Gynecology, Obstetrics and Perinatology

Biochemical markers of liver damage in HELLP syndrome

Objective. To assess the severity of liver damage in women with HELLP syndrome.
Patients and methods. A prospective examination of 52 pregnant women was performed. The treatment group comprised 12 women, whose pregnancy was complicated by the development of HELLP(ELLP) syndrome. The control group included 40 women with a physiological progression of pregnancy. Liver function was assessed with the help of a complex biochemical examination of blood serum that included testing for alanine aminotransferase, aspartate aminotransferase, total and conjugated bilirubin, total protein and its fractions, lactate dehydrogenase, alkaline phosphatase, glucose, urea, cholesterol, fibrinogen. For the purposes of evaluating possible morphostructural changes in the liver of pregnant women we for the first time used the noninvasive biochemical tests: FibroTest and APRI test.
Results. In pregnant women with HELLP syndrome, a decreased liver function can be observed, which is biochemically manifested by cytolytic, cholestatic syndrome, and also chronic liver cell failure syndrome. According to the noninvasive FibroTest evaluation, all women with HELLP syndrome had morphostructural changes in the liver that corresponded to stages F1–F3 of the histological METAVIR scoring system. In women with a physiological progression of gestation, the FibroTest parameters were within a reference range and the test’s numerical values corresponded to the histological index F0 of the МЕTAVIR score, which is indicative of the absence of morphostructural changes in the organ. 
Conclusion. Liver damage against the background of HELLP syndrome is not confined only to its functional disorders but might be associated with morphostructural alteration, which should be taken into consideration when choosing complex follow-up therapy after HELLP syndrome.
Key words: preeclampsia, liver disease in pregnancy, HELLP syndrome, Fibrotest.

For citation: Strizhakov A.N., Timokhina E.V., Fedyunina I.A., Ignatko I.V., Aslanov A.G., Ternova D.Yu., Pitskhelauri E.G. Biochemical markers of liver damage in HELLP syndrome. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2019; 18(4): 59–65. (In Russian).
DOI: 10.20953/1726-1678-2019-4-59-65