Liver stiffness in pregnant women with intrahepatic cholestasis of pregnancy:A case control study

作     者：Juliane Nees Franziska J Ammon Johannes Mueller Herbert Fluhr Sebastian Mueller 

作者机构：Department of Gynecology and ObstetricsUniversity Hospital HeidelbergHeidelberg 69120Germany Center for Alcohol ResearchUniversity Hospital HeidelbergHeidelberg 69120Germany Division of ObstetricsDepartment of Obstetrics and GynecologyMedical University of GrazGraz 8036Austria 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2023年第15卷第7期

页      面：904-913页

学科分类：1002[医学-临床医学] 100211[医学-妇产科学] 10[医学] 

基　　金：Medizinischen Fakultät Heidelberg  Universität Heidelberg 

主　　题：Intrahepatic cholestasis of pregnancy Transient elastography Bile acids Liver stiffness High risk pregnancy 

摘      要：BACKGROUND Intrahepatic cholestasis of pregnancy(ICP)is a rare but severe complication for both the mother and the unborn *** diagnosis is primarily based on elevated serum levels of bile *** a large ICP cohort,we here study in detail liver stiffness(LS)using transient elastography(TE),now widely used to noninvasively screen for liver cirrhosis within *** To specifically explore LS in a large cohort of women with ICP compared to a control group with uncomplicated *** LS and hepatic steatosis marker controlled attenuation parameter(CAP)were measured in 100 pregnant women with ICP using TE(Fibroscan,Echosens,Paris,France)between 2010 and *** 17 cases,LS could be measured postpartum.450 women before and 38 women after delivery with uncomplicated pregnancy served as control *** laboratory,levels of bile acids and apoptosis marker caspase-cleaved cytokeratin 18 fragment(M30)were also *** Women with ICP had significantly elevated transaminases but normal gammaglutamyl transferase(GGT).Mean LS was significantly increased at 7.3±3.0 kPa compared to the control group at 6.2±2.3 kPa(P0.0001).Postpartum LS decreased significantly in both groups but was still higher in ICP(5.8±1.7 kPa vs 4.2±0.9 kPa,P0.0001),*** ICP,LS was highly significantly correlated with levels of bile acids and M30 but not *** correlation was seen with GGT that even increased significantly after delivery in the ICP *** acids were mostly correlated with the liver apoptosis marker M30,LS and levels of alanine aminotransferase,aspartate aminotransferase,and *** multivariate analysis,LS remained the sole parameter that was independently associated with elevated bile *** In conclusion,LS is significantly elevated in ICP which is most likely due to toxic bile acid accumulation and hepatocyte *** association with conventional laboratory markers,LS provides additional non-invasive informati