妊娠特有肝病诊治进展

doi:10.3969/j.issn.1672-5069.2021.03.037

实用肝脏病杂志 ›› 2021, Vol. 24 ›› Issue (3): 449-452.doi: 10.3969/j.issn.1672-5069.2021.03.037

妊娠特有肝病诊治进展

朱琳综述, 秦刚审校

226006 江苏省南通市南通大学附属南通第三医院肝病中心

收稿日期:2020-05-25 出版日期:2021-05-30 发布日期:2021-04-30
通讯作者: 秦刚,E-mail: tonygqin@ntu.edu.cn
作者简介:朱琳,女,25岁,硕士研究生。主要从事妊娠期肝病临床研究
基金资助:
江苏省重点病种规范化诊疗研究项目(编号:BE2015655) ;南通市市级临床医学中心研究项目(编号:HS2016002)

Progress in diagnosis and treatment of patients with pregnancy-specific liver disease

Zhu Lin, Qin Gang

Center for Liver Disease Study, Third People's Hospital Affiliated to Nantong University, Nantong 226006, Jiangsu Province, China

Received:2020-05-25 Online:2021-05-30 Published:2021-04-30

摘要/Abstract

摘要： 妊娠期肝脏存在正常的生理变化。尽管如此,妊娠期仍有3%的孕妇出现肝功能异常。妊娠特有肝病是妊娠期肝功能异常的常见原因,在死亡的妊娠期妇女中,约0%～25%孕妇死于妊娠特有性肝病。提高对妊娠特有肝病的认知度和诊治水平尤为重要。本文回顾了近几年有关妊娠特有肝病的研究文献,总结了部分妊娠特有肝病的诊断和治疗进展,供临床医师参考。

关键词: 妊娠特有肝病, 诊断, 治疗

Abstract: There are normal physiological changes in the liver functions during pregnancy. Nevertheless, 3% of pregnant women have liver dysfunction. Pregnancy-specific liver disease is the main cause of abnormal liver function. About 0% to 25% of pregnant women die from pregnancy-specific liver disease. It is particularly important to improve clinician’s recognition of this entity. We reviewed the literature on pregnancy-specific liver disease in recent years and the progress in the pathogenesis, diagnosis and treatment of some pregnancy-specific liver diseases was summarized in this paper, in order to provide reference for its diagnosis and treatment.

Key words: Pregnancy-related liver diseases, Diagnosis, Treatment

朱琳, 秦刚. 妊娠特有肝病诊治进展[J]. 实用肝脏病杂志, 2021, 24(3): 449-452.

Zhu Lin, Qin Gang. Progress in diagnosis and treatment of patients with pregnancy-specific liver disease[J]. Journal of Practical Hepatology, 2021, 24(3): 449-452.

