妊娠期急性脂肪肝20例临床分析

Acute Fatty Liver of Pregnancy:Clinical Analysis of 20 Cases

目的:探讨妊娠期急性脂肪肝(AFLP)的临床特点、诊治及母儿预后。方法:回顾性分析我院近十年中出院诊断为AFLP的20例患者的临床经过、实验室检查和治疗。结果:母亲平均年龄24±3.7岁(20～35岁),平均发病孕周34.80±2.88周(28～40+2周),平均分娩孕周36.45±2.58周(30～40+2周)。全部患者的诊断根据临床症状和实验室检查,其中4例经肝穿刺活检证实。母亲并发症:肝性脑病9例、肝肾综合征11例、腹水18例、低血糖7例、产后出血9例。20例患者均接受大量血浆及白蛋白交替治疗,其中10例另接受血浆置换,并发急性呼吸窘迫综合征5例、腹腔置管7例。母亲死亡率25%(5/20),围生儿死亡率为23%(5/22)。结论:重视孕晚期孕妇出现恶心、呕吐、乏力等症状,及早进行肝肾功能和DIC检查;尽量早期确诊,及时终止妊娠,多科室合作的综合支持治疗,避免过度液体复苏,母亲预后可望改善。

Objective：To investigate the clinical feature,diagnosis and treatment of acute fatty liver of pregnancy （AFLP） as well as the prognosis of mother and fetus.Methods：The clinical courses,laboratory findings and therapies of 20 AFLP patients during past ten years in our hospital were retrospectively analyzed.Results：The average maternal age was 24±3.7 years old （20~35 y）and the gestational age at onset was 34.80±2.88 （28～40＋2）weeks.The average gestational age at delivery was 36.45±2.58（30～40＋2）weeks.The diagnosis of AFLP was made on the basis of clinical symptoms and laboratory findings,among them 4 cases received liver biopsy.The maternal complications included hepatic encephalopathy （9）,hepatorenal syndrome （11）,ascites （18）,hypoglycemia （7）,and postpartum hemorrhage （9）.All cases received a large-dose plasma and albumin alternative administration.Among them,10 cases received extra plasma exchange.The complications included acute respiratory distress syndrome （ARDS） （5）,abdominal drainage （7）.The maternal mortality was 25%（5/20）,and the perinatal mortality was 23% （5/22）.Conclusions：The patients with persistent nausea,malaise and vomiting in the third trimester should receive evaluation of hepatorenal function,and blood coagulation examination to earlier recognize the slight AFLP and terminate the pregnancy.To emphasize multidisciplinary and avoid overperfusion resuscitation might ameliorate the prognosis of mother and fetus.