利用酶法总胆汁酸测定作为以熊去氧胆酸治疗妊娠期肝内胆汁淤积症孕妇的监测策略：一项队列研究
【目的】
评价以酶法测定总胆汁酸水平作为熊去氧胆酸（ursodeoxycholicacid，UDCA）治疗妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）的监测策略。
【设计】
队列研究。
【处所与人群】
英国一家大学医院。
【主要测量结局】
UDCA治疗后酶法测定总胆汁酸和单个胆汁酸浓度的关系。
【方法】
孕期前瞻性地动态搜集患者样本。利用酶法测定总胆汁酸和高效液相色谱法测定单个胆汁酸。
【结果】
未治疗的患者中，胆汁酸主要由胆酸组成（51%），UDCA水平＜0.5%，而当治疗后UCDA占60%（IQR 43-69）血清胆汁酸，胆酸水平降至＜20%。总胆汁酸水平的改变反映了相似地病理性胆汁酸升高，例如酶法测定总胆汁酸升高2倍，在大多数UCDA剂量下胆酸和鹅去氧胆酸同样约上升2倍（P＜0.001）。大部分UDCA对胆酸的作用出现在第一周治疗时[60%相对降低，p=0.025，95%CI 0.2-0.9，由10nmol/L（4.7-17.6）至3.5nmol/L（1.4-7.5）].
【结论】
ICP治疗后，熊去氧胆酸成为胆汁酸主要成分。酶法测定总胆汁酸是反映胆酸和鹅去氧胆酸的良好指标，后两者是治疗前胆汁酸上升的主要成分。
【BJOG精选摘要】亚洲沙尘与胎盘早剥的相关性。日本一项病例交叉研究发现，沙尘可能是胎盘早剥的诱因。
Enzymatic quantification of total serum bile acids as a monitoringstrategy for women with intrahepatic cholestasis of pregnancy receivingursodeoxycholic acid treatment: a cohort study
LBManna COvadia ALövgren‐Sandblom JChambers SBegum PSeed IWalker LCChappellH‐UMarschall CWilliamson
First published: 04 September 2019
https://doi.org/10.1111/1471-0528.15926
【Objective】
To evaluate enzymatic total serum bile acidquantification as a monitoring strategy for women with intrahepatic cholestasisof pregnancy (ICP) treated with ursodeoxycholic acid (UDCA).
【Design】
Cohort.
【Setting】
One UK university hospital.【Population】
29 ICP cases treated with UDCA.29名UDCA治疗的ICP患者。
【Methods】
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.
【Results】
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).
【Conclusion】
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.
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（编译 王伟琳）
