影响妊娠急性脂肪肝患者治愈时间的危险因素

Risk factors of the cure time of patients with acute fatty liver of pregnancy

目的探讨影响妊娠急性脂肪肝(acute fatty liver of pregnancy,AFLP)患者治愈时间的危险因素。方法对2004年1月至2019年11月首都医科大学附属北京地坛医院收治的38例AFLP患者进行回顾性分析,根据纳入排除标准,最终纳入35例患者。根据治愈时间将患者分为治愈时间≤14 d组(17例)和治愈时间> 14 d组(18例)。记录患者的年龄、孕周、分娩男胎、子痫前期、急性肾功能不全、心功能不全、感染、肝性脑病、肝衰竭、产后出血、凝血酶原活动度(prothrombin time activity,PTA)<50%及低血糖等临床资料。采用多因素Logistic回归分析影响AFLP患者治愈时间的危险因素。结果单因素分析表明,治愈时间≤14 d组和治愈时间> 14 d组患者男胎分娩(9例vs 11例)、子痫前期(4例vs 8例)、急性肾功能不全(11例vs 12例)、低血糖(7例vs 9例)及肝性脑病(1例vs 2例)等差异无统计学意义(P均> 0.05),产后出血(3例vs10例;P=0.035)、PTA <50%(2例vs 13例;P <0.001)、肝衰竭(1例vs 10例;P=0.003)及感染(1例vs 10例;P=0.003)差异有统计学意义。多因素Logistic回归分析表明,感染是影响AFLP患者治愈时间的独立危险因素(OR=23.692,95%CI:1.550~362.662,P=0.023)。结论感染是影响AFLP患者治愈时间的危险因素,在救治过程中,有效预防感染是患者快速恢复、缩短病程的关键。

Objective To investigate the risk factors of cure time of patients with acute fatty liver of pregnancy(AFLP).Methods The clinical data of 38 patients with AFLP in Beijing Ditan Hospital,Capital Medical University from January 2004 to November 2019 were retrospectively analyzed.A total of 35 patients were eventually included based on inclusion criteria.The patients were divided into cure time≤14 d group(17 cases)and cure time>14 d group(18 cases).Clinical data including age,gestational weeks,male fetuses,preeclampsia,acute renal insufficiency,cardiac insufficiency,infection,hepatic encephalopathy,postpartum hemorrhage,prothrombin time activity(PTA)<50%and hypoglycemia of the patients were recorded.The risk factors of cure time in patients with AFLP were analyzed by multivariate Logistic regression analysis.Results Univariate analysis showed that there were no statistically significant differences in male fetuses(9 cases vs 11 cases),preeclampsia(4 cases vs 8 cases),acute renal insufficiency(11 cases vs 12 cases),hypoglycemia(7 cases vs 9 cases)and hepatic encephalopathy(1 case vs 2 cases)between patients in cure time≤14 d group and cure time>14 d group(all P>0.05),while there were statistically significant differences in postpartum hemorrhage(3 cases vs 10 cases;P=0.035),PTA<50%(2 cases vs 13 cases;P<0.001),liver failure(1 case vs 10 cases;P=0.003)and infection(1 case vs 10 cases;P=0.003).Multivariate Logistic regression analysis showed that infection was an independent risk factor of cure time for patients with AFLP(OR=23.692,95%CI:1.550~362.662,P=0.023).Conclusions Infection is an independent risk factor affecting the cure time of patients with AFLP.During the treatment of AFLP,effective prevention of infection is the key to rapid recovery and shortening the course of disease.