Gebelikte İntrahepatik Kolestazda Birinci Trimester APRI Skoru ve De-Ritis Oranının Tahmini Rolünün Karşılaştırılması

Öz

Amaç: APRI skoru ve De Ritis oranı karaciğer hastalıklarıyla ilişkilidir. Literatürde bu belirteçlerin gebeliğin intrahepatik kolestazındaki öngörücü rolü hakkında sınırlı veri bulunmaktadır. Bu çalışmada, gebeliğin intrahepatik kolestazındaki birinci trimester APRI ve De Ritis skorlarının öngörücü rolünü değerlendirmeyi ve karşılaştırmayı amaçladık. Gereç ve yöntem: Retrospektif çalışmamıza toplam 60 intrahepatik gebelik kolestazı ve 60 sağlıklı gebe dahil edildi. Demografik özellikler, ilk trimester aminotransferazları, tam kan sayımı düzeyleri, açlık safra asidi düzeyleri, pıhtılaşma testleri, doğum sonuçları kaydedildi ve gruplar arasında karşılaştırıldı. Receiver operating curve analizi, APRI ve De-Ritis skorunun intrahepatik gebelik kolestazı için öngörücü rolünü belirlemek için kullanıldı. Bulgular: APRI skoru intrahepatik kolestaz grubunda anlamlı olarak daha yüksek (p=0,017) iken De-Ritis oranı daha düşüktü (p=0,002). Açlık safra asidinin APRI skoru ile pozitif korelasyon gösterdiği bulundu (r=0,868, p<0,001). APRI skoru ile De Ritis oranı arasında zayıf pozitif korelasyon vardı (r=0,219, p=0,016). APRI skoru >0,42, %36,67 duyarlılık ve %98,33 özgüllükle intrahepatik kolestazı öngördü (AUC=0,626, p=0,016). De Ritis oranı ≤1,3, %83,33 duyarlılık ve %51,67 özgüllükle intrahepatik kolestazı öngördü (AUC=0,664, p=0,001). İntrahepatik kolestazı öngörmede iki indeks arasında anlamlı fark bulunmadı (p=0,065). Sonuç: Ucuz ve kolay hesaplanabilen ilk trimester APRI ve De Ritis skorları, gebeliğin intrahepatik kolestazını tahmin etmek için kullanılabilir. İki belirteç arasında bir üstünlük olmadığı düşünüldüğünde, her ikisinin de tahmin için kullanılabileceğini düşünmekteyiz.

Anahtar Kelimeler

• APRI skoru
• De Ritis oranı
• gebeliğin intrahepatik kolestazı

Comparison of the Predictive Role of First Trimester APRI Score and De-Ritis Ratio in Intrahepatic Cholestasis of Pregnancy

Öz

Aim: The APRI score and De Ritis ratio is associated with liver diseases. There is limited data in the literature on the predictive role of these markers in intrahepatic cholestasis of pregnancy. This study aimed to evaluate and compare the predictive role of first trimester APRI and De Ritis scores for intrahepatic cholestasis of pregnancy. Material and methods: A total of 60 intrahepatic cholestasis of pregnancy and 60 healthy pregnant were included in this retrospective study. Demographic features, first trimester aminotransferases, complete blood count levels, fasting bile acid levels, coagulation tests, birth outcomes were recorded and compared between groups. Receiver operating curve was used to determine the predictive role of APRI and De-Ritis score for intrahepatic cholestasis of pregnancy. Results: APRI score was significantly higher (p=0.017) whereas De-Ritis ratio was lower (p=0.002) in intrahepatic cholestasis group. Fasting bile acid was found to be positively correlated with APRI score (r=0.868, p<0.001). There was a weak positive correlation between APRI score and De Ritis ratio (r=0.219, p=0.016). APRI score >0.42 predicted intrahepatic cholestasis with 36.67% sensitivity and 98.33% specificity (AUC=0.626, p=0.016). De Ritis ratio ≤1.3 predicted intrahepatic cholestasis with 83.33% sensitivity and 51.67% specificity (AUC=0.664, p=0.001). No significant difference was found between two index for predicting intrahepatic cholestasis (p=0.065). Conclusion: The first trimester APRI and De Ritis scores, which are cheap and easily available, can be used to predict intrahepatic cholestasis of pregnancy. Considering that there is no superiority between two markers, we suggest that both can be used for prediction.

Anahtar Kelimeler

• APRI score
• De Ritis ratio
• intrahepatic cholestasis of pregnancy

Kaynakça

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