妊娠期乙型肝炎病毒及妊娠急性脂肪肝相关肝功能衰竭患者的临床分析

Clincal analysis of hepatitis B virus during pregnancy and acute fatty liver of pregnancy related to liver failure

目的探讨妊娠期乙型肝炎病毒及妊娠急性脂肪肝相关肝功能衰竭的鉴别,以及不同的产科处理要点。方法选取2009年1月至2014年10月首都医科大学附属北京地坛医院收治的妊娠期肝功能衰竭病例共11例的临床资料进行回顾性分析。根据不同病因,分为两组,即乙型肝炎病毒组(HBV组,6例)及妊娠急性脂肪肝组(AFLP组,5例),分别对两组患者分娩前ALT、AST、TBil、DBil、UA、Cr、BUN和CHE水平进行比较。结果 11例肝功能衰竭患者均有明显不适症状;HBV组与AFLP组比较,尿酸(t﹦5.536,P=0.001)和肌酐(t﹦3.392,P=0.012)水平差异均具有统计学意义。结论尿酸和肌酐的指标值可作为区别乙型肝炎病毒相关的妊娠期肝功能衰竭与妊娠急性脂肪肝相关的肝功能衰竭的依据。尽早明确肝功能衰竭的病因,根据病因选择不同的产科处理模式,配合多学科综合救治,成为改善母婴预后的关键。

Objective To explore the identiifcation of the hepatitis B virus during pregnancy and acute fatty liver of pregnancy related to liver failure, and the main points of different obstetric treatments. Methods From January 2009 to October 2014, the data of 11 pregnancy cases with liver failure in Beijing Ditan Hosptal, Capital Medical University were analyzed, retrospectively. According to the different causes, cases were divided into two groups：HBV group （5 cases） and AFLP group （6 cases）. The levels of ALT, AST, TBil, DBil, UA, Cr, BUN and CHE of the two groups before delivery were compared, respectively. Results Total of 11 cases with liver failure had obvious symptoms. In the comparison of group HBV and group AFLP, the levels of uric acid （t=5.536, P=0.001） and creatinine （t=3.392, P=0.012） were both with signiifcant differences. Conclusions Uric acid and creatinine index could be used as the difference between liver failure caused by viral hepatitis, and liver failure caused by acute fatty liver of pregnancy. Clear the cause of hepatic failure as soon as possible, the different choice of the mode of obstetrical treatment based on the cause, Cooperate with multi-disciplinary comprehensive treatment, becomes the key to improving the prognosis of maternal and infant.