妊娠期非酒精性脂肪肝的预后及影响因素

Prognosis and influencing factors of non-alcoholic fatty liver in pregnancy

目的分析妊娠期非酒精性脂肪肝的预后及影响因素,为临床干预提供指导。方法回顾性收集郑州大学附属洛阳中心医院产科2014年4月至2019年10月间收治80例妊娠期非酒精性脂肪肝患者的临床资料,根据所有患者预后评分将其分为预后良好组(n=57)与预后不良组(n=23);设计基线资料填写表,仔细查阅患者资料并记录研究所需基线资料,将可能的影响因素纳入,经多项Logistic回归分析影响妊娠期非酒精性脂肪肝患者预后不良的相关因素。结果预后不良组在直接胆红素(DBil)升高、肌酐(Cr)水平升高、白蛋白(Alb)水平降低、白细胞计数(WBC)计数升高、空腹血糖(GLU)水平升高方面与预后良好组相比,差异无统计学意义(P>0.05);预后不良组在出现症状至就诊时间、活化部分凝血活酶时间(APTT)水平升高方面与预后良好组相比,差异有统计学意义(P<0.05);经卡方检验单因素分析与非条件多项Logistic回归分析检验结果显示,出现症状至就诊时间>7 d、APTT水平升高可能是导致妊娠期非酒精性脂肪肝预后不良的影响因素(OR>1,P<0.05)。结论出现症状至就诊时间>7 d、APTT水平升高可能是导致妊娠期非酒精性脂肪肝预后不良的影响因素,临床工作中需积极予以对症治疗,以期改善妊娠期非酒精性脂肪肝患者预后。

Objective To analyze the prognosis and influencing factors of non-alcoholic fatty liver in pregnancy and provide guidance for clinical intervention.Methods The clinical data of 80 patients with nonalcoholic fatty liver of pregnancy admitted to the Department of Obstetrics,Luoyang Central Hospital,Zhengzhou University from April 2014 to October 2019 were retrospectively collected,and all patients were divided into a good prognosis group based on the prognosis score of all patients(n=57)and poor prognosis group(n=23);design the baseline data filling form,carefully review the patient data and record the baseline data required for the study,include possible influencing factors,and analyze the influence of non-alcoholicity during pregnancy by multiple logistic regression analysis Factors related to poor prognosis of fatty liver patients.Results The poor prognosis group had the same level of direct bilirubin(DBil)increase,creatinine(Cr)level,albumin(Alb)level,white blood cell count(WBC)increase,and fasting blood glucose(GLU)level.Compared with the good prognosis group,the difference was not statistically significant(P>0.05);the poor prognosis group was statistically different from the good prognosis group in terms of the time from onset of symptoms to treatment and elevated activated partial thromboplastin time(APTT)levels Significance(P<0.05);the results of univariate analysis and unconditional multinomial logistic regression analysis by Chi-square test showed that the time from onset of symptoms to treatment>7 days,and elevated APTT levels may cause non-alcoholic fatty liver in pregnancy Factors affecting poor prognosis(OR>1,P<0.05).Conclusion The time from onset of symptoms to medical treatment>7 days,and elevated APTT levels may be the factors that lead to poor prognosis of non-alcoholic fatty liver in pregnancy.Active symptomatic treatment is needed in clinical work to improve the prognosis of patients with non-alcoholic fatty liver in pregnancy.