To evaluate enzymatic total serum bile acidquantification as a monitoring strategy for women with intrahepatic cholestasisof pregnancy (ICP) treated with ursodeoxycholic acid (UDCA).
One UK university hospital.【Population】
29 ICP cases treated with UDCA.29名UDCA治疗的ICP患者。
Serial samples were collected prospectivelythroughout gestation. Total serum bile acids were measured enzymatically andindividual bile acids by high‐performance liquid chromatography‐tandem massspectrometry. Data were log‐transformed and analysed with random effectsgeneralised least square regression.
【Main outcome measures】
The relationship between enzymatic totalbile acid measurements and individual bile acid concentrations after UDCAtreatment.
In untreated women, cholic acid was theprincipal bile acid (51%) and UDCA concentrations were <0.5%, whereas UDCAconstituted 60% (IQR 43–69) of serum bile acids following treatment and cholicacid fell to <20%. Changes in the total bile acid measurement reflectedsimilar alterations in the concentrations of the pathologically elevated bileacids, e.g. a two‐fold increase in enzymatic total bile acids is accompanied byapproximately a two‐fold increase in cholic acid and chenodeoxycholic acid atmost UDCA doses (P < 0.001). Most of the effects of UDCA on cholicacid occur in the first week of treatment (60% relativereduction, P = 0.025, 95% CI 0.2–0.9, from 10 micromol/l(4.7–17.6) to 3.5 micromol/l (1.4–7.5).
Ursodeoxycholic acid becomes the maincomponent of the bile acid measurement after treatment. Enzymatic total bileacid assays are good predictors of both cholic acid and chenodeoxycholic acid,the primary bile acids that are raised prior to treatment.