妊娠期急性脂肪肝与HELLP综合征的临床特点分析和比较:一项回顾性队列研究

Clinical features between acute fatty liver of pregnancy versus the syndrome of hemolysis,elevated liver enzymes,and low platelet count:a retrospective cohort study

目的比较妊娠急性脂肪肝(acute fatty liver of pregnancy,AFLP)和HELLP综合征(the syndrome of hemolysis,elevated liver enzymes and low platelet counts)的孕产妇和新生儿结局,寻找早期、快速诊断的临床依据,为临床医生提供有效的鉴别诊断要点,提高诊治时效,有助于改善产妇预后及新生儿结局。方法收集2011年6月至2021年6月10年间在华中科技大学协和深圳医院产科住院诊断为AFLP和HELLP综合征产妇的病历资料进行回顾性研究分析。采用Swansea标准诊断AFLP,采用Tennessee分类系统诊断HELLP综合征。比较AFLP组和ELLP组的产妇特征、实验室数据、并发症和新生儿结局。计数资料采用卡方检验,计量资料采用Student’s t检验或Mann-Whitney U检验。结果在研究期间,有12例产妇符合AFLP诊断标准,年龄(31.4±3.9)岁,有60例产妇符合HELLP综合征诊断标准,年龄(31.6±5.0)岁。AFLP产妇共分娩新生儿14例,HELLP综合征产妇共分娩新生儿67例。与HELLP综合征组相比,AFLP组有更多的产妇并发症,包括黄疸[66.7%(8/12)比16.7%(10/60),P=0.001]、弥散性血管内凝血[DIC,50.0%(6/12)比5.0%(3/60),P<0.001]、急性肾功能损伤[25.0%(3/12)比3.3%(2/60),P=0.038],其输血率[58.3%(7/12)比10.0%(6/60),P<0.001]及重症监护病房(ICU)入院率[33.3%(4/12)比1.6%(1/60),P=0.001]也明显升高。而HELLP综合征组的重度子痫前期发生率[85.0%(51/60)比0.0%(0/12),P<0.001]显著升高。与AFLP组相比,HELLP综合征组出生体质量[(2002.2±850.7)g比(2650.7±667.1)g,P=0.009]及出生胎龄[33.9(6.6)周比36.7(1.4)周,P=0.045]均低于AFLP组,小于胎龄儿[SGA,49.3%(33/67)比14.3%(2/14),P=0.035]和新生儿呼吸窘迫综合征[NRDS,52.2%(35/67)比14.3%(2/14),P=0.022]的发生率更高。结论AFLP与产妇器官功能障碍发生率较高相关,而HELLP综合征更影响新生儿结局。

Objective To compare the outcomes of pregnant women with acute fatty liver of pregnancy(AFLP)and the syndrome of hemolysis,elevated liver enzymes,and low platelet count(HELLP),provide clinical evidences for their early and fast diagnosis,provide effective differential diagnosis points for clinical doctors,and improve diagnosis and treatment efficiencies as well as the pregnant women's prognosis and neonates'outcomes.Methods The case data of the pregnant women with AFLP and HELLP hospitalized at Department of Obstetrics,Union Shenzhen Hospital,Huazhong University of Science and Technology from June 2011 to June 2021 were retrospectively analyzed.AFLP was diagnosed according to the Swansea criteria,and HELLP syndrome according to the Tennessee Classification System.The maternal characteristics,laboratory data,complications,and neonatal outcomes were compared between the AFLP and HELLP women.The categorical variables were analyzed by Chi-square test,and the continuous variables by Student's t test or Mann-Whitney U test.Results In the period of the study,there were 12 women who met the diagnosis criteria of AFLP and who were(31.4±3.9)years old and 60 women who met the diagnosis criteria of HELLP syndrome and who were(31.6±5.0)years old.The AFLP women gave birth to 14 babies,and the HELLP syndrome women 67 babies.The incidences of jaundice,disseminated intravascular coagulation(DIC),and acute kidney injury,blood transfusion rate,and ICU admission rate in the AFLP women were higher than those in the HELLP syndrome women[66.7%(8/12)vs.16.7%(10/60),P=0.001;50.0%(6/12)vs.5.0%(3/60),P<0.001;25.0%(3/12)vs.3.3%(2/60),P=0.038;58.3%(7/12)vs.10.0%(6/60),P<0.001;and 33.3%(4/12)vs.1.6%(1/60),P=0.001].The incidence of severe preeclampsia in the HELLP syndrome women was higher than that in the AFLP women[85.0%(51/60)vs.0.0%(0/12),P<0.001].The birth weight and gestational age in the HELLP syndrome women were lower than those in the AFLP women[(2002.2±850.7)g vs.(2650.7±667.1)g,P=0.009;33.9(6.6)weeks vs.36.7(1.4)weeks,P=0.045].The incidences of small for gestational age infants(SGA)and neonatal respiratory distress syndrome(NRDS)in the HELLP syndrome women were higher than those in the AFLP women[49.3%(33/67)vs.14.3%(2/14),P=0.035;52.2%(35/67)vs.14.3%(2/14),P=0.022].Conclusion AFLP is associated with a higher incidence of maternal organ dysfunction,while HELLP syndrome affects neonatal outcomes more.