妊娠期急性脂肪肝39例临床分析

Clinical analysis of 39 cases with acute fatty liver of pregnancy

目的探讨妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)的临床特点以及早期诊断和治疗方法。方法对2004年1月至2016年4月于首都医科大学附属北京佑安医院诊治的39例妊娠期急性脂肪肝患者的临床资料进行回顾性分析,总结产妇及新生儿并发症的发生率,并根据是否合并肝肾功能衰竭分为两组,对两组间并发症的发生率进行比较分析。结果 39例AFLP患者中出现上消化道症状或黄疸37例;实验室检查结果示39例患者均有AST和ALT升高、凝血功能异常、胆碱酯酶升高和胆红素升高(以直接胆红素为主),多数患者伴有肾功能异常和低血糖。39例患者中发生肝性脑病12例,肝功能衰竭9例,腹水23例,腹腔感染20例,胸腔积液11例,肾功能不全16例,产后出血18例,妊娠期高血压6例。于本院分娩的26例患者中,早产12例,新生儿窒息11例,死胎3例。结论妊娠期急性脂肪肝是一种严重的妊娠期并发症,多发于妊娠晚期,对母儿危险性高,在临床诊治过程中,应重视患者的临床症状,早期诊断、积极治疗、及时终止妊娠以改善母儿预后。

Objective To investigate the clinical features, diagnosis and treatment methods of acute fatty liver of pregnancy（AFLP）. Methods Clinical data of 39 pregnant women with acute fatty liver of pregnancy were collected and analyzed retrospectively. All the cases were presented from January 2004 to April 2016 in Beijing Youan Hospital, Capital Medical University. The incidence of maternal and neonatal complications were summarized. The patients were divided into two groups according to whether they were complicated with hepatic or renal failure, and the incidence of complications between the two groups were compared. Results Out of the 39 cases with AFLP, 37 cases occurred upper gastrointestinal symptoms or jaundice. The laboratory examination results showed that all patients had elevated AST and ALT, abnormal coagulation function, elevated cholinesterase and bilirubin（mainly were direct bulirubin）. Most of the cases were accompanied with abnormal renal function and hypoglycemia. In the 39 patients, there were 12 cases with hepatic encephalopathy, 9 cases with hepatic failure, 23 cases with ascites, 20 cases with abdominal infection, 11 cases with pleural effusion, 16 cases with renal inadequacy, 18 cases with postpartum hemorrhage and 6 cases with gestational hypertension disease. There were 26 cases who delivered in Beijing Youan Hospital, Capital Medical University, and out of whom 12 cases were premature delivery, 11 cases occurred asphyxia neonatorum and 3 cases were stillbirth. Conclusions AFLP is a severe complication in pregnancy, which often occurs in the third trimester of pregnancy and has a high risk for both mothers and fetus. In clinical procedures, more attention should be paid to the symptoms of the patients in order to make early diagnosis and treat actively and timely termination can improve the outcomes of mothers and infants.