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Дифференциальная диагностика субклинического изолированного повышения трансаминаз печени во второй половине беременности
Дифференциальная диагностика субклинического изолированного повышения трансаминаз печени во второй половине беременности
Успенская Ю.Б., Кузнецова И.В. Дифференциальная диагностика субклинического изолированного повышения трансаминаз печени во второй половине беременности. Гинекология. 2015; 17 (5): 14–18.
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Аннотация
В обзоре рассматривается проблема повышения трансаминаз печени во второй половине беременности. Показатели печеночных аспартатаминотрансферазы (АСТ) и аланинаминотрансферазы (АЛТ) отражают процессы повреждения гепатоцитов, но не являются специфичными для диагностики конкретного заболевания печени. Вместе с тем определение причины изменения показателей печеночных проб в короткие сроки у беременных чрезвычайно важно из-за существенных различий как в прогнозе для матери и плода, так и в тактике лечения и ведения пациенток. Представлен алгоритм дифференциальной диагностики акушерских и неакушерских причин повышения АЛТ и АСТ на поздних сроках гестации.
Ключевые слова: беременность, повышение трансаминаз печени.
Key words: pregnancy, increase of hepatic transaminases.
Ключевые слова: беременность, повышение трансаминаз печени.
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Key words: pregnancy, increase of hepatic transaminases.
Полный текст
Список литературы
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21. Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology 2004; 40: 467–74.
22. Ioannou GN, Boyko EJ, Lee SP. The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999–2002. Am J Gastroenterol 2006; 101: 76–82.
23. Keitel V, Vogt C, Häussinger D, Kubitz R. Combined mutations of canalicular transporter proteins cause severe intrahepatic cholestasis of pregnancy. Gastroenterology 2006; 131 (2): 624–9.
24. Kirwan JP, Hauguel-De Mouzon S et al. TNF-alpha is a predictor of insulin resistance in human pregnancy. Diabetes 2002; 51 (7): 2207–13.
25. Kopylov U, Avidan B, Papageorgiou NP et al. Idiopathic liver function test abnormality in pregnancy is associated with assisted reproduction techniques. Fertil Steril 2013; 99 (2): 377–81.
26. Kuhl C. Etiology and pathogenesis of gestational diabetes. Diabetes Care 1998; 21 (2): 19–26.
27. Laatikainen T, Tulenheimo A. Maternal serum bile acid levels and fetal distress in cholestasis of pregnancy. Int J Gynaecol Obstet 1984; 22: 91–4.
28. Lago F, Dieguez C, Gomez Reino J. The emerging role of adipokines as mediators of inflammation and immune responses. Cytokine Growth Factor Rev 2007; 18: 313–25.
29. Lee RH, Kwok KM, Ingles S et al. Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. Am J Perinatol 2008; 25: 341–5.
30. Nathwani RA, Pais S, Reynolds TB et al. Serum alanine aminotransferase in skeletal muscle disease. Hepatology 2005; 41 (2): 380–2.
31. Schneider G, Paus TC, Kullak-Ublick GA et al. Linkage between a new splicing site mutation in the MDR3 alias ABCB4 gene and intrahepatic cholestasis of pregnancy. Hepatology 2007; 45 (1): 150–8.
32. Sgro C, Clinard F, Ouazir K et al. Incidence of drug-induced hepatic injuries: a French population-based study. Hepatology 2002; 36 (2): 451–5.
33. Shaw D, Frohlich J, Wittmann BA, Willms M. A prospective study of 18 patients with cholestasis of pregnancy. Am J Obstet Gynecol 1982; 142: 621–5.
34. Sibai BM, Ramadan MK, Usta I et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets HELLP syndrome. Am J Obstet Gynecol 1993; 169: 1000–6.
35. Sibai BM. Imitators of severe preeclampsia. Obstet Gynecol 2007; 109 (4): 956–66.
36. Vital Durand D, Lega JC, Fassier T et al. Unexplained, subclinical chronically elevated transaminases. Rev Med Intern 2013; 34 (8): 472–8.
37. Winkler K, Wetzka B, Hoffmann MM et al. Low density lipoprotein (LDL) subfractions during pregnancy: Accumulation of buoyant LDL with advancing gestation. Metab 2000; 85: 4543–45.
