Zhao Yang, Zhang Er-Ke, Li Dan-Hua, Zhou Yu-Jing, Jiang Hui, Jia Xiao-Chao, Qin Chuan
Department of Medical Ultrasound, Jinshan Hospital of Fudan University, Shanghai, China.
Department of Medical Ultrasound, The Central Hospital of Karamay, Karamay, China.
Front Med (Lausanne). 2024 Dec 23;11:1506340. doi: 10.3389/fmed.2024.1506340. eCollection 2024.
Acute fatty liver of pregnancy (AFLP) is a severe complication that can occur in the third trimester or immediately postpartum, characterized by rapid hepatic failure. This study aims to explore the changes in portal vein blood flow velocity and liver function during pregnancy, which may assist in the early diagnosis and management of AFLP.
This longitudinal study was conducted at a tertiary healthcare center with participants recruited from routine antenatal check-ups. The study included healthy women aged 20-40 years with singleton pregnancies. Doppler ultrasonography was used to assess portal vein flow and velocity, complemented by standard laboratory tests to monitor liver function. A nomogram model integrating the clinical features and Doppler ultrasonography parameters was constructed using logistic regression analysis for differentiating AFLP from normal controls.
A total of 135 women were enrolled, divided into control and AFLP groups. The AFLP group demonstrated a significant reduction in portal vein flow velocity and alterations in liver dimensions. Laboratory tests indicated elevated liver enzymes and altered lipid profiles in the AFLP group. Statistical analysis showed that portal vein flow velocity could be a sensitive marker for predicting liver dysfunction in AFLP. The area under the receiver operating characteristic (ROC) curves (AUC) of the nomogram model were 0.88 (95% confidence interval [CI]: 0.82-0.95) with specificity, sensitivity, negative predictive value, and positive predictive value of 67.8, 95.0, 95.0, and 67.8, respectively, in the training cohort and 0.86 (95% CI: 0.72-0.98) and 86.9, 75.0, 83.3, and 80.0 in the test cohort, respectively. The calibration curves demonstrated good agreement between the predicted and observed probability for predicting AFLP.
The study underscores the potential of using portal vein flow velocity as an early diagnostic marker for AFLP in pregnant women. Further research is required to establish standardized diagnostic thresholds for portal vein flow measurements.
妊娠急性脂肪肝（AFLP）是一种严重并发症，可发生于妊娠晚期或产后即刻，其特征为快速进展的肝功能衰竭。本研究旨在探讨孕期门静脉血流速度和肝功能的变化，这可能有助于AFLP的早期诊断和管理。
本纵向研究在一家三级医疗中心进行，研究对象从常规产前检查中招募。研究纳入年龄在20 - 40岁的单胎妊娠健康女性。采用多普勒超声评估门静脉血流和速度，并辅以标准实验室检查监测肝功能。使用逻辑回归分析构建一个整合临床特征和多普勒超声参数的列线图模型，用于区分AFLP与正常对照。
共纳入135名女性，分为对照组和AFLP组。AFLP组门静脉血流速度显著降低，肝脏尺寸也有改变。实验室检查表明AFLP组肝酶升高，血脂谱改变。统计分析显示门静脉血流速度可能是预测AFLP肝功能障碍的敏感指标。列线图模型在训练队列中的受试者工作特征（ROC）曲线下面积（AUC）为0.88（95%置信区间[CI]：0.82 - 0.95），特异性、敏感性、阴性预测值和阳性预测值分别为67.8、95.0、95.0和67.8；在测试队列中分别为0.86（95%CI：0.72 - 0.98）和86.9、75.0、83.3和80.0。校准曲线显示预测AFLP的预测概率与观察概率之间具有良好一致性。
该研究强调了将门静脉血流速度作为孕妇AFLP早期诊断标志物的潜力。需要进一步研究以确定门静脉血流测量的标准化诊断阈值。
