妊娠期急性脂肪肝的临床探讨

Clinical Observation of Acute Fatty Liver of Pregnancy

目的探讨妊娠期急性脂肪肝的临床特点、诊疗方法。方法整群选择该院自2012年7月—2015年1月收治的96例妊娠期急性脂肪肝患者的临床资料,全部患者均给予B超、CT等检查,结合实验室检查与病理活检确诊。确诊后,全部患者均给予积极的内科综合治疗,同时,及时终止妊娠。结果该组患者发病前1周,均有不同程度临床症状,全部患者有进行性黄疸加重情况。实验室检查可见细胞数量增加、血小板减少,肝、肾功能、凝血功能异常等症状。给予患者B超检查可见脂肪肝特点,CT可见肝实质均匀一致密度减低。该组患者均给予积极的对症治疗,并于24 h内给予终止妊娠,其中4例患者死亡,其发病时间到妊娠时间大于2周,共娩出胎儿92个,其中男活婴60例,女活婴28例,4例男死婴,围产儿死亡率4.2%。新生儿预后较好。结论加强妊娠晚期患者的临床观察,一旦发现疑似妊娠期急性脂肪肝,应立即给予检查。一经确诊,应立即给予治疗,并终止妊娠,以改善患者与围产儿预后。

Objective To observe the clinical features, diagnosis and treatment methods of acute fatty liver of pregnancy. Methods The clinical data of the 96 patients with acute fatty liver of pregnancy admitted in our hospital during July 2012 and January2015 was selected, all of whom had received b-ultrasonic examination and CT examination and had been confirmed by laboratory tests and pathologic biopsy. Once confirmed, all the patients underwent comprehensive medical treatment positively and timely termination of pregnancy together. Results Clinical symptoms of different levels, such as progressive jaundice exacerbation, were found in all the patients one week before the onset. Other symptoms showed by laboratory tests included the increasing of the number of cells, thrombocytopenia, abnormal liver and kidney function, coagulation disorders and so on. The characteristics of fatty liver can be indicated by b-ultrasonic examination and liver parenchyma density decreasing homogeneously by CT examination.After positive symptomatic treatment and termination of pregnancy within 24 h, there were 4 patients losing their life whose onset had lasted more than 2 weeks, and 92 cases of successful labor with 60 viable male infant and 28 viable female infant, and 4 cases of dead infant. The mortality of perinatal infants was 4.2% and neonatal prognosis was good. Conclusion Clinical observation of patients in late pregnancy should be strengthened and inspection should be done for suspected patients with acute fatty liver of pregnancy once found, and treatment and termination of pregnancy should be implemented once diagnosed so as to improve the prognosis of newborn and maternal.