2. Ignatova T.M. Zabolevaniia pecheni u beremennykh. Med. vestn. Severnogo Kavkaza. 2009; 2: 88–93. [in Russian]
3. Nikitin I.G. Skriningovaia programma po vyiavleniiu rasprostranennosti nealkogol'noi zhirovoi bolezni pecheni i opredeleniiu faktorov riska razvitiia zabolevaniia. Ros. med. vesti. 2010; XV (1): 41–6. [in Russian]
4. Rukovodstvo po ambulatorno-poliklinicheskoi pomoshchi v akusherstve i ginekologii. Pod red. V.E.Radzinskogo. 2-e izd., pererab. i dop. M.:GEOTAR–Media, 2014. [in Russian]
5. Abdo A, Meddings J, Swain M. Liver abnormalities in celiac disease. Clin Gastroenterol Hepatol 2004; 2: 107–12.
6. American Gastroenterological Association. Medical Position Statement: valuation of liver chemistry test. Gastroenterology 2002; 123: 136.
7. Andrade SE, Gurwitz JH, Davis RL et al. Prescription drug use in pregnancy. Am J Obstet Gynecol 2004; 191: 398–407.
8. Angulo P, Alba LM, Petrovic LM et al. Leptin, insulin resistance, and liver fibrosis in human nonalcoholic fatty liver disease. J Hepatol 2004; 41: 943–9.
9. Araujo AC, Leao MD, Nobrega MH et al. Characteristics and treatment of hepatic rupture caused by HELLP syndrome. Am J Obstet Gynecol 2006; 195: 129–33.
10. Bardella MT, Vecchi M, Conte D et al. Chronic unexplained hypertransaminasemia may be caused by occult celiac disease. Hepatology 1999; 29 (3): 654–7.
11. Bayraktar M, van Thiel DH. Abnormalities in measures of liver function and injury in thyroid disorders. Hepatogastroenterology 1997; 44: 1614–18.
12. Buch I, Hornnes PJ, Kuhl C. Glucose tolerance in early pregnancy. Acta Endocrinol (Copenh.) 1986; 112 (2): 263–6.
13. Castro MA, Fassett MJ, Reynolds TB et al. Reversible peripartum liver failure: a new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases. Am J Obstet Gynecol 1999; 181 (2): 389–95.
14. Catalano PM, Huston L, Amini SB, Kalhan SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Am J Obstet Gynecol 1999; 180: 903–16.
15. Catalano PM. Obesity, insulin resistance, and pregnancy outcome. Reproduction 2010; 140 (3): 365–71.
16. Czaja AJ, Freese DK. Diagnosis and treatment of autoimmune hepatitis. Hepatology 2002; 36: 479–97.
17. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking:systematic review of controlled studies. BMJ 2005; 330: 565.
18. Fábregues F, Balasch J, Ginès P et al. Ascites and liver test abnormalities during severe ovarian hyperstimulationsyndrome. Am J Gastroenterol 1999; 94 (4): 994–9.
19. Floreani A, Carderi I, Paternoster D et al. Intrahepatic cholestasis of pregnancy: three novel MDR3 gene mutations. Aliment Pharmacol Ther 2006; 23 (11): 1649–53.
20. Ghio A, Bertolotto A, Resi V et al. Triglyceride metabolism in pregnancy. Adv Clin Chem 2011; 55: 133–53.
21. Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology 2004; 40: 467–74.
22. Ioannou GN, Boyko EJ, Lee SP. The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999–2002. Am J Gastroenterol 2006; 101: 76–82.
23. Keitel V, Vogt C, Häussinger D, Kubitz R. Combined mutations of canalicular transporter proteins cause severe intrahepatic cholestasis of pregnancy. Gastroenterology 2006; 131 (2): 624–9.
24. Kirwan JP, Hauguel-De Mouzon S et al. TNF-alpha is a predictor of insulin resistance in human pregnancy. Diabetes 2002; 51 (7): 2207–13.
25. Kopylov U, Avidan B, Papageorgiou NP et al. Idiopathic liver function test abnormality in pregnancy is associated with assisted reproduction techniques. Fertil Steril 2013; 99 (2): 377–81.
26. Kuhl C. Etiology and pathogenesis of gestational diabetes. Diabetes Care 1998; 21 (2): 19–26.
27. Laatikainen T, Tulenheimo A. Maternal serum bile acid levels and fetal distress in cholestasis of pregnancy. Int J Gynaecol Obstet 1984; 22: 91–4.
28. Lago F, Dieguez C, Gomez Reino J. The emerging role of adipokines as mediators of inflammation and immune responses. Cytokine Growth Factor Rev 2007; 18: 313–25.
