妊娠期急性脂肪肝23例临床分析

Clinical analysis of 23 cases of acute fatty liver of pregnancy.

目的分析妊娠期急性脂肪肝(AFLP)的临床特点及诊治方法,以降低孕产妇及围生儿的病死率。方法回顾性分析2001年1月至2012年1月我院住院收治的23例AFLP患者的临床表现、孕产妇及围产儿结局,并进行随访。结果 23例AFLP发生孕周平均为34+2周,常见的主要首发症状为恶心、呕吐、食欲不振21例(91.3%),黄疸21例(91.3%),腹水13例(56.5%)和腹痛12例(52.2%);合并急性肾功能不全18例(78.3%)、弥漫性血管内凝血(DIC)11例(47.8%),产后出血10例(43.5%),肝性脑病8例(34.8%),合并妊娠期高血压6例(26.1%)。3例孕产妇死亡,8例围产儿死亡。结论 AFLP是发生于妊娠晚期的一种罕见临床综合征,多发生在妊娠34周左右。早期诊断和及时终止妊娠是改善AFLP预后的关键,多科协作、综合治疗、有效防治多脏器功能衰竭是治疗成功的保障。

Objective To analyze the clinical features and management of acute fatty liver of pregnancy （AFLP） to improve maternal and fetal survival. Methods From January 2001 to February 2012, medical records of patients with AFLP were reviewed, including symptoms, laboratory findings, and maternal and perinatal outcome. Results The mean gestational age at delivery was 34 weeks, 16 of the 23 patients （69.6%） were nulliparous and 4 had multiple gestation. The most common presenting symptom was nausea/vomiting （21 cases, 91.3%）, jaundice （21 cases, 91.3%）, ascites （13 cases, 56.5%）, and abdominal pain （12 cases, 52.2%）. Maternal morbidity included acute renal insufficiency （18 cases, 78.3%）, disseminated intravascular coagnlopathy （11 cases, 47.8%）, postpartum hemor- rhage （10 cases, 43.5%）, encephalopathy （8 cases, 34.8%）. There were three maternal deaths and eight perinatal deaths. Conclusion AFLP is a rare clinical syndrome of pregnancy that occurs during the third trimester, mostly in about 34 weeks. The early diagnosis and prompt delivery have improved prognosis, and multidisciplinary collab- oration, comprehensive treatment and effective prevention of multiple organ failure are guarantees of successful treatment.