妊娠早期孕妇肝功能异常病因分析及其临床结局评价

肝脏 ›› 2025, Vol. 30 ›› Issue (3): 395-397.

妊娠早期孕妇肝功能异常病因分析及其临床结局评价

张俊, 张阳, 张金伟

214023 江苏南京医科大学附属无锡人民医院妇产科

收稿日期:2024-10-25 出版日期:2025-03-31 发布日期:2025-06-16
通讯作者: 张金伟
基金资助:
无锡市妇幼健康科研项目重大项目(FYKY202301)

Etiological analysis and clinical outcome evaluation of abnormal liver function in pregnant women in early pregnancy

ZHANG Jun, ZHANG Yang, ZHANG Jin-wei

Department of Obstetrics and Gynecology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Jiangsu 214023, China

Received:2024-10-25 Online:2025-03-31 Published:2025-06-16
Contact: ZHANG Jin-wei

摘要/Abstract

摘要： 目的分析妊娠早期孕妇肝功能异常病因,并评价其临床结局。方法纳入2022年1月—2024年12月期间南京医科大学附属无锡人民医院收治的妊娠早期肝功能异常患者104例,分析病因并比较各病情治疗前后肝功能指标变化,对其进行免疫学检测、肝穿刺活检病例并作出分析,最后评价临床转归。结果经过病史采集,相关检验检查项目完善,必要时予以肝活检检查,104例妊娠早期肝功能异常患者病因包括CHB 27例(26.0%)、NAFLD 23例(22.1%)、DILI 20例(19.2%)、ICP 14例(13.5%)、AIH 11例(10.6%)、妊娠剧吐4例(3.8%)、PBC 3例(2.9%)及原因未明2例(1.9%)。与CHB、NAFLD、AIH相比,DILI、ICP治疗前ALT、AST显著升高(P<0.05);与其他组相比,ICP治疗前TBil显著升高(P<0.05);治疗后,各病因患者ALT、AST及TBil比较差异无统计学意义(P>0.05)。NAFLD、DILI血清IgM、IgG处于正常范围;DILI ANA阳性8例(40.0%);AIH以IgG升高为主,AMA和/或AMA- M2阳性9例(81.8%)。104例患者均接受保肝处理,同时治疗原发病。2周后复查肝功能,其中73例(70.2%)肝功能正常;27例(26.0%)肝功能好转,继续保肝处理,4～6周后随访逐步恢复正常。结论妊娠早期肝功能异常的病因复杂多样,包括感染性、代谢性、药物性、自身免疫性和妊娠相关特殊肝病等多种类型。各类病因在临床表现、实验室检查和病理特征方面具有一定的差异性。

关键词: 肝功能异常, 妊娠早期, 肝穿刺

Abstract: Objective To analyze the causes of abnormal liver function in pregnant women in early pregnancy and evaluate its clinical outcome.Methods 104 cases of abnormal liver function in early pregnancy admitted to our hospital between January 2022 and December 2024 were included. The causes were analyzed and the changes in liver function indexes before and after treatment were compared. The cases of immunological detection and liver biopsy were analyzed, and the clinical outcome was finally evaluated.Results Through the collection of medical history, the relevant examinations were completed, and liver biopsy was performed if necessary. The causes of 104 patients with abnormal liver function in early pregnancy included 27 cases of CHB (26.0%), 23 cases of NAFLD (22.1%), 20 cases of DILI (19.2%), 14 cases of ICP (13.5%) and 11 cases of AIH (10.6%). Compared with CHB, NAFLD and AIH, after treatment in DILI and ICP, ALT, AST were significantly higher (P<0.05). Compared with other groups, TBil increased significantly before ICP treatment (P<0.05). After treatment, there was no significant difference in ALT, AST and TBil among patients with various causes (P>0.05). NAFLD and DILI serum IgM and IgG were in the normal range; DILI ANA was positive in 8 cases (40.0%); The majority of AIH was IgG, and 9 cases (81.8%) were positive for AMA and/or AMA- M2. 104 patients were treated with liver protection and primary disease. After 2 weeks, liver function was rechecked, and 73 cases (70.2%) had normal liver function. 27 cases (26.0%) had improved liver function, and continued to be treated with liver protection. After 4-6 weeks of follow-up, they gradually returned to normal.Conclusion The causes of abnormal liver function in early pregnancy are complex and diverse, including infectious, metabolic, drug-induced, autoimmune and pregnancy-related special liver diseases. There are some differences in clinical manifestations, laboratory tests and pathological features among various etiologies.

Key words: Abnormal liver function, Early pregnancy, Liver puncture

张俊, 张阳, 张金伟. 妊娠早期孕妇肝功能异常病因分析及其临床结局评价[J]. 肝脏, 2025, 30(3): 395-397.

ZHANG Jun, ZHANG Yang, ZHANG Jin-wei. Etiological analysis and clinical outcome evaluation of abnormal liver function in pregnant women in early pregnancy[J]. Chinese Hepatolgy, 2025, 30(3): 395-397.

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