29. Lee RH, Kwok KM, Ingles S et al. Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. Am J Perinatol 2008; 25: 341–5.
30. Nathwani RA, Pais S, Reynolds TB et al. Serum alanine aminotransferase in skeletal muscle disease. Hepatology 2005; 41 (2): 380–2.
31. Schneider G, Paus TC, Kullak-Ublick GA et al. Linkage between a new splicing site mutation in the MDR3 alias ABCB4 gene and intrahepatic cholestasis of pregnancy. Hepatology 2007; 45 (1): 150–8.
32. Sgro C, Clinard F, Ouazir K et al. Incidence of drug-induced hepatic injuries: a French population-based study. Hepatology 2002; 36 (2): 451–5.
33. Shaw D, Frohlich J, Wittmann BA, Willms M. A prospective study of 18 patients with cholestasis of pregnancy. Am J Obstet Gynecol 1982; 142: 621–5.
34. Sibai BM, Ramadan MK, Usta I et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets HELLP syndrome. Am J Obstet Gynecol 1993; 169: 1000–6.
35. Sibai BM. Imitators of severe preeclampsia. Obstet Gynecol 2007; 109 (4): 956–66.
36. Vital Durand D, Lega JC, Fassier T et al. Unexplained, subclinical chronically elevated transaminases. Rev Med Intern 2013; 34 (8): 472–8.
37. Winkler K, Wetzka B, Hoffmann MM et al. Low density lipoprotein (LDL) subfractions during pregnancy: Accumulation of buoyant LDL with advancing gestation. Metab 2000; 85: 4543–45.
2. Игнатова Т.М. Заболевания печени у беременных. Мед. вестн. Северного Кавказа. 2009; 2: 88–93. / Ignatova T.M. Zabolevaniia pecheni u beremennykh. Med. vestn. Severnogo Kavkaza. 2009; 2: 88–93. [in Russian]
3. Никитин И.Г. Скрининговая программа по выявлению распространенности неалкогольной жировой болезни печени и определению факторов риска развития заболевания. Рос. мед. вести. 2010; XV (1): 41–6. / Nikitin I.G. Skriningovaia programma po vyiavleniiu rasprostranennosti nealkogol'noi zhirovoi bolezni pecheni i opredeleniiu faktorov riska razvitiia zabolevaniia. Ros. med. vesti. 2010; XV (1): 41–6. [in Russian]
4. Руководство по амбулаторно-поликлинической помощи в акушерстве и гинекологии. Под ред. В.Е.Радзинского. 2-е изд., перераб. и доп. М.:ГЭОТАР–Медиа, 2014. / Rukovodstvo po ambulatorno-poliklinicheskoi pomoshchi v akusherstve i ginekologii. Pod red. V.E.Radzinskogo. 2-e izd., pererab. i dop. M.:GEOTAR–Media, 2014. [in Russian]
5. Abdo A, Meddings J, Swain M. Liver abnormalities in celiac disease. Clin Gastroenterol Hepatol 2004; 2: 107–12.
6. American Gastroenterological Association. Medical Position Statement: valuation of liver chemistry test. Gastroenterology 2002; 123: 136.
7. Andrade SE, Gurwitz JH, Davis RL et al. Prescription drug use in pregnancy. Am J Obstet Gynecol 2004; 191: 398–407.
8. Angulo P, Alba LM, Petrovic LM et al. Leptin, insulin resistance, and liver fibrosis in human nonalcoholic fatty liver disease. J Hepatol 2004; 41: 943–9.
9. Araujo AC, Leao MD, Nobrega MH et al. Characteristics and treatment of hepatic rupture caused by HELLP syndrome. Am J Obstet Gynecol 2006; 195: 129–33.
10. Bardella MT, Vecchi M, Conte D et al. Chronic unexplained hypertransaminasemia may be caused by occult celiac disease. Hepatology 1999; 29 (3): 654–7.
11. Bayraktar M, van Thiel DH. Abnormalities in measures of liver function and injury in thyroid disorders. Hepatogastroenterology 1997; 44: 1614–18.
12. Buch I, Hornnes PJ, Kuhl C. Glucose tolerance in early pregnancy. Acta Endocrinol (Copenh.) 1986; 112 (2): 263–6.
13. Castro MA, Fassett MJ, Reynolds TB et al. Reversible peripartum liver failure: a new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases. Am J Obstet Gynecol 1999; 181 (2): 389–95.
