妊娠急性脂肪肝的临床诊断及治疗方法

Clinical diagnosis and treatment of acute fatty liver of pregnancy

目的探讨妊娠急性脂肪肝的临床诊断及治疗方法。方法对上海市公共卫生临床中心1988年1月至2007年7月收治的36例妊娠急性脂肪肝患者的临床资料进行回顾性分析。结果 (1)临床表现:36例妊娠急性脂肪肝患者均发生于妊娠晚期,有明显的临床症状(以恶心、呕吐为主)和实验室检查特征(36例患者全部出现白细胞计数、肝酶及血清总胆红素水平升高,全部出现凝血酶原时间延长及血清白蛋白水平降低)。肝脏 B 超的阳性检出率为57%(17/30),肝脏 CT 的阳性检出率为73%(16/22),肝脏 CT 的阳性检出率高于 B 超(P<0.05)。(2)分娩方式:阴道分娩12例,其中产后出血发生率为42%(5/12),孕产妇死亡率为50%(6/12),围产儿死亡率为50%(6/12),新生儿窒息发生率为58%(7/12);剖宫产分娩24例,其中产后出血发生率为42%(10/24),孕产妇死亡率为8%(2/24),围产儿死亡率为13%(3/24),新生儿窒息发生率为38%(9/24)。(3)剖宫产终止妊娠加内科综合支持治疗能明显降低产后出血发生率、孕产妇死亡率、围产儿死亡率、新生儿窒息发生率。剖宫产分娩的孕产妇死亡率及围产儿死亡率与阴道分娩比较,差异有统计学意义(P<0.05),剖宫产分娩的产后出血发生率及新生儿窒息发生率与阴道分娩比较,差异无统计学意义(P>0.05)。(4)全部死亡病例均是从发病至接受正规治疗时间超过7 d 的患者。结论结合临床症状、实验室检查特征、肝脏 B 超、CT 检查等,力争在发病1周内明确诊断;立即剖官产术终止妊娠、积极内科综合支持疗法是改善母儿预后的关键。

Objective To study the clinical diagnosis and treatment of acute fatty liver of pregnancy （AFLP）. Method The clinical data of 36 cases of AFLP were reviewed retrospectively, who were treated during Jan 1988-July 2007 in the Department of Obstetrics and Gynecology, Public Health Clinical Center Affiliated to Fu Dan University, Shanghai. Results All 36 cases were hospitalized in late pregnancy with various clinical symptoms and physical signs. Lab examinations were also performed. In the case of natural delivery,the rate of postpartum hemorrhage, and maternal mortality were 42% , and 50%, and the perinatal mortality and asphyxia in newborns were 50% and 58% respectively. In the case of cesarean section ,the rate was 42% , 8% , and 13% ,38% respectively. The comprehensive therapies of termination of pregnancy by cesarean section plus medical supportive treatment can reduce the rate of postpartum hemorrhage, maternal mortality, perinatal mortality,and asphyxia in newborns significantly. Compared with the natural delivery, cesarean section had the higher rate of postpartum hemorrhage and the rate of asphyxia in newborns （ P 〉 0. 05 ）,higher rate of maternal mortality and perinatal mortality （P 〈 0. 05 ）. All the death cases occurred in patients who only began to receive treatment 7 days after presentation of the symptoms. Compared with B ultrasonography, of which diagnosis rate of AFLP was 57%, CT had a higher diagnosis rate of 73% （P 〈 0. 05 ）. Conclusion Early diagnosis, termination of pregnancy by cesarean section as soon as possible and a comprehensive therapy are the key to improve the mother and newborn＇s prognosis.