血浆置换在治疗妊娠期急性脂肪肝中的应用价值

Clinical value of plasma exchange in treating patients with acute fatty liver of pregnancy

目的探讨血浆置换在治疗妊娠期急性脂肪肝的中的应用价值。方法对2010年1月至2013年12月中山大学附属第三医院产科收治的17例采用血浆置换治疗妊娠期急性脂肪肝患者的临床资料进行回顾性分析,分析患者治疗前后的临床症状、体征、肝肾功能、凝血等指标,以及血浆置换出现的副作用。结果 (1)患者治疗前后各项检查指标的比较:白细胞(20.2±9.1)×109/L与(15.2±5.9)×109/L、天冬氨酸转氨酶(304.3±312.6)U/L与(81.4±99.5)U/L、丙氨酸转氨酶(332.5±348.3)U/L与(116.7±198.9)U/L、总胆红素(130.5±113.6)μmol/L与(84.3±35.5)μmol/L、凝血酶原时间(22.5±6.3)s与(19.6±6.7)s、尿素(9.6±7.8)mmol/L与(7.6±4.2)mmol/L、尿酸(515.3±167.0)μmol/L与(380.0±219.4)μmol/L,均得到明显改善(P值均<0.05);(2)血浆置换副作用小,未出现因不良反应而终止血浆置换治疗的病例。结论血浆置换用于治疗妊娠期急性脂肪肝具有安全、有效等特点,在及时终止妊娠后使用血浆置换可有效遏制病情的发展。

Objective To explore the application value of plasma exchange in treating acute fatty liver of pregnancy （AFLP）. Methods This study collected the clinical data of 17 AFLP patients, who were treated with plasma exchange in the obstetrics department of The Third Affiliated Hospital of Sun Yat- sen University from January 2010 to December 2013. Symptoms, physical signs, hepatorenal function, coagulation function before and after treatment of plasma exchange and the adverse effects were retrospectively analyzed. Results （ 1 ） Compared with before treatment and after treatment, white blood cell, aspartate transaminase, alanine aminotransferase, total bilirubin, prothrombin time, urea and uric acid were obviously improved （P 〈 0. 05 ）. Before treatment, white blood cell, aspartate transaminase, alanine aminotransferase, total bilirubin, prothrombin time, urea and uric acid were（20. 2± 9. 1 ）×10^9/L, （304.3 ±312.6）U/L,（332.5 ±348.3）U/L, （130.5 ± 113.6） μmol/L, （22.5 ±6.3）s, （9.6 ±7.8）mmoL/L, （515.3± 167.0） μmol/L, respectively. After treatment, they were （ 15.2 ±5. 9）×10^9/L, （81.4 ±99. 5） U/L, （116.7 ±198.9）U/L, （84.3±35.5）μmol/L, （19.6±6.7）s, （7.6±4.2）mmol/L, （380.0±219.4）μmol/L, respectively. （2） Adverse reactions during plasma exchange were generally mild and tolerable, and no patients discontinued treatment due to adverse events. Conclusion Plasma exchange is safe and effective for the AFLP patients, and timely application of plasma exchange after termination of pregnancy can effectively reverse the progression of AFLP.