16例妊娠急性脂肪肝临床分析

Clinical analysis of 16 cases acute fatty liver of pregnancy

目的:探讨妊娠急性脂肪肝(AFLP)的早期诊断、治疗及预后有关问题。方法:对焦作市妇幼保健院1999年6月～2009年6月10年间收治的妊娠急性脂肪肝患者16例的临床资料进行回顾性分析。结果:①对具有AFLP高危因素的孕妇,孕晚期进行肝肾功能、心肌酶谱及肝脏超声检查,可筛查出部分极早期病例。②重视AFLP的早期临床表现,进行实验室及影像学检查,尽早明确诊断,及时终止妊娠,可使母婴死亡率明显降低。③AFLP的预后与病程长短有关,病程越长死亡率越高,病程小于7～14d者,死亡率较低,病程超过14d死亡率明显升高;更与病情严重程度有关,若合并低血糖、凝血功能障碍、黄疸1周以上者,死亡率更高。结论:早期诊断和及时终止妊娠,积极内科综合治疗是改善母儿预后的关键。AFLP的预后与病程长短有关,病程越长死亡率越高,更与病情严重程度有关,特别合并严重低血糖、凝血功能障碍者、黄疸1周以上者,死亡率更高。

Objective：To study the acute fatty liver（AFLP） pregnancy early diagnosis,treatment and prognosis related questions.Methods：Maternal and Child Health Hospital in Jiaozuo City,June 1999 to June 2009 10 years admitted with acute fatty liver of pregnancy,clinical data of 16 patients were retrospectively analyzed.Results：①The risk factors for pregnant women with AFLP,third trimester for liver and kidney function,myocardial enzymes and liver ultrasound,could be screened out of some very early cases.②Importance of AFLP early clinical manifestations,laboratory and imaging tests,early diagnosis and timely termination of pregnancy,could significantly reduce maternal and infant mortality.③AFLP prognosis and the length of the course,the longer the duration the higher mortality rate,duration of less than 7-14 d the death rate was low,the course more than 14 d mortality rate was significantly higher;more with disease severity,if combined with low blood glucose,coagulation disorders,jaundice more than 1 week the death rate was higher.Conclusion：Early diagnosis and prompt termination of pregnancy,active medical treatment is to improve the overall prognosis of the key female children.AFLP and duration of disease,the prognosis,the longer the duration the higher mortality rate,but with the severity of disease,particularly with severe hypoglycemia,coagulation dysfunction,jaundice more than 1 week the death rate is higher.