智利妊娠期肝内胆汁淤积症：流行病学变化分析和微生物学假说

摘要(中文译文)

妊娠肝内胆汁淤积症是一种妊娠期病理状态，其流行病学和病理生理学表现较为特殊，目前仍部分未明。其当前全球发病率为0.1%至2%。然而，在智利，20世纪70年代发病率曾高达15%，随后数十年显著下降，如今约为1%至2%。这一历史性变化的原因尚未完全清楚。本文基于文献进行分析，聚焦于肝内胆汁淤积症及其他肝胆疾病的临床、微生物学和流行病学研究。目的是探讨现有证据，并提出一种微生物学假说，以帮助解释智利所观察到的流行病学转变。值得注意的是，发病率的时间性下降与全国胆道疾病和伤寒热的减少相平行。我们推测，某些病原体（如伤寒沙门菌）的根除或显著减少，可能促进了智利妊娠肝内胆汁淤积症发病率的正常化。

Abstract

Intrahepatic cholestasis of pregnancy is a gestational pathology with an unusual epidemiological and pathophysiological behavior that remains partially unexplained. Its current global incidence ranges from 0.1% to 2%. However, in Chile, the incidence reached up to 15% in the 1970s, with a marked decrease over subsequent decades, being nowadays about 1 to 2%. The reasons for this historical change are not fully understood. A literature-based analysis was conducted, focusing on clinical, microbiological, and epidemiological studies on intrahepatic cholestasis and other hepatobiliary diseases. The aim of this was to explore existing evidence and to propose a microbiological hypothesis that could help explain the epidemiological transition observed in Chile. Notably, the temporal reduction in incidence paralleled a nationwide decline in biliary disease and typhoid fever. We hypothesize that the eradication or significant reduction of certain pathogens, such as Typhi, may have contributed to the normalization of intrahepatic cholestasis of pregnancy rates in Chile.

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