利用Child-Pugh改良评分法分析妊娠期急性脂肪肝的临床特点及预后

Analysis on clinical characteristics and prognosis of acute fatty liver of pregnancy by modified Child-Pugh score

目的根据Child-Pugh改良评分对妊娠期急性脂肪肝(AFLP)患者进行分级,总结妊娠期急性脂肪肝患者的临床特征及预后,探讨母儿结局及临床诊治要点。方法采用回顾性分析的方法分析2008年1月-2017年1月该院收治的36例AFLP患者的预后及临床特点。36例患者均表现为肝脏损害为主伴多器官功能受损,根据Child-Pugh改良评分对肝脏功能评级分为:A级组5例,B级组16例,C级组15例。结果 3组间多器官功能障碍综合征(MODS)发生率和围生儿死亡率比较差异有统计学意义(P<0.05)。评分越高,MODS发生率和围生儿死亡率越高。结论临床AFLP误诊率高,肝功能恶化期间肝损程度和支持治疗对母儿预后影响大。尽早就诊、早期诊断、及时终止妊娠是降低母儿死亡率的关键。

Objective To grade acute fatty liver of pregnancy（ AFLP） by modified Child-Pugh score,summarize clinical characteristics and prognosis of AFLP patients,explore maternal and infantile outcomes,key points of clinical diagnosis and treatment. Methods The prognosis and clinical characteristics of 36 patients with AFLP treated in the First Affiliated Hospital of Guangxi Medical University from January 2008 to January 2017 were analyzed retrospectively,the main symptom was liver damage complicated with multiple organ damage. According to modified Child-Pugh score,the patients were divided into group A（ 5 patients）,group B（ 16 patients）,and group C（ 15 patients）. Results There were statistically significant differences in the incidence rate of multiple organ dysfunction syndrome（ MODS） and perinatal mortality among the three groups（ P〈0. 05）. The higher the score was,the higher the incidence rate of MODS and perinatal mortality were. Conclusion The clinical misdiagnostic rate of AFLP is high. The effects of liver damage degree and support therapy on maternal and infantile prognosis are large during aggravation of liver function. Early diagnosis,timely termination of pregnancy are key points to reduce maternal and infantile mortality.