妊娠期急性脂肪肝26例临床病例分析

Clinical Features of Acute Fatty Liver of Pregnancy:Analysis of 26 cases

目的分析妊娠期急性脂肪肝(AFLP)临床特点及诊治方法 ,以提高对AFLP的早期诊治能力,从而降低孕产妇及围生儿的病死率。方法回顾性分析2003年6月—2009年8月我院妇产科收治的26例AFLP患者的临床特征与实验室检查结果及诊治方法。结果 16例(61.5%)AFLP患者发生在妊娠35周左右,26例患者均有明显的消化系统症状,23例(88.5%)患者出现黄疸,患者均表现为血清转氨酶不同程度的升高,而肝炎病毒标志物检查均为阴性,21例(80.7%)患者出现血清胆红素升高,而25例患者尿胆红素阴性。其中2例患者经阴道自然分娩,其余均在确诊后及时行子宫下段剖宫产术。6例AFLP患者死亡,4例新生儿死亡,1例死胎。结论 AFLP是一种妊娠期间特发的,以多脏器受损为特征的产科危重病,多发生在妊娠35周左右。早期诊断和及时终止妊娠是改善AFLP预后的关键,多科协作、综合治疗、有效防治多脏器功能衰竭是治疗成功的保障。

Objective To analyze the clinical features of acute fatty liver of pregnancy （AFLP） and its treatments to improve early diagnosis,thus to reduce the mortality of pregnant and parturient women and perineonates.Methods A retrospective analysis was performed on clinical data,laboratory test results,diagnoses and treatments of 26 AFLP patients admitted to our obstetrics and gynecology department from June 2003 to August 2009.Results Sixteen patients had AFLP in weeks 35 of pregnancy （61.5%）;26 had obvious gastrointestinal symptoms;23 presented with jaundice （88.5%）,serum transaminase elevated in all,but hepatitis virus markers were negative;21 presented with elevated serum bilirubin （80.7%）,but bilirubin in urine was negative in 25.Two had natural vaginal delivery,the others received timely lower uterine segment cesarean section after diagnosis.Six AFLP patients and 4 neonates died,1 case was fetal death.Conclusion AFLP is a obstetric critical illness characterized by spontaneous and multiple organ damage,mostly occurring in about weeks 35 of pregnancy.Early diagnosis and timely termination of pregnancy are the keys of AFLP prognosis improvement,and multidisciplinary collaboration,comprehensive treatment and effective prevention of multiple organ failure are guarantees of successful treatment.