人工血浆置换治疗对妊娠期急性脂肪肝患者实验室指标及妊娠结局的影响

Effect of Artificial Plasma Exchange Therapy on Laboratory Indexes and Pregnancy Outcome in Patients with Acute Fatty Liver During Pregnancy

【目的】探讨人工血浆置换治疗对妊娠期急性脂肪肝患者实验室指标及妊娠结局的影响。【方法】选取2017年1月至2019年4月在海军军医大学第一附属医院诊治的46例妊娠期急性脂肪肝患者,按照治疗方法不同分为对照组(采用综合治疗,n=23)和观察组(采用综合治疗联合人工血浆置换治疗,n=23)。比较两组患者治疗前后肝功能指标、凝血指标及疗效、妊娠结局。【结果】治疗前,两组患者直接胆红素(DBIL)、总胆红素(TBIL)、谷草转氨酶(AST)、丙氨酸转氨酶(ALT)、凝血酶原时间(PT)、血小板计数(PLT)、纤维蛋白原(FIB)水平比较,差异无统计学意义(P>0.05)。与治疗前相比,两组患者治疗后DBIL、TBIL、AST、ALT、PT水平降低,PLT、FIB水平升高;观察组上述指标改善效果及总有效率均优于对照组(P<0.05)。观察组新生儿轻度窒息、重度窒息发生率明显低于对照组(P<0.05)。【结论】人工血浆置换治疗可有效改善妊娠期急性脂肪肝患者的肝功能、凝血功能及妊娠结局,且具有一定的安全性,值得临床推广应用。

【Objective】To investigate the effect of artificial plasma exchange on laboratory indexes and pregnancy outcome of patients with acute fatty liver during pregnancy.【Methods】A total of 46 patients with gestational acute fatty liver diagnosed and treated in the First Affiliated Hospital of Naval Medical University from January 2017 to April 2019 were selected and divided into control group(comprehensive treatment,n=23)and observation group(comprehensive treatment combined with artificial plasma exchange,n=23)according to different treatment methods.The liver function index,coagulation index,curative effect and pregnancy outcome were compared between the two groups before and after treatment.【Results】Before treatment,the expression levels of direct bilirubin(DBIL),total bilirubin(TBIL),aspartate aminotransferase(AST),alanine aminotransferase(ALT),prothrombin time(PT),platelet count(PLT)and fibrinogen(FIB)were not significantly different between the two groups(P>0.05).Compared with that before treatment,the levels of DBIL,TBIL,AST,ALT and PT decreased and the levels of PLT and FIB increased in the two groups after treatment;The improvement effect and total effective rate of the above indexes in the observation group were better than those in the control group(P<0.05).The incidence of neonatal mild asphyxia and severe asphyxia in the observation group was significantly lower than that in the control group(P<0.05).【Conclusion】Artificial plasma exchange therapy can effectively improve the liver function,coagulation function and pregnancy outcome of patients with acute fatty liver during pregnancy,and has certain safety,which is worthy of clinical application.