63例妊娠期急性脂肪肝临床分析

Clinical analysis of acute fatty liver of pregnancy in 63 cases

目的探讨妊娠期急性脂肪肝的临床特点。方法对2014年1月至2018年8月在广州医科大学附属第三医院就诊的63例妊娠期急性脂肪肝(AFLP)患者的临床资料进行回顾性分析,根据凝血酶原国际比值(INR)分为2组:≥1.5为重型组(n=32),<1.5为轻型组(n=31),观察两组临床特征、实验室检查指标、并发症、孕产妇及胎儿结局等情况。结果妊娠期急性脂肪肝患者多存在消化道症状,更多见于初产妇,且多采用剖宫产终止妊娠;患者具有异常的检验指标,其中轻型组丙氨酸氨基转移酶(ALT)、血小板(PLT)、凝血酶原活动度(PTA)、纤维蛋白原(FBG)高于重型组(P<0.05),总胆红素(TBIL)、直接胆红素(DBIL)、白细胞(WBC)、肌酐(SCr)、INR低于重型组(P<0.05);重型组较轻型组更易并发子痫、低蛋白及急性肾损伤(AKI),P值分别为0.043、0.032、0.036。结论 AFLP患者具有异常的ALT、PLT、PTA、FBG、INR、TBIL、DBIL、WBC、SCr指标;应根据凝血等指标积极补充相关物质,明确诊断后及时终止妊娠,进一步提高AFLP患者救治率。

Objective To investigate the clinical features of acute fatty liver of pregnancy (AFLP). Methods Clinical data of 63 patients with AFLP who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 2014 to August 2018 were retrospectively analyzed. According to prothrombin international ratio (INR), the patients were divided into the severe group (n = 32), in which the INR value was 1.5, and the light group (n = 31), in which the INR value was <1.5. Clinical characteristics, laboratory tests, complications, the outcome of the maternal and fetus were compared between the two groups. Results Most of AFLP patients existed many gastrointestinal symptoms, appeared more common in primipara, and were terminated by cesarean section. Compared with the severe group, propionate aminotransferase (ALT), platelet (PLT), prothrombin activity ( PTA) and fibrinogen ( FBG) levels were higher (all P<0.05), while total bilirubin (TBIL), direct bilirubin (DBIL), white blood cells (WBC), creatinine ( SCr), and INR were lower in the light group (all Pv0.05). Compared with the light group, the complications such as eclampsia, low protein and acute kidney injury ( AKI) were more common in the severe group, with the P value being 0.043, 0.032 and 0.036, respectively. Conclusion AFLP patients have abnormal ALT, PLT, PTA, FBG, INR, TBIL, DBIL, WBC, and SCr indicators. Positively supplementing related substances according to indicators such as coagulation and timely terminating of pregnancy after diagnosis are necessary to further improve the rate of treatment in AFLP.