妊娠期肝病的临床特征及研究进展

段兴平; 王燕; 黄常友; 郑会贤; 罗一; 覃正文; 任郁

doi:10.3969/j.issn.1001-5256.2020.06.048

妊娠期肝病的临床特征及研究进展

DOI: 10.3969/j.issn.1001-5256.2020.06.048

1. 自贡市妇幼保健院药剂科
2. 自贡市妇幼保健院新生儿科
3. 自贡市妇幼保健院妇产科

基金项目:

自贡市科技局重点科技计划项目(2018SHFZ08)；自贡市哲学社会科学重点研究项目(YDJKY19-09)；

详细信息

中图分类号: R714.255
计量
- 文章访问数: 784
- HTML全文浏览量: 42
- PDF下载量: 195
- 被引次数: 0
出版历程
- 出版日期: 2020-06-20

Research advances in the clinical features of liver disease during pregnancy

Research funding:

摘要

摘要:
严重的妊娠期肝病临床罕见。妊娠期肝病最常见的发病原因为肝功能紊乱,总发病率约为3%。妊娠期肝病主要分为妊娠期特有肝病和非妊娠期特有肝病,即妊娠前已经存在的基础性肝病或妊娠期间偶发肝病。对妊娠期已存在的肝脏疾病及合并的肝脏疾病进行鉴别诊断,有助于改善母婴结局。在临床诊断、选择治疗、干预方式时,应优先考虑对母婴的潜在影响。介绍了妊娠期主要肝脏疾病的概况、发病机制、治疗和妊娠结局的最新研究进展,阐述了患基础性肝病的妊娠风险及应对措施,以指导临床诊疗和患者管理。
- 妊娠并发症 /
- 肝疾病 /
- 诊断 /
- 治疗学
Abstract:
Severe liver disease during pregnancy is uncommon in clinical practice. The most common cause of liver disease during pregnancy is liver dysfunction,with an overall prevalence rate of approximately 3%. Liver disease during pregnancy is classified into the liver diseases directly caused by pregnancy and those co-existing with pregnancy,i. e.,pre-existing liver disease or occasional liver disease during pregnancy. A differential diagnosis of pre-existing and co-existing liver diseases may help to improve maternal and fetal outcome. During clinical diagnosis and selection of treatment and intervention measures,priority should be given to the potential impact on mother and fetus.This article introduces the latest research advances in the general information,pathogenesis,treatment,and pregnancy outcome of major liver diseases during pregnancy and elaborates on the risk of pregnancy and related coping measures for patients with pre-existing liver disease,so as to guide clinical diagnosis and treatment and patient management.
- pregnancy complications /
- liver diseases /
- diagnosis /
- therapeutics

HTML全文

参考文献(43)

[1] WESTBROOK RH,DUSHEIKO G,WILLIAMSON C. Pregnancy and liver disease[J]. J Hepatol,2016,64(4):933-945.

[2] MIKOLASEVIC I,FILIPECKANIZAJ T,JAKOPCIC I,et al. Liver disease during pregnancy:A challenging clinical issue[J].Med Sci Monit,2018,24:4080-4090.

[3] GOEL A,JAMWAL KD,RAMACHANDRAN A,et al. Pregnancy-related liver disorders[J]. J Clin Exp Hepatol,2014,4(2):151-162.

[4] KAMIMURA K,ABE H,KAWAI H,et al. Advances in understanding and treating liver diseases during pregnancy:A review[J]. World J Gastroenterol,2015,21(17):5183-5190.

[5] KELLY C,PERICLEOUS M. Pregnancy-associated liver disease:A curriculum-based review[J]. Frontline Gastroenterol,2018,9(3):170-174.

[6] MISHRA N,MISHRA VN,THAKUR P. Study of abnormal liver function test during pregnancy in a tertiary care hospital in chhattisgarh[J]. J Obstet Gynaecol India,2016,66(Suppl1):129-135.

[7] Italian Association for the Study of the Liver(AISF),Italian Association for the Study of the Liver AISF. AISF position paper on liver disease and pregnancy[J]. Dig Liver Dis,2016,48(2):120-137.

[8] SHEKHAR S,DIDDI G. Liver disease in pregnancy[J]. Taiwan J Obstet Gynecol,2015,54(5):475-482.

