Evaluación de la relación UDCA / LCA en la colestasis intrahepática del embarazo

CONTIN MARIO; MARTINEFSKI MANUELA; DICARLO MARIA; LUCANGIOLI SILVIA; TRIPODI VALERIA

Congreso; Congreso Argentino de Fisiología, Sociedad Argentina de Investigación Clínica (SAIC); 2010

La colestasis intrahepática del embarazo (CIE) es una patología hepática que se presenta en el segundo o tercer trimestre del embarazo y desaparece espontáneamente luego del parto. La CIE se caracteriza por la presencia de prurito generalizado y funcionalidad hepática alterada y esta asociada a un incremento del distress fetal, partos prematuros y morbi-mortalidad perinatal. Por lo tanto, un diagnostico precoz y diferencial ICP is characterized by generalized skin pruritus and abnormal liver function and it is associated with increased fetal distress, premature deliveries and perinatal mortality and morbidity. Therefore, an early and accurate diagnosis of this high risk pregnancy is essential. Usually, diagnosis of ICP is based on pruritus with mild or moderate elevated levels of amino transferases and raised total serum bile acids (TSBA). However, it is often difficult to diagnose ICP only by performing routine laboratory test because these are also affected in other conditions. In fact, the existence of subclinical cholestasis during pregnancy may also compromise the identification of the disease. Moreover, pruritus in pregnancy is a common symptom and it may be the only evidence in ICP, so it is necessary to discriminate women with ICP from those with bening condition of pruritus gravidum (Castaño + 5 de Castaño). In addition, a subgroup of asymptomatic pregnant women with high levels of TSBA, without pruritus and normal liver function tests has recently been described as women with asymptomatic hypercholanaemia of pregnancy (AHP) (Castaño + 9-11 de Castaño). In previously works, we have demonstrated that individual serum bile acids, specially litocholic acid (LCA), provide more information than TSBA determination both, in the differential diagnosis of ICP and to evaluate the effectiveness of usodesoxicholic acid (UDCA) treatment in those patients, using capillary electrophoresis as a convenient methodology to simultaneously determine the serum bile acid profiles. Several authors have demonstrated LCA toxicity and UDCA protective effect, however, their determination evaluated separately are not enough to differencially diagnose and evaluate the severity of ICP condition. Taking into account that the severity of ICP is traduced in a higher isk delivery, we aimed to establish if determination of the relation of both, LCA and UDCA together could be a better maker than TSBA and individual bile acids to accurate and undoubetely diagnose and evaluate the severity of ICP condition.