Department of Obstetrics and Gynecology, İstanbul Education and Research Hospital, Kasap İlyas Mah. Org. Abdurrahman Nafiz Gürman Cd, 34098, Fatih, Istanbul, Turkey.
Arch Gynecol Obstet. 2024 Nov;310(5):2531-2539. doi: 10.1007/s00404-024-07736-3. Epub 2024 Oct 1.
The aim of this study is to determine the albumin/bilirubin ratio index and the aspartate aminotransferase (AST)/alanine aminotransferase ratio (ALT) index in patients diagnosed with cholestasis during pregnancy, and to demonstrate their correlation with liver damage. Additionally, potential strategies to prevent liver damage will be elucidated.
Our study is a retrospective study. A total of 4019 pregnant women aged between 18 and 40 years, presenting with itching complaints at 32-36 weeks of gestation, were screened at the Department of Obstetrics and Gynecology, Istanbul Training and Research Hospital of Health Sciences University between January 1, 2018, and December 31, 2023. Among them, 104 pregnant women without any other accompanying diseases were diagnosed with Gestational Cholestasis. Among the 104 diagnosed women, 78 met the inclusion criteria and were included in the study. Twenty-six women were excluded from the study due to missing albumin and total bilirubin values or due to blood samples being taken at different times. The serum albumin/bilirubin ratio index and the alanine aminotransferase/aspartate aminotransferase ratio index were calculated and statistically compared between pregnant women diagnosed with cholestasis and healthy pregnant women at the same gestational week.
We found that AST, ALT, albumin, and total bilirubin levels were significantly higher in pregnant women diagnosed with cholestasis compared to the control group (p < 0.05). The AST/ALT index in the case group was significantly lower compared to the control group. However, there were no significant differences found between the case and control groups regarding the albumin/total bilirubin index and ALBI grade. When comparing ALBI grades in cases, no significant differences were found in terms of patients' age, gestational week, AST, ALT, and AST/ALT index. When compared according to ALBI grades, the albumin level was higher in patients with ALBI grade I compared to grade II, and in patients with grade II compared to grade III. The total bilirubin level was significantly higher in patients with ALBI grade III compared to grades I and II, but there was no significant difference between grades I and II. No significant differences were found among the groups separated according to ALBI grades when FBA values were compared.
In this study, the negative correlation between lower AST/ALT ratio and FBA values in patients with severe cholestasis suggests the need for careful consideration regarding future liver damage. The lack of difference in ALBI score between the case and control groups, as well as the absence of correlation with FBA values, indicates the necessity to evaluate ALBI score based on patients' long-term prognosis.
本研究旨在确定妊娠期胆汁淤积症患者的白蛋白/胆红素比值指数和天冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT）比值指数，并探讨其与肝损伤的相关性。此外，还将阐明潜在的肝损伤预防策略。
本研究为回顾性研究。2018 年 1 月 1 日至 2023 年 12 月 31 日期间，伊斯坦布尔培训与研究医院妇产科共筛查了 18-40 岁、妊娠 32-36 周时出现瘙痒症状的 4019 名孕妇，其中 104 名孕妇被诊断为妊娠胆汁淤积症，无其他伴随疾病。在这 104 名诊断为妊娠胆汁淤积症的孕妇中，有 78 名符合纳入标准，并被纳入研究。26 名孕妇因白蛋白和总胆红素值缺失或因血液样本采集时间不同而被排除在研究之外。计算并比较了妊娠期胆汁淤积症孕妇与同期健康孕妇的血清白蛋白/胆红素比值指数和丙氨酸氨基转移酶/天冬氨酸氨基转移酶比值指数。
与对照组相比，妊娠期胆汁淤积症孕妇的 AST、ALT、白蛋白和总胆红素水平显著升高（p<0.05）。病例组的 AST/ALT 指数明显低于对照组。然而，病例组和对照组在白蛋白/总胆红素指数和 ALBI 分级方面没有显著差异。在病例组中比较 ALBI 分级时，患者年龄、孕周、AST、ALT 和 AST/ALT 指数无显著差异。按 ALBI 分级比较时，ALBI 分级 I 患者的白蛋白水平高于分级 II，ALBI 分级 II 患者的白蛋白水平高于分级 III。ALBI 分级 III 患者的总胆红素水平明显高于分级 I 和 II，但分级 I 和 II 之间无显著差异。根据 ALBI 分级分组比较 FBA 值时，各组间无显著差异。
本研究中，严重胆汁淤积症患者 AST/ALT 比值较低与 FBA 值之间呈负相关，提示需要谨慎考虑未来的肝损伤。病例组和对照组的 ALBI 评分无差异，与 FBA 值也无相关性，表明需要根据患者的长期预后评估 ALBI 评分。
