妊娠期急性脂肪肝9例分析

Analysis of 9 cases with acute fatty liver in pregnancy

目的探讨妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)的临床特点,为早期诊断、治疗提供临床依据。方法对2002～2009年首都医科大学附属北京妇产医院收治的9例AFLP患者的临床资料进行回顾性分析。结果本资料中9例患者,首发症状均为消化道症状,短期内可出现不同程度的肝肾功能损伤及凝血功能改变,严重时发生弥漫性血管内凝血、多脏器功能衰竭。结论 AFLP患者及新生儿预后与病程长短及治疗密切相关。对AFLP患者进行早期诊断及治疗,及时终止妊娠,积极预防DIC,补充凝血物质,有利于改善AFLP患者及围产儿预后。

Objective To detect the clinical characteristics of acute fatty liver in pregnancy.Methods Retrospective analysis was performed on 9 cases delivered in Beijing Obstetrics and Gynecology Hospital during the recent 6 years.Results Acute fatty liver in pregnancy occured in the third trimester,the first symptom of the 9 cases was the digestive tract symptom,such as nausea,vomiting,malaise,etc.The damage of liver,kidney and coagulatory system would appear within short time.Liver function abnormality included hypoalbuminemia and elevated hepatic aminotransferase levels（ALT,AST）,total bilirubin and direct bilirubin.Kidney function abnormality included elevated BUN and creatinine.Clotting dysfunction included prolonged prothrombin time,low platelet and disseminated intravascular coagulation（DIC）.The mortality of pregnant women with this syndrome was 11.1%,and the mortality of neonates was 16.7%.Conclusion The outcome of pregnant women and neonates was closely related to the course of the illness and therapy.Early diagnosis,termination of pregnancy in time,and prevention of DIC would improve the outcome of pregnant women and neonates.