妊娠期药物性肝损伤病因分析、临床表现及妊娠结局研究

摘要/Abstract

摘要： 目的探讨妊娠期药物性肝损伤病因分析、临床表现及妊娠结局。方法选取2020年1月至2024年10月本院收治的98例妊娠期合并药物性肝损伤患者为观察组,另选取同时间段在本院接受检查的102例妊娠期肝功能正常产妇作为对照组。收集两组的临床资料,分析观察组发生药物性肝损伤的病因,对比两组肝功能指标和妊娠结局。结果观察组丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、总胆汁酸(TBA)水平分别为(152.11±20.47)U/ L、(138.48±14.58)U/ L、(30.45±4.26)μmol / L、(20.68±3.17)μmol / L,均高于对照组,而白蛋白(Alb)低于对照组[(30.15±4.18)vs(39.41±4.56)g/ L] ,差异有统计学意义(P<0.05)。观察组98例妊娠期合并药物性肝损伤患者中,36例(36.73%)合并病毒性肝炎,甲型肝炎6例、乙型肝炎20例、丙型肝炎4例、巨细胞病毒感染3例、EB病毒感染3例;16例(16.33%)合并妊娠高血压;24例(24.49%)妊娠期肝内胆汁淤积症;12例(12.24%)合并甲状腺功能亢进,服用丙硫氧嘧啶;19例(19.39%)合并抑郁症,服用舍曲林;18例(18.37%)自行服用中草药或相关保健品;10例(10.20%)服用抗生素,观察组中合并病毒性肝炎、妊娠高血压、妊娠期肝内胆汁淤积症、甲状腺功能亢进、抑郁症、服用中草药、服用抗生素及不良妊娠结局的占比均高于对照组(P<0.05)。结论妊娠期药物性肝损伤与多种病因密切相关,导致患者肝功能异常,并增加不良妊娠结局风险。

关键词: 妊娠期, 药物性肝损伤, 妊娠结局, 风险因素分析

Abstract: Objective To explore the etiology, clinical manifestations, and pregnancy outcomes of drug-induced liver injury (DILI) during pregnancy. Methods A total of 98 pregnant female patients diagnosed with drug-induced liver injury hospitalized at our institution from January 2020 to October 2024 were included in the observation group. Meanwhile, 102 pregnant female patients with normal liver function during pregnancy, who underwent examination at our hospital during the same period were chosen as the control group. Clinical data were collected from both groups to analyze the etiology of DILI in the observation group and to compare liver function indicators and pregnancy outcomes between the two groups. Results The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), total bile acid (TBA), and albumin (Alb) in the observation group were (152.11±20.47) U/L, (138.48±14.58) U/L, (30.45±4.26) μmol/L, (20.68±3.17) μmol/L, respectively, higher than those in the control group, while ALB was lower than the control group [(30.15±4.18) vs (39.41±4.56) g/L], with statistical significance (P<0.05). Among the 98 patients in the observation group, 36 cases (36.73%) had concomitant viral hepatitis, including 6 cases of hepatitis A, 20 cases of hepatitis B, 4 cases of hepatitis C, 3 cases of cytomegalovirus infection, and 3 cases of Epstein-Barr virus infection. Additionally, 16 cases (16.33%) had gestational hypertension; 24 cases (24.49%) had intrahepatic cholestasis of pregnancy; 12 cases (12.24%) had hyperthyroidism and were treated with propylthiouracil; 19 cases (19.39%) had depression and were treated with sertraline; 18 cases (18.37%) self-administered herbal medicines or related health supplements; and 10 cases (10.20%) used antibiotics. The proportions of patients with viral hepatitis, gestational hypertension, intrahepatic cholestasis of pregnancy, hyperthyroidism, depression, use of herbal medicines, use of antibiotics, and adverse pregnancy outcomes were higher in the observation group than that in the control group (P<0.05). Conclusion Drug-induced liver injury during pregnancy is strongly linked to various causes, resulting in liver dysfunction and a higher risk of adverse pregnancy outcomes.

Key words: Pregnancy, Drug-induced liver injury, Pregnancy outcomes, Risk factor analysis

王凤梅, 杨悦, 贺亚杰. 妊娠期药物性肝损伤病因分析、临床表现及妊娠结局研究[J]. 肝脏, 2025, 30(6): 852-856.

WANG Feng-mei, YANG Yue, HE Ya-jie. Study on the etiology, clinical manifestations, and pregnancy outcomes of drug-induced liver injury in pregnancy[J]. Chinese Hepatolgy, 2025, 30(6): 852-856.

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