14. Catalano PM, Huston L, Amini SB, Kalhan SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Am J Obstet Gynecol 1999; 180: 903–16.
15. Catalano PM. Obesity, insulin resistance, and pregnancy outcome. Reproduction 2010; 140 (3): 365–71.
16. Czaja AJ, Freese DK. Diagnosis and treatment of autoimmune hepatitis. Hepatology 2002; 36: 479–97.
17. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking:systematic review of controlled studies. BMJ 2005; 330: 565.
18. Fábregues F, Balasch J, Ginès P et al. Ascites and liver test abnormalities during severe ovarian hyperstimulationsyndrome. Am J Gastroenterol 1999; 94 (4): 994–9.
19. Floreani A, Carderi I, Paternoster D et al. Intrahepatic cholestasis of pregnancy: three novel MDR3 gene mutations. Aliment Pharmacol Ther 2006; 23 (11): 1649–53.
20. Ghio A, Bertolotto A, Resi V et al. Triglyceride metabolism in pregnancy. Adv Clin Chem 2011; 55: 133–53.
21. Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology 2004; 40: 467–74.
22. Ioannou GN, Boyko EJ, Lee SP. The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999–2002. Am J Gastroenterol 2006; 101: 76–82.
23. Keitel V, Vogt C, Häussinger D, Kubitz R. Combined mutations of canalicular transporter proteins cause severe intrahepatic cholestasis of pregnancy. Gastroenterology 2006; 131 (2): 624–9.
24. Kirwan JP, Hauguel-De Mouzon S et al. TNF-alpha is a predictor of insulin resistance in human pregnancy. Diabetes 2002; 51 (7): 2207–13.
25. Kopylov U, Avidan B, Papageorgiou NP et al. Idiopathic liver function test abnormality in pregnancy is associated with assisted reproduction techniques. Fertil Steril 2013; 99 (2): 377–81.
26. Kuhl C. Etiology and pathogenesis of gestational diabetes. Diabetes Care 1998; 21 (2): 19–26.
27. Laatikainen T, Tulenheimo A. Maternal serum bile acid levels and fetal distress in cholestasis of pregnancy. Int J Gynaecol Obstet 1984; 22: 91–4.
28. Lago F, Dieguez C, Gomez Reino J. The emerging role of adipokines as mediators of inflammation and immune responses. Cytokine Growth Factor Rev 2007; 18: 313–25.
29. Lee RH, Kwok KM, Ingles S et al. Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. Am J Perinatol 2008; 25: 341–5.
30. Nathwani RA, Pais S, Reynolds TB et al. Serum alanine aminotransferase in skeletal muscle disease. Hepatology 2005; 41 (2): 380–2.
31. Schneider G, Paus TC, Kullak-Ublick GA et al. Linkage between a new splicing site mutation in the MDR3 alias ABCB4 gene and intrahepatic cholestasis of pregnancy. Hepatology 2007; 45 (1): 150–8.
32. Sgro C, Clinard F, Ouazir K et al. Incidence of drug-induced hepatic injuries: a French population-based study. Hepatology 2002; 36 (2): 451–5.
33. Shaw D, Frohlich J, Wittmann BA, Willms M. A prospective study of 18 patients with cholestasis of pregnancy. Am J Obstet Gynecol 1982; 142: 621–5.
34. Sibai BM, Ramadan MK, Usta I et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets HELLP syndrome. Am J Obstet Gynecol 1993; 169: 1000–6.
35. Sibai BM. Imitators of severe preeclampsia. Obstet Gynecol 2007; 109 (4): 956–66.
36. Vital Durand D, Lega JC, Fassier T et al. Unexplained, subclinical chronically elevated transaminases. Rev Med Intern 2013; 34 (8): 472–8.
37. Winkler K, Wetzka B, Hoffmann MM et al. Low density lipoprotein (LDL) subfractions during pregnancy: Accumulation of buoyant LDL with advancing gestation. Metab 2000; 85: 4543–45.
