妊娠急性脂肪肝与溶血、肝酶升高和低血小板综合征的比较

Comparison of maternal and neonatal outcomes in acute fatty liver of pregnancy and hemolysis,elevated liver enzymes and low platelet syndrome

目的 探究妊娠期急性脂肪肝(AFLP)与溶血、肝酶升高和低血小板综合征(HELLP)这两种妊娠并发症之间的差异,为减少AFLP和HELLP综合征的误诊提供帮助。方法 研究回顾性地收集了2009年—2021年北京市朝阳区妇幼保健院妇产科收治的13名AFLP患者和69名HELLP患者的入院时的一般资料(年龄、体质量指数、入院时血压、临床症状和妊娠情况),入院时实验室检测的相关指标,患者的住院天数以及并发症和胎儿结局进行统计分析。结果 AFLP组患者相比起HELLP组患者入院时表现出更多的食欲减退(53.85%)、恶心呕吐(69.23%)和黄疸(53.85%)的临床症状,而HELLP组患者更多表现出头痛的症状(72.46%)。实验室检测指标情况。AFLP组和HELLP组的血糖水平、血红蛋白水平、白蛋白水平、乳酸脱氢酶水平均无显著差异(P>0.05)。而AFLP组和HELLP组相比,除胆固醇水平HELLP组显著高于AFLP组外,AFLP组的血小板计数、白细胞计数、总胆红素、总胆汁酸、谷丙转氨酶、谷草转氨酶、血浆凝血酶原时间、纤维蛋白原、血尿素氮、血清肌酐和尿酸水平均显著高于HELLP组(P<0.05)。在孕产妇不良并发症发生情况方面AFLP组患者黄疸、需要输血、凝血障碍、急性肾功能障碍和肝性脑病的发生情况均显著高于HELLP组患者,HELLP组患者则出现较多的先兆子痫。AFLP组和HELLP组的胎儿不良结局上两组间无明显差异。结论 实验室检测指标对于区分AFLP和HELLP综合征有重要意义,尤其是HELLP综合征孕产妇的胆固醇水平和纤维蛋白原水平显著高于AFLP患者。AFLP患者相比起HELLP患者会出现较多类型的严重并发症。

Objective To investigate the differences between acute fatty liver of pregnancy(AFLP)and haemolysis,elevated liver enzymes and low platelet syndrome(HELLP)so as to help reduce misdiagnosis.Methods Blood samples were collected on admission for relevant clinical laboratory test,relative data were collected too;elated clinical examinations were cariied out,and complications,pregnancy status,and outcome were recorded from 13 pregnant women diagnosed as with AFLP and 69 pregnant women diagnosed as with HELLP.SPSS 25.0 software was used to carry out statistical analysis.Results The patients in the AFLP group showed more clinical symptoms of loss of appetite(53.85%),nausea and vomiting(69.23%)and jaundice(53.85%)at admission compared to the patients in the HELLP group,who showed more symptoms of headache(72.46%).There were no significant differences in the levels of systolic blood pressure and diastolic blood at admission,length of hospital stay,blood glucose,haemoglobin s,albumin,and lactate dehydrogenase and adverse fetal outcomes between the AFLP and HELLP groups(all P>0.05).The levels of white blood cell count,total bilirubin,total bile acids,alanine aminotransferase,aspartate aminotransferase,prothrombin time,blood urea nitrogen,serum creatinine and uric acid of the AFLP group were all significantly higher than those of the HELLP group,and the fibrinogen and cholesterol levels of the AFLP group were significantly lower than that of the HELLP group(all P<0.05).Conclusion Laboratory tests are important in differentiating AFLP from HELLP syndrome,especially in mothers with HELLP syndrome who have significantly higher cholesterol and fibrinogen levels than those with AFLP.The patients with AFLP have more types of serious complications than those with HELLP.