Clinical characteristics of fulminant hepatitis in pregnancy

AIM： To investigate the clinical characteristics of fulminant hepatitis in pregnancy. METHODS： We compared and analyzed the etiology, clinical characteristics, and laboratory examinations of 25 cases of fulminant hepatitis in pregnancy and 30 cases of fulminant hepatitis not in pregnancy. RESULTS： HBV infection and chronic fulminant hepatitis were most common both in the pregnant and in the non-pregnant groups. Jaundice, digestive tract symptoms, increase of bilirubin and thrombinogen activity were the main manifestations. The incidence of hepatic encephalopathy （HE） and hepato-renal syndrome （HRS） was significantly different between the two groups. The incidence of preterm labor, dead fetus and neonatal asphyxia was high. CONCLUSION： Fulminant hepatitis is likely to occur in late pregnancy wibh more severe complications, which significantly influences maternity, perinatal fetus, and newborn.

Etiology of Fulminant Viral Hepatitis in Shenyang

Serological methods were used to determine the cause of fulminant hepatitisin 207 patients. They were admitted to the isolation wards of 4 hospitals inShenyang between 1986-1990. The final diagnoses were: hepatitis type A 4 cas-es (2.0%), type B 144 cases (69.4% ),superinfections with A and B 3 cases (1.5%), hepatitis non-A non-B (NANB) 51 cases (24.6%), type D 2 cases (1.0%), type E 2 cases (1.0%) and cytomegalovirus (CW) infection 1 case (0.5%). The risk factors were found to be concerned with type D and several typesuper infections (prognosis poor).

Liver synthetic function in predicting the prognosis of pregnancy complicating fulminant hepatitis

Pregnancy complicating fulminant hepatitis is characterized by rapid progress, complicated clinical symptoms, and association with blood coagulation dysfunction, hepatic encephalopathy, hepatorenal syndrome, toxic enteroparalysis and infection. Late pregnancy complicating fulminant hepatitis, which has a high fatality rate, is one of the maior causes of death of gravida and puerperant in China. Searching for exact objective indexes and correct judgement of the prognosis is extremely important to clinical work. The indexes of liver function mainly include （1） indexes for the damage of hepatic cells and its degree such as alanine transaminase （ALT）, etc; （2） indexes for the synthesis function of hepatic cells such as albumin （ALB）, total cholesterol （CHOL）, prothrombin time （PT）, prothrombin activity （PTA）, etc; （3） indexes for the function of liver excretion, metabolism and detoxication such as total bilirubin （TBIL）, total bile acid （TBA）, blood ammonia （NH3）, etc.

Prognostic factors of fulminant hepatitis in pregnancy

Fulminant hepatitis （FH） refers to liver diseases that have severe state and complicated manifestations. It will endanger patients＇lives and health largely. The incidence of fulminant hepatitis in pregnancy （FHP） is 66 times of patients not in pregnancy,1 which is more dangerous and is one of the major causes of maternal and perinatal death in China. In order to predict the prognoses of FHP and decrease maternal and perinatal death rate, we summarized clinical information of 25 cases of FHP admitted to our hospital and investigated into prognostic factors that influenced FHP.

First successful perinatal management of pregnancy after ABO-incompatible liver transplantation

Many papers have reported on pregnancy and delivery after liver transplantation, but there have been no reports on pregnancy after ABO-incompatible liver transplantation. This paper reports the first successful pregnancy and delivery of a newborn after ABOincompatible liver transplantation for fulminant hepatic failure. The patient was a 39-year-old female. She had an ABO-incompatible liver transplantation, donated from her husband, due to subacute fulminant hepatitis of unknown etiology. She was taking tacrolimus, methylprednisolone, and mizoribine orally for the maintenance of immunosuppression at the time of discharge. She was discharged uneventfully on postoperative day 38 without any rejection episodes. At 1 year and 6 mo after transplantation, she indicated a wish to become pregnant. Therefore, treatment with mycophenolate mofetil was interrupted at that time. After two miscarriages, she finally became pregnant and delivered transvaginally 3 years after the transplantation. All of the pregnancies were conceived naturally. The newborn was female with a birth weight of 3146 g; the Apgar scores were 9 and 10. Delivery was performed smoothly, and the newborn exhibited no malformations. The mother and the newborn were discharged uneventfully. We suggest that pregnancy is possible for recipients after ABO-incompatible liver transplantation.

Acute fatty liver of pregnancy associated with severe acute pancreatitis:A case report

Acute fatty liver of pregnancy is a rare disease that affects women in the third trimester of pregnancy. Although infrequent, the disease can cause maternal mortality. The diagnosis is not always clear until the pregnancy is terminated, and significant complications, such as acute pancreatitis, can occur. Pancreatic involvement typically only occurs in severe cases after the development of hepatic and renal impairment. To date, little knowledge is available regarding how the disease causes pancreatitis. Treatment involves supportive measures and pregnancy interruption. In this report, we describe a case of a previously healthy 26-year-old woman at a gestational age of 27 wk and 6 d who was admitted with severe abdominal pain and vomiting. This case illustrates the clinical and laboratory overlap between acute fatty liver of pregnancy and pancreatitis, highlighting the difficulties in differentiating each disease. Furthermore, the hypothesis for this overlapping is presented, and the therapeutic options are discussed.

