妊娠期急性脂肪肝38例临床分析

Clinical analysis of the acute fatty liver in pregnancy

目的探讨妊娠期急性脂肪肝（AFLP）的临床特点。方法对北京佑安医院2008年5月至2013年11月收治的38例AFLP患者的临床资料进行回顾性分析，包括临床特征、实验室检查和治疗、转归情况。结果38例患者在发病前1-2周均出现不同程度乏力、不适症状，38例均有肝功能障碍，18例肝肾功能衰竭，死亡4例（10．5％），围产儿死亡3例（7.3％）。结论妊娠期急性脂肪肝起病急、病情凶险，应早期诊断治疗、及时终止妊娠，AFLP患者发生产后出血和多脏器功能不全的比例较高，应严密监测及调节凝血功能、肝肾功能，血浆置换治疗可有效降低母体病死率。

Objective To summarize the clinical feature of acute fatty liver in pregnancy（AFLP）. Methods The clinical feature, laboratory examination, treatment and prognosis were retrospectively analyzed of thirty-eight patients who were diagnosed as AFLP from May 2008 to November 2013 in Beijing Youan Hospital. Results All 38 cases of patients with AFLP had fatigue in different degree as the initial symptom during the first 1-2 weeks. All 38 cases had liver dysfunc- tion, 18 cases had liver and kidney failure, 4 cases died（ 10.5% ）, perinatal death in 3 patients（7.3% ）. Conclusion Early diagnosis, termination of pregnancy and cooperation among different disciplines for AFLP is necessary. The possibility for AFLP patients to have postpartum hemorrhage and MODS is high. It should be monitored strictly, and coagulation function and liver as well as kidney function should be adjusted to avoid postpartum hemorrhage and MODS. Plasma exchange treatment can effectively reduce maternal mortality.