GEBELİK İNTRAHEPATİK KOLESTAZINDA KARACİĞER FONKSİYON ENDEKSLERİNİN DEĞERLENDİRİLMESİ: TANI YARARLIĞI VE YENİDOĞAN SONUÇLARI

Yıl 2024, Cilt: 57 Sayı: 3, 114 - 119, 22.01.2025

Gülşan Karabay , Zeynep Şeyhanlı , Serap Topkara Sucu , Betül Tokgöz , Gizem Aktemur , Nazan Vanlı Tonyalı , Umut Karabay , Selver Özge Şefik , Gulsah Dagdeviren , Şevki Çelen

https://doi.org/10.20492/aeahtd.1495698

Öz

Amaç: Gebelikte intrahepatik kolestaz (ICP), gebeliklerin %0,2-2'sinde görülen bir karaciğer hastalığıdır. Yoğun kaşıntı ve kan dolaşımında safra asitlerinin artmasıyla karakterizedir. Olumsuz neonatal sonuçların kesin olarak tanımlanması ve öngörülmesi çok önemlidir. Bu çalışma, ICP hastalarında karaciğerle ilgili APRI (aspartat aminotransferaz-trombosit), ALBI (albümin-bilirubin), PALBI (trombosit-albümin-bilirubin) ve FAR (fibrinojen/albümin oranı) değerinin tanısal performansını değerlendirmekte ve bunların gebelik sonuçlarıyla olan ilişkisini incelemektedir.
Gereç ve Yöntem: Bu çalışma Ocak 2023-Ocak 2024 tarihleri arasında Ankara Etlik Şehir Hastanesi'nde tedavi gören 180 hastanın retrospektif analizidir. 90 ICP hastası (Grup 1) ile 90 kontrol hastası (Grup 2) karşılaştırıldı. PALBI, ALBI, APRI skorları ve FAR üçüncü trimester laboratuvar değerleri kullanılarak hesaplandı. Doğum ağırlığı, APGAR skorları, yenidoğan yoğun bakım ünitesine kabul, sepsis, solunum sıkıntısı ve neonatal ölümü içeren neonatal sonuçlar kaydedildi. İstatistiksel analiz, ROC (Receiver Operating Characteristics) eğrisi analizi ve Spearman korelasyonu ile yapıldı.
Bulgular: ICP hastalarında PALBI, ALBI, APRI skorları ve FAR anlamlı olarak yüksekti (p<0,001). APRI puanı en yüksek tanısal performansı gösterdi (AUC: 0.870). PALBI skoru için cut-off değeri>-2,58 (sensivite %62, spesifite %81), ALBI skoru için >-2,47 (sensitive %67, spesifite %81), APRI skoru için >0,3 (sensivite %78, spesifite %68) idi. Yenidoğan sonuçları gruplar arasında anlamlı farklılık göstermedi. Yenidoğanlarda açlık safra asidi düzeyleri ve karaciğer hasarı belirteçleri ile olumsuz sonuçlar arasında bir korelasyon yoktu.
Sonuç: Açlık safra asidi düzeylerinin test edilmesinin mümkün olmadığı merkezlerde PALBI, ALBI, APRI skorları ve FAR değeri intrahepatik gebelik kolestazı olan bireylerin değerlendirilmesinde alternatif bir yaklaşım sunmaktadır. Bu parametrelerin güvenilirliğini arttırmak için daha geniş hasta gruplarıyla gelecek çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Gebelikte intrahepatik kolestaz , PALBI skoru , açlık safra asitleri

EVALUATION OF LIVER FUNCTION INDICES IN INTRAHEPATIC CHOLESTASIS OF PREGNANCY: DIAGNOSTIC UTILITY AND NEONATAL OUTCOMES

Öz

Aim: Intrahepatic cholestasis of pregnancy (ICP) is a hepatic condition that occurs in 0.2-2% of pregnancies. It is characterized by intense itching and increased levels of bile acids in the bloodstream. Precise identification and anticipation of adverse neonatal outcomes are crucial. This study evaluates the diagnostic performance of liver-related scores—APRI (aspartate aminotransferase- platelet), ALBI (albumin-bilirubin), PALBI (platelet- albumin-bilirubin), and FAR (fibrinogen/albumin ratio) —in ICP patients and examines their relationship to pregnancy outcomes.
Material and Method: This study was a retrospective analysis of 180 patients who were treated at Ankara Etlik City Hospital between January 2023 and January 2024. 90 ICP patients (Group 1) and 90 control patients (Group 2) were compared. The PALBI, ALBI, APRI scores, and FAR were calculated using third-trimester laboratory values. Neonatal outcomes, including birth weight, APGAR scores, NICU (neonatal intensive care unit) admission, sepsis, RDS (respiratory distress syndrome), and neonatal death were recorded. Statistical analyses included ROC (Receiver Operating Characteristics) curve analysis and Spearman correlation.
Results: The PALBI, ALBI, APRI scores, and FAR were significantly higher in ICP patients (p<0.001). The APRI score showed the highest diagnostic performance (area under curve 0.870). Cut-off values were >-2.58 for PALBI (sensitivity 62%, specificity 81%), >-2.47 for ALBI (sensitivity 67%, specificity 81%), and >0.3 for APRI (sensitivity 78%, specificity 68%). Neonatal outcomes did not differ significantly between the groups. There was no correlation between fasting bile acid levels and liver damage markers with negative outcomes in newborns.
Conclusion: In facilities where it is not possible to test fasting bile acid levels, PALBI, ALBI, APRI scores and FAR value offer an alternative approach to the evaluation of individuals with intrahepatic cholestasis of pregnancy (ICP). Future studies with larger patient groups are needed to increase the reliability of these parameters.

Anahtar Kelimeler

Intrahepatic cholestasis of pregnancy , PALBI score , fasting bile acids

Kaynakça

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