妊娠急性脂肪肝的临床诊治分析

Analysis of the clinical diagnosis and treatment of acute fatty liver of pregnancy

目的:探讨妊娠急性脂肪肝(AFLP)的早期诊断方法和治疗原则。方法:对2007年1月一2011年10月在解放军总医院收治的7例AFLP患者的临床资料进行回顾性分析。结果:7例AFLP患者中食欲下降6例(85.7%),恶心、呕吐5例(71.4%),黄疸7例(100.0%),水肿6例(85.7%);并发产后大出血5例(71.4%),肾功能衰竭3例(42.9%),弥散性血管内凝血(DIC)3例(42.9%)。6例患者经过及时终止妊娠和综合治疗,预后良好。1例孕产妇死于多脏器功能障碍综合症,1例围产儿死亡。结论:早期诊断,及时终止妊娠,加强多学科综合治疗是改善AFLP母婴预后的关键。

Objective： To explore the early diagnosis and therapeutic principle of acute fatty liver of pregnancy （AFLP）. Methods： Clinical data of 7 cases with AFLP who were treated in the Chinese PLA General Hospital from January 2007 to October 2011 were analyzed retrospectively. Results： AFLP often presented symptoms inclu- ding anorexia （6 cases, 85.7%） ,nausea and vomiting （5 cases, 71.4%）, jaundice （7 cases, 100.0%） and edema （6 cases, 85.7%）,and it was usually complicated with postpartum hemorrhage （5 cases, 71.4%）, renal failure （3 cases, 42.9%）, disseminated intravascular coagulation （3 cases, 42.9%） and so on. Six AFLP patients recov- ered after early delivery,and comprehensive treatments. One pregnant woman died of multiple organ dysfunction syndrome. There was one perinatal fetus death. Conclusion： AFLP is a serious complication which occurs in late trimester of pregnancy. Early diagnosis, termination of pregnancy by cesarean section as soon as possible, and comprehensive therapy are crucial for improving the prognosis of both mother and newborn.