妊娠期急性脂肪肝母婴不良结局15例分析

ADVERSE MATERNAL AND FETAL OUTCOMES IN ACUTE FATTY LIVER OF PREGNANCY:AN ANALYSIS OF 15 CASES

目的探讨妊娠期急性脂肪肝(AFLP)产妇及其新生儿临床特征与不良结局的关系。方法回顾性分析2013年1月—2016年12月就诊于本院的15例AFLP产妇及其分娩新生儿的临床资料。结果 15例产妇孕周为33~39+6周,绝大多数为初产妇(11例,占73.3%),常见首发症状为消化道症状(12例,占80.0%);实验室检查显示多数产妇存在肝肾功能异常、低蛋白血症、低糖血症、凝血功能异常等,待胎儿娩出后逐渐恢复正常。15例产妇共娩出新生儿19例,其中足月儿10例,早产儿9例;男性新生儿13例,女性新生儿6例。19例新生儿中死亡2例,17例存活儿中发生宫内窘迫5例、新生儿窒息8例。13例转入新生儿重症监护室,均存在不同程度代谢性酸中毒,发生新生儿低糖血症7例,合并多脏器损伤8例,其中脑损伤7例。结论 AFLP是妊娠中晚期少见的致命性并发症,新生儿不良预后受产妇临床表现影响并加重产妇并发症。

Objective To investigate the association of the clinical features of parturients with acute fatty liver of pregnancy（AFLP）and their neonates with adverse outcomes. Methods A retrospective analysis was performed for the clinical data of 15 parturients with AFLP and their neonates who visited our hospital from January 2013 to December 2016. Results The gestational weeks of these parturients ranged from 33 to 39＋6,and of all 15 parturients,11（73.3%）were primiparous.The most common initial symptom was digestive tract symptom,seen in 12 parturients（80.0%）,and laboratory examination showed that most parturients had abnormal liver and renal function,hypoproteinemia,hypoglycemia,and coagulation disorders,which gradually returned to normal after delivery.A total of 19 infants were delivered,with 10 full-term infants and 9 preterm infants;there were 13 boys and 6 girls.Two out of the 19 infants died,and among the 17 infants who survived,5 experienced intrauterine distress and 8 experienced neonatal asphyxia.A total of 13 neonates were admitted to the neonatal intensive care unit and had varying degrees of metabolic acidosis.Seven neonates developed hypoglycemia,and eight were complicated by multiple organ damage,among whom 7 had brain injury. Conclusion AFLP is a rare and fatal complication in the second or third trimester of pregnancy,and the poor prognosis of neonates is affected by the clinical manifestations of parturients and aggravates the complication of partu-rients.