________________________________________________
2. Ignatova T.M. Zabolevaniia pecheni u beremennykh. Med. vestn. Severnogo Kavkaza. 2009; 2: 88–93. [in Russian]
3. Nikitin I.G. Skriningovaia programma po vyiavleniiu rasprostranennosti nealkogol'noi zhirovoi bolezni pecheni i opredeleniiu faktorov riska razvitiia zabolevaniia. Ros. med. vesti. 2010; XV (1): 41–6. [in Russian]
4. Rukovodstvo po ambulatorno-poliklinicheskoi pomoshchi v akusherstve i ginekologii. Pod red. V.E.Radzinskogo. 2-e izd., pererab. i dop. M.:GEOTAR–Media, 2014. [in Russian]
5. Abdo A, Meddings J, Swain M. Liver abnormalities in celiac disease. Clin Gastroenterol Hepatol 2004; 2: 107–12.
6. American Gastroenterological Association. Medical Position Statement: valuation of liver chemistry test. Gastroenterology 2002; 123: 136.
7. Andrade SE, Gurwitz JH, Davis RL et al. Prescription drug use in pregnancy. Am J Obstet Gynecol 2004; 191: 398–407.
8. Angulo P, Alba LM, Petrovic LM et al. Leptin, insulin resistance, and liver fibrosis in human nonalcoholic fatty liver disease. J Hepatol 2004; 41: 943–9.
9. Araujo AC, Leao MD, Nobrega MH et al. Characteristics and treatment of hepatic rupture caused by HELLP syndrome. Am J Obstet Gynecol 2006; 195: 129–33.
10. Bardella MT, Vecchi M, Conte D et al. Chronic unexplained hypertransaminasemia may be caused by occult celiac disease. Hepatology 1999; 29 (3): 654–7.
11. Bayraktar M, van Thiel DH. Abnormalities in measures of liver function and injury in thyroid disorders. Hepatogastroenterology 1997; 44: 1614–18.
12. Buch I, Hornnes PJ, Kuhl C. Glucose tolerance in early pregnancy. Acta Endocrinol (Copenh.) 1986; 112 (2): 263–6.
13. Castro MA, Fassett MJ, Reynolds TB et al. Reversible peripartum liver failure: a new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases. Am J Obstet Gynecol 1999; 181 (2): 389–95.
14. Catalano PM, Huston L, Amini SB, Kalhan SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Am J Obstet Gynecol 1999; 180: 903–16.
15. Catalano PM. Obesity, insulin resistance, and pregnancy outcome. Reproduction 2010; 140 (3): 365–71.
16. Czaja AJ, Freese DK. Diagnosis and treatment of autoimmune hepatitis. Hepatology 2002; 36: 479–97.
17. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking:systematic review of controlled studies. BMJ 2005; 330: 565.
18. Fábregues F, Balasch J, Ginès P et al. Ascites and liver test abnormalities during severe ovarian hyperstimulationsyndrome. Am J Gastroenterol 1999; 94 (4): 994–9.
19. Floreani A, Carderi I, Paternoster D et al. Intrahepatic cholestasis of pregnancy: three novel MDR3 gene mutations. Aliment Pharmacol Ther 2006; 23 (11): 1649–53.
20. Ghio A, Bertolotto A, Resi V et al. Triglyceride metabolism in pregnancy. Adv Clin Chem 2011; 55: 133–53.
21. Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology 2004; 40: 467–74.
22. Ioannou GN, Boyko EJ, Lee SP. The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999–2002. Am J Gastroenterol 2006; 101: 76–82.
23. Keitel V, Vogt C, Häussinger D, Kubitz R. Combined mutations of canalicular transporter proteins cause severe intrahepatic cholestasis of pregnancy. Gastroenterology 2006; 131 (2): 624–9.
24. Kirwan JP, Hauguel-De Mouzon S et al. TNF-alpha is a predictor of insulin resistance in human pregnancy. Diabetes 2002; 51 (7): 2207–13.
25. Kopylov U, Avidan B, Papageorgiou NP et al. Idiopathic liver function test abnormality in pregnancy is associated with assisted reproduction techniques. Fertil Steril 2013; 99 (2): 377–81.
26. Kuhl C. Etiology and pathogenesis of gestational diabetes. Diabetes Care 1998; 21 (2): 19–26.
27. Laatikainen T, Tulenheimo A. Maternal serum bile acid levels and fetal distress in cholestasis of pregnancy. Int J Gynaecol Obstet 1984; 22: 91–4.
28. Lago F, Dieguez C, Gomez Reino J. The emerging role of adipokines as mediators of inflammation and immune responses. Cytokine Growth Factor Rev 2007; 18: 313–25.
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Авторы
Ю.Б.Успенская*, И.В.Кузнецова
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*jusp@mail.ru
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*jusp@mail.ru
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*jusp@mail.ru
________________________________________________
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*jusp@mail.ru
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