Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment.
Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment.
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DOI：
10.1016/s1665-2681(19)30975-5
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发表时间：
2014-11
影响因子：
3.8
通讯作者：
O. de Bari;Tony Y. Wang;Min Liu;C. Paik;P. Portincasa;David Q.‐H. Wang
中科院分区：
文献类型：
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作者：
O. de Bari;Tony Y. Wang;Min Liu;C. Paik;P. Portincasa;David Q.‐H. Wang
流行病学和临床研究发现，在所研究的所有人群中，所有年龄段的女性胆结石患病率是男性的两倍。怀孕期间发生的荷尔蒙变化使女性面临更高的风险。胆道污泥（胆结石的前兆）和胆结石在妊娠期和产后的发病率分别高达30%和12%，1-3%的孕妇在产后一年内因临床症状或并发症接受胆囊切除术。妊娠期间雌激素水平升高会引起肝胆系统显著的代谢变化，包括胆固醇-过饱和胆汁的形成和胆囊运动迟缓，这两个因素促进了胆石的形成。治疗方法是保守的，因为在怀孕期间胆道疾病的争议频率。在大多数孕妇中，胆道污泥和胆结石往往在分娩后自行溶解。然而，在某些情况下，病情持续存在，需要昂贵的治疗干预措施。必要时，诸如腹腔镜胆囊切除术等侵入性手术的耐受性相对较好，最好在妊娠中期或产后进行。虽然出于安全考虑，建议使用腹腔镜手术，但也可以考虑使用熊去氧胆酸（UDCA）和新型降脂化合物依折替米布等药物。本文系统综述了妊娠相关胆泥和胆结石形成的发生率和自然历史，并详细探讨了雌激素对妊娠期胆结石形成的产石作用的分子机制。我们还总结了预防和治疗孕妇胆结石的必要策略的最新进展。
Epidemiological and clinical studies have found that gallstone prevalence is twice as high in women as in men at all ages in every population studied. Hormonal changes occurring during pregnancy put women at higher risk. The incidence rates of biliary sludge (a precursor to gallstones) and gallstones are up to 30 and 12%, respectively, during pregnancy and postpartum, and 1-3% of pregnant women undergo cholecystectomy due to clinical symptoms or complications within the first year postpartum. Increased estrogen levels during pregnancy induce significant metabolic changes in the hepatobiliary system, including the formation of cholesterol-supersaturated bile and sluggish gallbladder motility, two factors enhancing cholelithogenesis. The therapeutic approaches are conservative during pregnancy because of the controversial frequency of biliary disorders. In the majority of pregnant women, biliary sludge and gallstones tend to dissolve spontaneously after parturition. In some situations, however, the conditions persist and require costly therapeutic interventions. When necessary, invasive procedures such as laparoscopic cholecystectomy are relatively well tolerated, preferably during the second trimester of pregnancy or postpartum. Although laparoscopic operation is recommended for its safety, the use of drugs such as ursodeoxycholic acid (UDCA) and the novel lipid-lowering compound, ezetimibe would also be considered. In this paper, we systematically review the incidence and natural history of pregnancy-related biliary sludge and gallstone formation and carefully discuss the molecular mechanisms underlying the lithogenic effect of estrogen on gallstone formation during pregnancy. We also summarize recent progress in the necessary strategies recommended for the prevention and the treatment of gallstones in pregnant women.