巯嘌呤和硫唑嘌呤致妊娠期肝内胆汁淤积症：病例报告及文献复习。
Azathioprine and 6-mercaptopurine-induced intrahepatic cholestasis of pregnancy: Case report and review of the literature.
机构信息
Department of Obstetrics & Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel; Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel.
出版信息
Taiwan J Obstet Gynecol. 2023 Sep;62(5):761-764. doi: 10.1016/j.tjog.2023.07.023.
OBJECTIVE
Azathioprine, a prodrug of 6-mercaptopurine (6-MP), is used in the treatment of inflammatory bowel disease and may be continued during pregnancy. Acute cholestatic liver injury has been reported to occur with azathioprine. We aimed to examine azathioprine related cholestasis effect on pregnancy complications and outcome.
CASE REPORT
We present a unique case of 6-MP-induced severe intrahepatic cholestasis of pregnancy (ICP) that required meticulous combined therapy including plasma exchange. The symptoms resolved following 6-MP withdrawal. A literature review revealed 11 pregnancies complicated by early-induced severe ICP among women treated with azathioprine or 6-MP.
CONCLUSION
We recommend weekly bile acid level tests for pregnant women treated with azathioprine or 6-MP, beginning early in the second trimester of pregnancy, and the prompt discontinuation of treatment upon establishment of an ICP diagnosis.
目的
巯嘌呤（6-MP）的前体药物硫唑嘌呤用于治疗炎症性肠病，并且可能在怀孕期间继续使用。据报道，硫唑嘌呤可引起急性胆汁淤积性肝损伤。我们旨在研究硫唑嘌呤相关的胆汁淤积对妊娠并发症和结局的影响。
病例报告
我们介绍了一例独特的 6-MP 诱导的严重妊娠肝内胆汁淤积症（ICP）病例，需要精心联合治疗，包括血浆置换。停用 6-MP 后症状得到缓解。文献回顾显示，在接受硫唑嘌呤或 6-MP 治疗的孕妇中，有 11 例妊娠合并早发性严重 ICP。
结论
我们建议在妊娠中期开始，每周对接受硫唑嘌呤或 6-MP 治疗的孕妇进行胆汁酸水平检测，并在确诊 ICP 后立即停止治疗。
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