妊娠期肝衰竭的临床特点分析

Clinical characteristics of pregnant women with hepatic failure

目的探讨妊娠期肝衰竭的病因分布,比较妊娠晚期乙型肝炎与妊娠期急性脂肪肝(AFLP)引起的肝衰竭临床特点差异。方法收集2005至2014年中山大学附属第三医院收治的妊娠期肝衰竭患者临床资料,分析妊娠期肝衰竭的病因分布,比较妊娠晚期乙型肝炎与AFLP引起肝衰竭间一般资料、实验室检查结果、治疗方式、母婴预后的差异。结果共纳入65例妊娠期肝衰竭患者,病因为乙型肝炎30例(其中晚期妊娠22例)、AFLP 22例(其中晚期妊娠21例)、戊型肝炎3例、自身免疫性肝炎1例,病因不明9例。在晚期妊娠期肝衰竭患者中,AFLP患者中多胎妊娠、高尿酸血症者比例和乳酸脱氢酶、白细胞计数、血清肌酐升高者比例均高于乙型肝炎患者(P均<0.05);乙型肝炎患者中ALT升高>10倍者比例高于AFLP患者(P<0.05);乙型肝炎患者的治疗方式及母婴预后与AFLP比较差异无统计学意义(P均>0.05)。结论妊娠期肝衰竭的病因以乙型肝炎和AFLP为主,乳酸脱氢酶、白细胞计数、血清肌酐、血清尿酸及ALT水平对鉴别乙型肝炎和AFLP引起的妊娠晚期肝衰竭有一定的价值。

Objective To investigate the etiology of hepatic failure during pregnancy and compare the clinical characteristics of pregnant women with hepatic failure induced by hepatitis B and acute fatty liver of pregnancy（ AFLP） in late pregnancy. Methods Clinical data of pregnant women with hepatic failure in the Third Affiliated Hospital of Sun Yat-sen University between 2005 and 2014 were collected. The etiology of hepatic failure during pregnancy was analyzed. General data,laboratory examination outcomes,clinical treatment and the prognosis of mother and infant were statistically compared between pregnant women with hepatic failure induced by hepatitis B and AFLP in late pregnancy. Results Sixty five pregnant women with hepatic failure were recruited. Among them,30 patients with hepatic failure were caused by hepatitis B（ 22 during the late pregnancy） and 22 induced by AFLP（21 during the late pregnancy）,3 by hepatitis E,1 by autoimmune hepatitis and 9 by unknown causes. Among the pregnant women with hepatic failure in the late pregnancy,the percentage of multiple pregnancy,hyperuricemia,elevated levels of lactate dehydrogenase,white blood cell and serum creatinine in the AFLP patients was significantly higher compared with that in their counterparts with hepatitis B（ all P〈0. 05）. The proportion of hepatitis B patients with a level of alanine aminotransferase increased by more than 10 times was significantly higher than AFLP counterparts（ P〈0. 05）. Clinical treatment and the prognosis of mother and infant did not significantly differ between pregnant women with hepatitis B and AFLP（ both P〉0. 05）. Conclusions Hepatic failure during pregnancy is mainly caused by hepatitis B and AFLP. Lactate dehydrogenase,white blood cell,serum creatinine,serum uric acid and alanine aminotransferase levels have certain significance in the differential diagnosis of hepatitis B- and AFLP-induced hepatic failure during late pregnancy.