妊娠期急性脂肪肝与HELLP综合征临床分析

Clinical analysis about acute fatty liver and HELLP syndromeduring pregnancy

目的通过对比妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)和HELLP(the syndrome of Hemolysis,elevated liver enzymes and low platelet counts)综合征临床表现、一般情况、妊娠结局、术前术后实验室检查,寻找不同点为临床早期识别和鉴别诊断提供临床依据。方法AFLP患者13例为AFLP组,HELLP综合征患者20例为HELLP组,健康孕妇34例为对照组。结果三组年龄、孕产次、民族、发病孕周、产后出血量、早产率、新生儿体重、住院天数指标差异有统计学意义(P<0.05)。三组凝血酶时间、部分活化凝血酶原时间、纤维蛋白原、血小板计数、血小板压积、血红蛋白、白细胞计数、天门冬氨酸氨基转移酶、谷氨酸氨基转移酶、总胆红素、乳酸脱氢酶、白蛋白、尿素、肌酐指标术前、术后1 d和4 d差异有统计学意义(P<0.05);三组血小板平均分布宽度、尿酸、血糖指标术前、术后1 d差异有统计学意义(P<0.05)。结论加强认识两组疾病的发生发展及转归特点,重视妊娠晚期的所有消化症状。

Objective By comparing the clinical presentation,general condition,pregnancy outcomes,pre-and post-operative laboratory tests of acute fatty liver of pregnancy(AFLP)and HELLP(the syndrome of Hemolysis,elevated liver enzymes and low platelet counts),tofind the difference sandlay a foundation forearlyclinicalidentification and differentialdiagnosis.Methods Thirteen AFLP patients were included in the AFLP group,twenty patients with HELLP syndrome were included in the HELLP group,and 34 healthy pregnant women were dividedinto the control group.Results There were statistically significant differences(P<0.05)between the three groups in terms of age,gravidity and parity history,ethnicity,gestational week of onset,postpartum haemorrhage,preterm birth rate,neonatal weight and hospital days index.Thevaluesin prothrombin time,partially activated prothrombin time,fibrinogen,platelet count,platelet pressure,hemoglobin,white blood cell count,aspartate acid aminotransferase,glutamate aminotransferase,total bilirubin,lactate dehydrogenase,albumin,urea,creatinine indicatorswere statistically significantly different(P<0.05)beforeoperation,1 and 4 days after surgery in three groups.The differences in the mean platelet distribution width,uric acid,and blood glucose indexes of three groups beforeoperation and 1 day after surgery were statistically significant(P<0.05).Conclusion We shouldtakemeasures to strengthen the understanding of the occurrence,development and outcome of the disease in both groups,and to pay attention to all gastrointestinal symptoms in the third trimester of pregnancy.