Deli Tamás, Tóth Judit, Csépes-Ruzicska Lea, Török Olga, Krasznai Zoárd Tibor, Mosolygó-Lukács Ágnes, Kappelmayer János, Lampé Rudolf
1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Nagyerdei krt. 98., 4032 Magyarország.
2 Debreceni Egyetem, Általános Orvostudományi Kar, Laboratóriumi Medicina Intézet Debrecen Magyarország.
Orv Hetil. 2022 May 15;163(20):797-805. doi: 10.1556/650.2022.32474.
Introduction: Intrahepatic cholestasis of pregnancy complicates 1% of pregnancies. It increases the risk of severe fetal complications significantly, including preterm delivery and stillbirth. Objective: To summarize our experience with serum total bile acid level measurement that has recently become available for clinical routine in Hungary, and to present the way of gestational cholestasis care at our university. Patients and method: In a retrospective case series, we analyse the data of 12 patients suffering from severe cholestasis of pregnancy treated between September 2020 and September 2021 at the Department of Obstetrics and Gynecology, University of Debrecen. We also determine the statistical correlation between bile acid, transaminase and bilirubin levels in severe cholestasis. Results: 1258 serum samples of 758 patients were measured. 5 of them (0.7% of all cases, 6.4% of cholestasis cases) had severe (total bile acid 40-99 mu mol/L), 7 (0.9% of all cases and 9.0% of cholestasis cases) had very severe (total bile acid >= 100 mu mol/L) disease. The average age of the 12 cases was 30.6 (21-43) years, 7 of them were primigravid. 5 of the patients had a predisposing disease in their history. 6/12 patients received ursodeoxycholic acid treatment, resulting in significant decrease in the bile acid concentrations. Bile acid and GOT (R-2 = 0,14) and bile acid and GPT (R-2 = 0,17) correlations were found to be week in severe cholestasis (n = 45). Postpartum bile acid levels showed rapid improvement. So far, 11 of the patients have delivered and 13 neonates were born, 2/12 were multiple pregnancies. Average gestational age at delivery was 37 (33-40) weeks. 3/11 (27%) were preterm deliveries. 7/8 (88%) of term deliveries were induced. Elective cesarean delivery was not indicated in any of the cases, and in only 2/11 (18%) of the cases did emergency cesarean sections become necessary during labour. No stillbirth occurred. Conclusion: Serum total bile acid measurement is an effective tool in the diagnosis and follow-up of intrahepatic cholestasis of pregnancy, and is inevitable for the protocoll-based obstetrical management of patients. We also present the local protocol of our Department for the management of obstetrical cholestasis.
妊娠期肝内胆汁淤积症在1%的妊娠中会出现并发症。它显著增加了严重胎儿并发症的风险，包括早产和死产。目的：总结我们在匈牙利最近已可用于临床常规的血清总胆汁酸水平测量方面的经验，并介绍我校妊娠期胆汁淤积症的护理方法。患者与方法：在一项回顾性病例系列研究中，我们分析了2020年9月至2021年9月在德布勒森大学妇产科接受治疗的12例重度妊娠期胆汁淤积症患者的数据。我们还确定了重度胆汁淤积症中胆汁酸、转氨酶和胆红素水平之间的统计相关性。结果：对758例患者的1258份血清样本进行了测量。其中5例（占所有病例的0.7%，胆汁淤积症病例的6.4%）患有重度（总胆汁酸40 - 99 μmol/L），7例（占所有病例的0.9%，胆汁淤积症病例的9.0%）患有极重度（总胆汁酸≥100 μmol/L）疾病。12例患者的平均年龄为30.6（21 - 43）岁，其中7例为初产妇。5例患者既往有易感疾病史。12例患者中有6例接受了熊去氧胆酸治疗，导致胆汁酸浓度显著降低。在重度胆汁淤积症（n = 45）中发现胆汁酸与谷草转氨酶（R² = 0.14）以及胆汁酸与谷丙转氨酶（R² = 0.17）的相关性较弱。产后胆汁酸水平迅速改善。到目前为止，11例患者已分娩，共出生13例新生儿，12例中有2例为多胎妊娠。分娩时的平均孕周为37（33 - 40）周。3/11（27%）为早产。8例足月分娩中有7例（88%）为引产。所有病例均未进行择期剖宫产，仅11例中有2例（18%）在分娩期间需要进行急诊剖宫产。未发生死产。结论：血清总胆汁酸测量是妊娠期肝内胆汁淤积症诊断和随访的有效工具，对于基于方案的患者产科管理是必不可少的。我们还介绍了我们科室妊娠期胆汁淤积症管理的本地方案。
