正常孕妇肝功能指标的序贯性研究

目的：了解正常妊娠妇女血清中常用肝功能指标测定结果及变化。方法：分别在早孕（孕10～14周）、中孕（孕20～24周）、晚孕（孕30～34周）及产后（产后12周）四个时期序贯性测定120例正常妊娠妇女血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转移酶（GGT）、乳酸脱氢酶（LDH）、总胆红素（TBIL）、直接胆红素（DBIL）、总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）的水平并进行比较。结果：ALT、AST在早、中、晚孕及产后各期相对于正常对照均升高（P〈0．01）；TBIL和DBIL在早、中、晚孕均降低（P〈0．01）；TP、ALB随孕期增加逐渐下降，产后回升，到产后12周上升到正常水平（早、中、晚孕P〈0．01，产后P〉0．05）；GGT在孕期中逐渐升高，于晚孕期达最高峰（P〈0．01），产后稍有下降；LDH在孕早中期无明显变化（P〉0．05），孕晚期上升，到产后12周仍呈一上升趋势（P〈0．01）；PA在孕早期低于正常对照（P〈0．01），后随孕期上升，到中孕期后上升到正常（P〉0．05）。结论：本次实验观察到在妊娠期肝功指标ALT、AST、GGT、LDH升高，可能因为孕妇肝脏负荷增加、基础代谢和能量消耗增多、甾体激素水平增高引起。胆红素代谢指标及营养性指标TBIL、DBIL、TP、ALB、PA降低，可能是妊娠期血浆稀释引起。临床诊断妊娠合并肝功能损害时应考虑上述变化。

Serial Study of Liver Function Variables of Normal Pregnancy

Objective： To study the trends of liver function indicators during normal pregnancy and postpartum. Methods： The series comprised 120 women with a normal pregnancy and a normal delivery. Blood samples were obtained at 10-14 weeks, 20-24 weeks, 30-34 weeks gestation and at 12weeks postpartum. The following indicators were analyzed： Alanine aminotransferase （ALT）, aspartate aminotransferase （AST）,）＇ glutamyl transferase （GGT）, lactate dehydrogenase （LDH）, total bilirubin （TBIL）, direct bilirubin （DBIL）, total protein （TP）, albumin （ALB） and prealbumin （PA）. Results： Compared to normal ranges, ALT and AST values increased during pregnancy （P〈0.01） while TBIL and DBIL values declined （P〈0.01）. TP and ALB fell down in the whole process of pregnancy （P〈 0.01） and displayed a significant increase after delivery. GGT increased gradually during pregnancy and achieved the highest level at 30-34 weeks gestation （P〈0. 01）, then it slipped slightly after delivery. LDH did not show a clear change at 10-14 weeks and 20-24 weeks （P〉0.05）, but it increased significantly at 30-34 weeks and postpartum （P〈 0.01）. PA was lower than reference standard in 10-14 weeks gestation （P〈0.01）, then went back to normal since 20-24 weeks （P〉0. 05）. Conclusion： The increase of ALT, AST, GGT, LDH values during pregnancy might be caused by the raise of the load of the liver, basal metabolic rate, energy consumption, and the level of serum estrogen and progesterone. The haemodilution and increased blood volume during pregnancy could probably explain the low TBIL, DBIL, TP, ALB and PA levels. These changes should be taken into account when considering a possible liver dysfunction in pregnancy.