妊娠期急性脂肪肝9例临床分析

目的提高对妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)临床特点的认识,以便早期诊断和及时治疗,降低母婴死亡率。方法对近两年来收治的AFLP患者的临床资料进行回顾性分析。结果该病好发于孕晚期,临床表现为厌食、恶心、呕吐、乏力、黄疸、上腹不适等,实验室检查白细胞异常升高,纤维蛋白原下降,凝血酶原时间延长,胆红素水平升高,低血糖,血清转氨酶水平均增高等,B超检查符合脂肪肝显像特点。结论 AFLP是一种发生在妊娠晚期或产后早期的罕见的、危及生命的疾病。虽然早期诊断存在一定困难,然而详细询问病史及体格检查,结合实验室及影像学检查足以作出诊断。尽快终止妊娠及强有力的支持治疗是AFLP治疗的基础。

Objective To enhance the recognition of the clinical features of AFLP, to early diagnosis and management, decrease the maternal and fetal mortality. Methods The clinical findings and outcomes of pregnancy were retrospectively analyzed in 9 patients with AFLP in our hospital in recent 2 years. Results The majority of women who are diagnosed with AFLP are in the third trimester of pregnancy. The manifestations included anorexia, nausea, vomiting, progressive jaundice et al. laboratory findings included elevated white blood cell count, hypofibrinogenemia, prolonged prothrombin time, hyperbilirubinemia, hypoglycemia, elevated serum aminotransferases. Ultrasonic indicated fatty liver. Conclusion AFLP is an uncommon, life-threatening disorder developing in the third trimester of pregnancy or early postpartum period. Early diagnosis sometimes can be difficult. However, careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis. Prompt delivery of the infant and intensive supportive care remain as the mainstay treatment for AFLP.