AFLP并发ALF孕妇的临床特点及实验室指标分析研究

Study on the analysis of clinical characteristics and laboratory indexes of pregnancy with AFLP and ALF

目的分析妊娠急性脂肪肝(AFLP)并发急性肝衰竭(ALF)孕妇的临床特点及实验室相关指标。方法选取2006-2018年达州市中心医院和重庆医科大学附属第二医院收治的57例AFLP孕妇为研究对象,根据是否并发ALF分为并发组(n=23)和未并发组(n=34),回顾性分析两组临床特点、治疗预后及实验室指标等资料。结果并发组平均发病孕周(35.8±2.1)周,入院时以黄疸、纳差、恶心呕吐等消化道症状最为常见。与未并发组比较,并发组总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、尿素氮(BUN)、血肌酐(SCR)、血氨、凝血酶原时间(PT)、白细胞计数(WBC)水平更高,清蛋白(ALB)、血糖(GLU)、纤维蛋白原(FIB)和血小板计数(PLT)水平更低,差异有统计学意义(P<0.05)。并发组易发生凝血功能障碍、低蛋白血症、急性肾损伤及低血糖等并发症,其中4例死于多脏器衰竭。结论早期诊治及控制ALF相关并发症是改善AFLP并发ALF孕妇预后的关键措施。

Objective To analyze the clinical characteristics and laboratory-related indicators of pregnant women with acute fatty liver of pregnancy(AFLP)complicated with acute liver failure(ALF).Methods A total of 57 AFLP pregnant women admitted to Dazhou Central Hospital and the Second Affiliated Hospital of Chongqing Medical University from 2006 to 2018 were selected as the research subjects.According to whether ALF was complicated,they were divided into the complicated group(n=23)and the non-complicated group(n=34),the clinical characteristics,prognosis and laboratory indicators of the two groups were analyzed retrospectively.Results In the complicated group,the average gestational week was(35.8±2.1)weeks,the most common clinical manifestation was gastrointestinal symptoms such as jaundice,anorexia,nausea and vomiting.Compared with the non-complicated group,the levels of total bilirubin(TBil),alanine aminotransferase(ALT),urea nitrogen(BUN),blood creatinine(SCR),blood ammonia,prothrombin time(PT),white blood cells count(WBC)in the complicated group were higher,while the levels of albumin(ALB),blood glucose(GLU),fibrinogen(FIB)and platelet count(PLT)were lower,the difference was statistically significant(P<0.05).Complications such as coagulation dysfunction,hypoproteinemia,acute kidney injury,and hypoglycemia were prone to occur.Of these,4 patients died of multiple organ failure.Conclusion Early diagnosis,treatment and controlling of ALF-related complications are the key to improving prognosis of AFLP complicated ALF pregnant women.