妊娠期孕妇肝功能异常123例临床分析

Clinical analysis of 123 cases of abnormal liver function in pregnancy

目的探讨妊娠期孕妇肝功能异常的病因及对妊娠结局的影响。方法分析123例(占同期住院妊娠孕妇的2.45)妊娠期肝功能异常病人的病因及预后情况。结果123例由妊娠相关因素引起的肝功能异常56例(占45.53),非妊娠特异因素引起的肝功能异常45例(占36.59),另22例孕妇(17.89)肝功能异常无特定的原因。123例肝功能异常孕妇的临床诊断主要包括:妊娠剧吐9例,妊娠高血压综合征(PIH)18例,妊娠期肝内胆汁郁积症(ICP)28例,妊娠期急性脂肪肝1例,乙型肝炎(HB)35例,自身免疫性肝炎3例,脂肪性肝炎3例,甲、丙、戊型肝炎各1例,药物性肝炎1例。与妊娠相关的肝功能异常发生在孕中期(26.02)和孕晚期(64.23)相对多于孕早期(9.76)。孕早期以妊娠剧吐为主。孕中、晚期以病毒性肝炎(HV)、ICP和PIH为多见。这部分病人的早产率、产后出血率、剖宫产率、胎儿宫内窘迫率有明显增加(P<0.05)。结论乙型病毒性肝炎、妊娠期肝内胆汁郁积症、妊娠高血压综合征是引起妊娠期肝功能异常的主要原因,这些合并症均可不同程度地增加妊娠及分娩时母子的危险性。

Objective To investigate the etiology of liver dysfunction in pregnancy and the effects on pregnancy outcome. MethodsTo analyze the etiology of abnormal liver function in 123 pregnant women （ accounted for 2.45% of pregnant women over the same period of hospitalization） and the effects on pregnancy outcome. ResultsOf the 123 pregnant women with abnormal liver tests, 56 （45.53%） cases were related to and 45 （36.59%） cases were unrelated to pregnancy. In addition 22 （ 17.89% ） cases were cryptogenic. The clinical diagnosis included hyperemesis gravidarum （9）, pregnancy - induced hypertension syndrome （PIH） （ 18 ） , intrahepatic cholestasis of pregnancy （PIH） （ 28 ）, acute fatty liver of pregnancy （AFLP） （ 1 ） ; hepatitis B （HB） （35）, autoimmune hepatitis （AIH） （ 3 ）, steatohepatitis （ 3 ）, hepatitis A （ 1 ）, hepatitis C （ 1 ）, hepatitis E （ 1 ） and drug - induced hepatitis （ 1 ）. Pregnancy related abnormal liver function occurred more frequently in the second （26.02%） and third （64.23%） trimesters than those in the first trimester （9.76%）. The main reason for liver dysfunction in the first trimester was hyperemesis gravidarum, while in the second and third trimesters were viral hepatitis （HV）, ICP and PIH. Of these patients, the rates of premature birth, postpartum bleeding and cesarean section, and the rate of fetus distress in uterus significantly increased （ P 〈 0.05 ）. Conclusion HB, ICP and PIH were the commonest causes of abnormal liver tests in pregnancy and these complications may increase the risk of mother and fetus during pregnancy and delivery in different degrees.