31例妊娠期急性脂肪肝的腹部超声特点及分析

Abdominal Ultrasonic Image Feather and Analysis of Acute Fatty Liver of Pregnancy on 31 Cases

目的:探讨妊娠期急性脂肪肝的孕妇腹部超声特点。材料和方法:收集上海市公共卫生临床中心31例AFLP患者病史、腹部超声及血清总胆红素黄疸资料。结果:根据其肝超声三种表现分为三组,第一组脂肪肝组11例、第二组肝质地密集组15例、第三组肝质地无改变组5例;产前的三组患者分别为9/19例、9/19例、1/19例,产后的三组患者分别为2/12例、6/12例、4/12例,产前、产后比较,其第一、第三组病例数有显著差异(P<0.05)。三组患者的超声表现与黄疸情况无关,无轻度黄疸,重度、中度黄疸无显著差异。伴随腹部其他脏器受损,胆囊改变发生率最高,最常见的胆囊改变为胆囊壁水肿伴无胆汁或胆汁充盈差;有胰腺肿大伴胰周积液者2例提示病情危重,均为产前,其中1例死于该病的稀有并发症呼吸衰竭;产后脾肿大、胸腹腔积液较产前多。结论:AFLP腹部超声有其特点,可为临床诊治和预后提供帮助。

Purpose To explore abdominal ultrasound features of pregnant women with acute fatty liver. Materials and Methods Thirty-one cases of acute fatty liver of pregnancy （AFLP） in our hospital were collected. The history, abdominal ultrasound information and serum total bilirubin jaundice data of these 31 cases were analysed. Results Abdominal ultrasound features were divided into 3 groups： Group 1, 11patients with fatty liver; group 2, 15patients with dense texture liver; and group 3, patients with normal liver density. The prenatal patients of three groups were 9/19, 9/19, and 1/19, respectively. The posetnatal patients of three groups were 2/12, 6/12, and 4/12, respectively. When compared with prenatal and postnatal data, there was significant difference between group 1 and group 3 （P〈0.05）. The abdominal ultrasound features of three groups had nothing to do with jaundice. There was no significant difference among patients without jaundice, with mild, moderate or severe jaundice. Other abdominal organs could be damaged, especially gallbladder, and the gallbladder wall edema was most common with little or without bile. Two Patients with pancreatic enlargement and peripancreatic effusion were critical patients. Both of them were prenatal and one of them died of respiratory failure which was a rare complication. Splenomegaly and pleural fluids of postpartum patients were more than those of prenatal patients. Conclusions Abdominal ultrasound of AFLP has its own characteris tics, which would be useful for diagnosis treatment and predict prognosis.