妊娠急性脂肪肝11例早期诊治分析

Early diagnosis and treatment of acute fatty liver of pregnancy

目的探讨妊娠急性脂肪肝(AFLP)的早期诊断方法和处理原则。方法对四川大学华西第二医院2003年1月至2006年12月收治的11例AFLP病例进行回顾性分析。结果(1)临床表现:患者出现恶心、呕吐、厌食、乏力、黄疸等临床表现;(2)实验室检查:肝功异常:丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)轻到中度升高,总胆红素、直接胆红素明显升高,白蛋白降低;肾功异常:肌酐、尿素氮明显升高;凝血功能障碍:凝血酶原时间延长、血小板降低、DIC;其他:部分患者白细胞增高,血糖降低;(3)影像学检查:超声诊断AFLP9例,CT诊断AFLP2例;(4)孕产妇及围生儿结局:孕产妇死亡1例;围生儿死亡1例。结论早期诊断和及时终止妊娠,并加强支持疗法是治疗AFLP的关键,可有效降低母婴死亡率。

Objective To explore the early diagnosis methods and treatment principle of acute fatty liver of pregnancy. Methods Eleven cases of AFLP treated in Second West China Hospital from Jan, 2003 to Dec. 2006 were analyzed retrospectively. Results （ 1 ） Clinical feature ： All cases had nausea, vomiting, malaise, jaundice, etc. （2） Laboratory examination：（1）Abnormal liver function： Liver function abnormality contained hypoalbumin and elevated hepatic aminotransferase levels（ ALT,AST）, total bilirubin and direct bilirubin. （2）Abnormal kidney function： Kidney function abnormality contained elevated BUN and creatine, （3）Clotting dysfunction ：Clotting dysfunction contained prolonged prothrombin time, low platelet and disseminated intravascular coagulation （DIC）. （4）Others： Some patients had elevated leukocytosis and hypoglycaemia. （3）Imaging examination： Diagnosis was confirmed by B ultrasonography in 9 patients, and confirmed by CT in 2 patients. （4）Pregnancy woman and neonate outcomes：the mortality of pregnancy women was 9.1% （1/11 ）, and the mortality of neonates was 7.7 % （ 1/13 ）. Conclusion The key point to treating AFLP is early diagnosis, timely termination of pregnancy, and strengthening supporting therapy. This can decrease the mortality of mother and children effectively.