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Liver stiffness reversibly increases during pregnancy and independently predicts preeclampsia

World Journal of Gastroenterology 2018年第38期24卷 4393-4402页

作者： Franziska J Ammon Anna Kohlhaas Omar Elshaarawy Johannes Mueller Thomas Bruckner Christof Sohn gabriele fluhr Herbert fluhr Sebastian Mueller Department of Obstetrics and Gynecology University of Heidelberg Department of Medicine and Center for Alcohol Research Liver Disease and NutritionSalem Medical CenterUniversity of Heidelberg Institute of Medical Biometry und Informatics University of Heidelberg

AIM To study liver stiffness(LS) during pregnancy and its association with complications during *** In this observational, diagnostic study, 537 pregnant women were prospectively enrolled at the Department of Obstetrics and Gynecology, University hospital Heidelberg and Salem Medical Center. LS was measured using the Fibroscan device(Echosens, Paris) in all women and in 41 cases 24 h after delivery. Clinical and morphological data were recorded and abdominal ultrasound and standard laboratory tests were performed. No complications were observed in 475 women(controls) while preeclampsia and intrahepatic cholestasis of pregnancy(ICP) developed in 22 and 40 women, *** In controls, LS increased significantly from initially 4.5 ± 1.2 kPa in the second trimester to 6.0 ± 2.3 kPa(P < 0.001) in the third trimester. In the third trimester, 41% of women had a LS higher than 6 kPa. Elevated LS in controls was significantly correlated with alkaline phosphatase, leukocytes, gestational age and an increase in body weight and body mass index(BMI). In women with pregnancy complications, LS was significantly higher as compared to controls(P < 0.0001). Moreover, in multivariate analysis, LS was an independent predictor for preeclampsia with an odds ratio of 2.05(1.27-3.31) and a cut-off value of 7.6 kPa. In contrast, ICP could not be predicted by LS. Finally, LS rapidly decreased in all women within 24 h after delivery from 7.2 ± 3.3 kPa down to 4.9 ± 2.2 kPa(P < 0.001).CONCLUSION During pregnancy, LS significantly and reversibly increases in the final trimester of pregnant women without complications. In women with preeclampsia, LS is significantly elevated and an independent noninvasive predictor.

关键词： Pregnancy Transient elastography Liver stiffness Pregnancy complications Hemolysis,elevated liver enzymes and low platelets syndrome Intrahepatic cholestasis of pregnancy Preeclampsia

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