妊娠期急性脂肪肝孕妇腹部超声检查的特点分析

Analysis of characteristics of abdominal ultrasonography in pregnant women with acute fatty liver

目的分析妊娠期急性脂肪肝孕妇腹部超声检查的特点。方法30例妊娠期急性脂肪肝孕妇,均实施腹部超声诊断、实验室检查、病理活检。分析孕妇超声诊断结果以及实验室指标[白细胞计数(WBC)、血小板计数(PLT)、血浆纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、血清总胆红素(TBiL)、直接胆红素(DBiL)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)、血糖(Glu)、丙氨酸氨基转移酶(ALT)]检查结果。结果经超声诊断,诊断准确率为100%。影像学图像中,孕妇肝脏体积变大,22例孕妇肝实质回声表现出弥漫性增强现象,细且亮;8例孕妇回声较弱,呈现雪花状,且深度越深,所有孕妇的回声越弱。肝内管道结构不清,可见管壁,平均门静脉内径为(9.54±1.48)mm。经血流成像分析,孕妇肝静脉血流呈现间断现象,脉冲多普勒检测发现平均门静脉最大流速为(0.25±0.06)m/s。孕妇病情变化过程中,15例孕妇肝脏体积明显变小,多见于肝右叶,肝实质回声弥漫变粗且弱;6例孕妇呈现部分低回声区,不明界限,但可见肝内管道结构。19例孕妇出现腹腔积液,量少。17例孕妇胆囊呈现异常状态,胆囊壁较厚,双边影,胆汁透声性能减弱,胆汁淤积。10例孕妇出现胰腺肿大现象,无清楚边界,脾脏大小相对正常。经实验室指标分析:孕妇WBC(18.11±5.32)×10^(9)/L、TBiL(223.57±62.47)μmol/L、DBiL(133.88±42.37)μmol/L、AST(158.19±22.67)U/L、ALT(195.47±46.77)U/L均升高,PLT(76.38±24.68)×10^(9)/L、ALB(29.34±3.67)g/L、FIB(1.30±0.31)g/L、Glu(5.02±1.07)mmol/L均降低,PT(31.58±6.27)s、APTT(55.87±6.34)s、TT(32.79±5.89)s延长。WBC、PLT、TBiL、DBiL、AST、ALT、ALB、FIB、PT、APTT、TT、Glu阳性检出率分别为90.00%、86.67%、100.00%、100.00%、90.00%、93.33%、76.67%、70.00%、90.00%、86.67%、93.33%、90.00%。结论妊娠期急性脂肪肝孕妇腹部超声图像特点典型,临床诊断准确性高,结合实验室检查效果更佳,值得临床推广。

Objective To analyze the characteristics of abdominal ultrasonography in pregnant women with acute fatty liver.Methods 30 pregnant women with acute fatty liver were studied.All patients underwent abdominal ultrasonography,laboratory examinations,and pathological biopsies.The ultrasound diagnostic results as well as laboratory index findings[white blood cell count(WBC),platelet count(PLT),fibrinogen(FIB),prothrombin time(PT),activated partial thrombin time(APTT),thrombin time(TT),total bilirubin(TBiL),direct bilirubin(DBiL),aspartate aminotransferase(AST),albumin(ALB),glucose(Glu),alanine aminotransferase(ALT)]were analyzed.Results The diagnostic accuracy was 100%by ultrasound.In the imaging images,the patient's liver volume became larger,the liver parenchymal echo showed diffuse enhancement phenomenon in 22 patients,fine and bright,8 patients had weak echoes with a snowy appearance,and the deeper the depth,the weaker the echo in all patients.The intrahepatic ductal structure was indistinct,with visible duct walls,and the mean portal vein diameter was(9.54±1.48)mm.Color Doppler flow imaging showed intermittent hepatic venous flow,and the mean maximum portal flow velocity was(0.25±0.06)m/s on pulsed Doppler echocardiography.In the course of disease change,15 patients had significantly smaller liver volumes,mostly in the right lobe of the liver,with diffuse thickening and weak echogenicity of the liver parenchyma,and 6 patients presented partial hypoechoic areas with unknown boundaries,but intrahepatic ductal structures were visible.Abdominal effusion was found in 19 patients with small amounts.The gallbladder presented an abnormal state in 17 patients,with a thick gallbladder wall,bilateral shadowing,reduced bile transmissibility,and bile stasis.10 patients showed pancreatic enlargement without clear borders,and the spleen was relatively normal in size.Laboratory index analysis:the WBC[(18.11±5.32)×10^(9)/L],TBiL[(223.57±62.47)μmol/L],DBiL[(133.88±42.37)μmol/L],AST[(158.19±22.67)U/L],ALT[(195.47±46.77)U/L]increased,the levels of PLT[(76.38±24.68)×10^(9)/L],ALB[(29.34±3.67)g/L],FIB[(1.30±0.31)g/L],Glu[(5.02±1.07)mmol/L]decreased,and PT[(31.58±6.27)s],APTT[(55.87±6.34)s],TT[(32.79±5.89)s]prolonged.The positive rates of WBC,PLT,TBiL,DBiL,AST,ALT,ALB,FIB,PT,APTT,TT and Glu were 90.00%,86.67%,100.00%,100.00%,90.00%,93.33%,76.67%,70.00%,90.00%,86.67%,93.33%,and 90.00%.Conclusion The abdominal ultrasound image characteristics of pregnant women with acute fatty liver are typical,with high clinical diagnostic accuracy and the result is better in combination with laboratory tests,which is worthy of clinical promotion.