[9] LIU J,GHAZIANI TT,WOLF JL. Acute fatty liver disease of pregnancy:Updates in pathogenesis,diagnosis,and management[J]. Am J Gastroenterol,2017,112(6):838-846.

[10] LIU MM,JIA SN,ZHANG Q,et al. Advances in clinical research on liver disease during pregnancy[J]. J Clin Hepatol,2016,32(2):386-389.(in Chinese)刘苗苗，贾胜男，张倩，等．妊娠期肝病的临床研究进展[J]．临床肝胆病杂志，2016,32(2):386-389.

[11] GOMES CF,SOUSA M,LOURENO I,et al. Gastrointestinal diseases during pregnancy:What does the gastroenterologist need to know?[J]. Ann Gastroenterol,2018,31(4):385-394.

[12] FELL DB,DODDS L,JOSEPH KS,et al. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy[J]. Obstet Gynecol,2006,107(2 Pt 1):277-284.

[13] AGMON N,SADE S,PARIENTE G,et al. Hyperemesis gravidarum and adverse pregnancy outcomes[J]. Arch Gynecol Obstet,2019,300(2):347-353.

[14] STICOVA E,JIRSA M,PAWOWSKA J. New insights in genetic cholestasis:From molecular mechanisms to clinical implications[J]. Can J Gastroenterol Hepatol, 2018, 2018:2313675.

[15] LI M,WEI W. Expression of sulfatase 2A1 in intrahepatic cholestasis of pregnancy and its correlation with total bile acid,serum bilirubin,cholelithic acid and alanine aminotransferase[J]. Clin J Med Offic,2019,47(8):835-836,839.(in Chinese)李敏，韦巍．妊娠期肝内胆汁淤积症患者硫酸基转移酶2A1表达及其与总胆汁酸、血清胆红素、石胆酸、谷丙转氨酶相关性研究[J]．临床军医杂志，2019,47(8):835-836,839.

[16] WOOD AM,LIVINGSTON EG,HUGHES BL,et al. Intrahepatic cholestasis of pregnancy:A review of diagnosis and management[J]. Obstet Gynecol Surv,2018,73(2):103-109.

[17] KAN YT,YANG YF. Role of cholestatic liver disease-related genes in intrahepatic cholestasis of pregnancy[J]. J Clin Hepatol,2019,35(7):1439-1443.(in Chinese)阚延婷，杨永峰．胆汁淤积性肝病相关基因及其在妊娠期肝内胆汁淤积症中的作用[J]．临床肝胆病杂志，2019,35(7):1439-1443.

[18] PI TEK K,KURZAWIN'SKA G,MAGIEDA J,et al. The role of ABC transporters'gene polymorphism in the etiology of intrahepatic cholestasis of pregnancy[J]. Ginekol Pol,2018,89(7):393-397.

[19] DAVIT-SPRAUL A,GONZALES E,JACQUEMIN E. NR1H4analysis in patients with progressive familial intrahepatic cholestasis,drug-induced cholestasis or intrahepatic cholestasis of pregnancy unrelated to ATP8B1,ABCB11 and ABCB4 mutations[J]. Clin Res Hepatol Gastroenterol,2012,36(6):569-573.

[20] MENZ·YK T,BATOR M,DERRA A,et al. The role of metabolic disorders in the pathogenesis of intrahepatic cholestasis of pregnancy[J]. Clin Exp Hepatol,2018,4(4):217-223.

[21] CHAPPELL LC,CHAMBERS J,THORNTON JG,et al. Does ursodeoxycholic acid improve perinatal outcomes in women with intrahepatic cholestasis of pregnancy?[J]. BMJ,2018,360:k104.

[22] TRANQUILLI AL,DEKKER G,MAGEE L,et al. The classification,diagnosis and management of the hypertensive disorders of pregnancy:A revised statement from the ISSHP[J]. Pregnancy Hypertens,2014,4(2):97-104.

[23] NADERI S,TSAI SA,KHANDELWAL A. Hypertensive disorders of pregnancy[J]. Curr Atheroscler Rep,2017,19(3):15.

[24] ARMALY Z,JADAON JE,JABBOUR A,et al. Preeclampsia:Novel mechanisms and potential therapeutic approaches[J].Front Physiol,2018,9:973.

