唑嘌呤治疗的患者中出现非典型 ICP。与硫唑嘌呤相关的 ICP 在生物学上似乎更为严重，且比“标准”ICP 更早发生。此外，当停用硫唑嘌呤时，与 ICP 相关的临床和生化异常会消失。应重新考虑硫唑嘌呤的安全性，并建议临床医生在诊断为 ICP 后尽快停止使用该药。
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