参考文献

[1] 中华医学会妇产科学分会产科学组. 妊娠剧吐的诊断及临床处理专家共识(2015). 中华妇产科杂志, 2015, 50(11): 801-804.
[2]ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. Obstet Gynecol, 2018, 131(1): e15-e30.
[3] Fejzo MS, Trovik J, Grooten IJ, et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers, 2019, 5(1): 62.
[4] ACOG Practice Bulletin No. 153: Nausea and Vomiting of Pregnancy. Obstet Gynecol, 2015, 126(3): e12-24.
[5] Niemeijer MN, Grooten IJ, Vos N, et al. Diagnostic markers for hyperemesis gravidarum: a systematic review and metaanalysis. Am J Obstet Gynecol, 2014, 211(2): 150 e151-115.
[6] Fejzo MS, Sazonova OV, Sathirapongsasuti JF, et al. Placenta and appetite genes GDF15 and IGFBP7 are associated with hyperemesis gravidarum. Nat Commun, 2018, 9(1): 1178.
[7] Hsu JY, Crawley S, Chen M, et al. Non-homeostatic body weight regulation through a brainstem-restricted receptor for GDF15. Nature, 2017, 550(7675): 255-259.
[8] Fejzo MS, Fasching PA, Schneider MO, et al. Analysis of GDF15 and IGFBP7 in Hyperemesis Gravidarum Support Causality. Geburtshilfe Frauenheilkd, 2019, 79(4): 382-388.
[9] 中华医学会妇产科学分会产科学组. 妊娠期肝内胆汁淤积症诊疗指南(2015). 中华妇产科杂志, 2015, 50(7): 481-485.
[10] Manzotti C, Casazza G, Stimac T, et al. Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy. Cochrane Database Syst Rev, 2019, 7: CD012546.
[11] Ma L, Zhang XQ, Zhou DX, et al. Feasibility of urinary microRNA profiling detection in intrahepatic cholestasis of pregnancy and its potential as a non-invasive biomarker. Sci Rep, 2016, 6: 31535.
[12] Jiang PY, Zhu XJ, Jiang RA, et al. MicroRNAs derived from urinary exosomes act as novel biomarkers in the diagnosis of intrahepatic cholestasis of pregnancy. Am J Transl Res, 2019, 11(9): 6249-6261.
[13] Chen Z, Shen Z, Hu L, et al. Identification of Matrix Metalloproteinase-2 and 9 as Biomarker of Intrahepatic Cholestasis of Pregnancy. Ann Hepatol, 2017, 16(2): 291-296.
[14] Chappell LC, Bell JL, Smith A, et al. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet, 2019, 394(10201): 849-860.
[15] Ovadia C, Seed PT, Sklavounos A, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet, 2019, 393(10174): 899-909.
[16] You S, Cui AM, Hashmi SF, et al. Dysregulation of bile acids increases the risk for preterm birth in pregnant women. Nat Commun, 2020, 11(1): 2111.
[17] Puljic A, Kim E, Page J, et al. The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age. Am J Obstet Gynecol, 2015, 212(5): 667 e661-665.
[18] Brown MA, Magee LA, Kenny LC, et al. Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension, 2018, 72(1): 24-43.
[19] 中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2015). 中华产科急救电子杂志, 2015, (4): 206-213.
[20] Zeisler H, Llurba E, Chantraine F, et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med, 2016, 374(1): 13-22.
[21] Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J, 2018, 39(34): 3165-3241.
[22] Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet, 2019, 145 Suppl 1: 1-33.
[23] Rolnik DL, Wright D, Poon LC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med, 2017, 377(7): 613-622.
[24] ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol, 2019, 133(1): e1-e25.
[25] Sasmaz MI, Ayvaz MA, Dulger AC, et al. Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome. Am J Emerg Med, 2019.
[26] Schnabel A, Blois SM, Meint P, et al. Elevated systemic galectin-1 levels characterize HELLP syndrome. J Reprod Immunol, 2016, 114: 38-43.
[27] Munoz-Hernandez R, Medrano-Campillo P, Miranda ML, et al. Total and Fetal Circulating Cell-Free DNA, Angiogenic, and Antiangiogenic Factors in Preeclampsia and HELLP Syndrome. Am J Hypertens, 2017, 30(7): 673-682.
[28] Woudstra DM, Chandra S, Hofmeyr GJ, et al. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev, 2010, (9): CD008148.
[29] Goel A, Ramakrishna B, Zachariah U, et al. How accurate are the Swansea criteria to diagnose acute fatty liver of pregnancy in predicting hepatic microvesicular steatosis? Gut, 2011, 60(1): 138-139; author reply 139-140.
[30] Morikawa M, Kawabata K, Kato-Hirayama E, et al. Liver dysfunction in women with pregnancy-induced antithrombin deficiency. J Obstet Gynaecol Res, 2017, 43(2): 257-264.

妊娠特有肝病诊治进展

Progress in diagnosis and treatment of patients with pregnancy-specific liver disease

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