[25] NATARAJAN SK,IBDAH JA. Role of 3-hydroxy fatty acidinduced hepatic lipotoxicity in acute fatty liver of pregnancy[J]. Int J Mol Sci,2018,19(1).

[26] KNIGHT M,NELSON-PIERCY C,KURINCZUK JJ,et al. A prospective national study of acute fatty liver of pregnancy in the UK[J]. Gut,2008,57(7):951-956.

[27] AL-HUSBAN N,AL-KURAN O,AL HELOU A. Postpartum acute fatty liver of pregnancy:A case report[J]. J Med Case Rep,2018,12(1):67.

[28] GEENES V,WILLIAMSON C. Liver disease in pregnancy[J].Best Pract Res Clin Obstet Gynaecol,2015,29(5):612-624.

[29] MORTON A,LAURIE J. Physiological changes of pregnancy and the Swansea criteria in diagnosing acute fatty liver of pregnancy[J]. Obstet Med,2018,11(3):126-131.

[30] WIJARNPREECHA K,THONGPRAYOON C,SANGUANKEO A,et al. Hepatitis C infection and intrahepatic cholestasis of pregnancy:A systematic review and meta-analysis[J]. Clin Res Hepatol Gastroenterol,2017,41(1):39-45.

[31] HARTL J,WEHMEYER MH,PISCHKE S. Acute hepatitis E:Two sides of the same coin[J]. Viruses,2016,8(11):e299.

[32] BHATTA AK,KEYAL U,LIU Y,et al. Vertical transmission of herpes simplex virus:An update[J]. J Dtsch Dermatol Ges,2018,16(6):685-692.

[33] TOSONE G,SIMEONE D,SPERA AM,et al. Epidemiology and pathogenesis of fulminant viral hepatitis in pregnant women[J].Minerva Ginecol,2018,70(4):480-486.

[34] GRUS T,LAMBERT L,GRUSOVG,et al. Budd-Chiari syndrome[J]. Prague Med Rep,2017,118(2-3):69-80.

[35] Chinese Society of Infectious Diseases,Chinese Medical Association; Chinese Society of Hepatology,Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(version 2019)[J]. J Clin Hepatol,2019,35(12):2648-2669.(in Chinese)中华医学会感染病学分会，中华医学会肝病学分会．慢性乙型肝炎防治指南(2019年版)[J]．临床肝胆病杂志，2019,35(12):2648-2669.

[36] TATYANA,KUSHNER,MONIKA,et al. Chronic hepatitis B in pregnancy[J]. Clin Liver Dis,2018,12(1):24-28.

[37] MARRERO JA,AHN J,RAJENDER REDDY K,et al. ACG clinical guideline:The diagnosis and management of focal liver lesions[J]. Am J Gastroenterol,2014,109(9):1328-1347; quiz 1348.

[38] HAGSTRM H,HIJER J,MARSCHALL HU,et al. Outcomes of pregnancy in mothers with cirrhosis:A national populationbased cohort study of 1. 3 million pregnancies[J]. Hepatol Commun,2018,2(11):1299-1305.

[39] PFEIFFENBERGER J,BEINHARDT S,GOTTHARDT DN,et al.Pregnancy in Wilson disease-management and outcome[J].Hepatology,2018,67(4):1261-1269.

[40] LLOVET LP,HORTA D,ELIZ MG,et al. Presentation and outcomes of pregnancy in patients with autoimmune hepatitis[J].Clin Gastroenterol Hepatol,2019,17(13):2819-2821.

[41] PRODROMIDOU A,KOSTAKIS ID,MACHAIRAS N,et al. Pregnancy outcomes after liver transplantation:A systematic review[J]. Transplant Proc,2019,51(2):446-449.

[42] LIM TY,GONSALKORALA E,CANNON MD,et al. Successful pregnancy outcomes following liver transplantation is predicted by renal function[J]. Liver Transpl,2018,24(5):606-615.

[43] CHARLTON M,LEVITSKY J,AQEL B,et al. International liver transplantation society consensus statement on immunosuppression in liver transplant recipients[J]. Transplantation,2018,102(5):727-743.

施引文献

资源附件(0)

访问统计