The incidence of sporadic viral hepatitis in North India:a preliminary study

BACKGROUND: Viral hepatitis is one of the major causes of mortality and morbidity in developing countries. Hepatitis E virus (HEV) among the major etiological agents is responsible for both sporadic and epidemic outbreaks. The epidemic outbreak is water-borne whereas the sporadic outbreak is possibly through contact. Various diagnostic tools at times fail to pinpoint the cause of viral hepatitis. This study was carried out to evaluate the utility of ELISA and nRT-PCR (nested reverse transcriptase polymerase chain reaction) for the diagnosis of sporadic and acute viral hepatitis (AVH) caused by HEV in an endemic situation in North India. METHODS: Serum samples were collected from all the affected and suspected persons and subjected to serological detection of HAV IgM, HBsAg, HCV antibody and HEV IgM. The samples that were positive for HEV IgM were further processed for the detection of HEV RNA by nRT-PCR. RESULTS: A total of 843 samples were collected from 685 patients with AVH, 70 patients with fulminant hepatic failure (FHF), 53 patients with chronic liver disease (CLD), 11 patients with antituberculosis therapy (ATT)-induced jaundice, and 24 pregnant women. The percentage of positivity for anti-HEV IgM was 58.3% in the pregnant women, 41.4% in the paients with FHF, 38.6% in the patients with AVH, 9.4% in the patients with CLD and 18.2% in the patients with ATT induced jaundice. 9.4% of HBsAg carriers were positive for anti-HEV IgM. Males outnumbered females (62.8% vs. 37.1%). Furthermore, the rates of fulminant and acute outbreaks of hepatitis with HEV RNA positivity were 41.4% and 9.4%, respectively. CONCLUSION: Serological and molecular analysis should be combined for the diagnosis of viral infections, especially in endemic areas.

劈离式肝移植术后成功妊娠分娩1例并文献复习

目的探讨劈离式肝移植(SLT)术后患者妊娠分娩的临床管理经验。方法收集1例我院器官移植中心收治的SLT术后妊娠并成功分娩患者的临床资料,并复习相关文献。结果患者因“自身免疫性肝炎后肝硬化(失代偿期)”接受同种异体原位SLT,术后出现轻度急性排斥反应,经调整免疫抑制药物治疗后好转。患者术后2年自然妊娠,因既往服用麦考酚钠肠溶片,选择终止妊娠并停用该药。术后3年再次妊娠并出现移植物波动,予调整抗排异药物剂量、保肝对症治疗、先兆早产保胎治疗等处理,最终在肝移植科、产科和新生儿科等相关学科共同指导下,于孕35周剖宫产诞下1名健康女婴。结论SLT受者虽然孕期可能出现移植物功能波动、早产等情况,但在多学科共同合作、科学指导用药及密切随访监测下,亦可以获得满意预后。

应用Cox比例风险模型分析抗病毒治疗对慢性乙型重型肝炎预后的影响

目的应用Cox比例风险模型分析核苷(酸)类似物抗病毒治疗对慢性乙型重型肝炎预后的影响。方法选择219例慢性乙型重型肝炎患者,采用Cox比例风险模型对可能影响其预后的因素进行单变量和多变量回归分析。重点分析核苷(酸)类似物抗病毒治疗对慢性乙型重型肝炎预后的影响。结果多变量回归分析结果显示:年龄、肝性脑病、总胆红素、白蛋白、凝血酶原活动度、血尿素氮、核苷(酸)类似物抗病毒治疗具有独立的预后意义(P<0.05)。纠正混杂因素后,在多变量Cox比例风险模型中比较拉米夫定与恩替卡韦两种药物对慢性乙型重型肝炎预后的影响程度,两者无显著性差异(P>0.05);比较在慢性乙型重型肝炎的早期、中期和晚期抗病毒治疗对预后的影响程度,结果在早期和中期抗与不抗病毒治疗有显著性差异(P<0.05),但晚期抗与不抗病毒治疗已无显著性差异(P>0.05)。结论核苷(酸)类似物抗病毒治疗是影响慢性乙型重型肝炎预后的独立因素。较早开始抗病毒治疗可以改善预后。拉米夫定和恩替卡韦均可选用于对这种患者的治疗。

妊娠期慢性乙型肝炎病毒携带者病毒载量与妊娠结局的相关性

【目的】分析妊娠期慢性乙型肝炎病毒(HBV)携带者病毒载量与妊娠结局的关系。【方法】按HBV-DNA是否≥1.0×103 U/m L分为:HBV-DNA阳性组,172例;及HBV-DNA阴性组,206例;并设立非HBV携带者作为对照组1144例。分别比较各组产妇的住院时间、分娩孕周、剖宫产率、妊娠期并发症(早产、产后出血、妊娠期糖尿病、妊娠期高血压疾病、胎儿生长受限、羊水量异常、胎儿窘迫)及新生儿出生体质量、新生儿窒息、新生儿高胆红素血症等的差异。【结果】HBVDNA阳性组<34周早产发生率较非HBV携带组(对照组)升高,差异有统计学意义(P<0.017);产后出血、妊娠期糖尿病、妊娠期高血压疾病、胎儿生长受限、羊水量异常、胎儿窘迫等发生率组间差异无统计学意义。HBV-DNA阳性组、HBV-DNA阴性组与对照组相比新生儿平均出生体质量下降,新生儿高胆红素血症发生率升高,差异有统计学意义(P<0.001)。3组新生儿窒息发生率差异无统计学意义。【结论】乙型肝炎病毒载量升高时,小于34周的自发性早产的发生率升高,新生儿出生体质量下降;乙型肝炎病毒载量高低不影响其他妊娠期并发症的发生。

妊娠合并重症肝炎患者产前的护理

目的总结妊娠合并重症肝炎患者产前的护理要点。方法对我院2000年1月～2004年10月收治的18例妊娠合并重症肝炎患者进行治疗护理,并统计患者并发症发生情况。结果18例患者出现消化道症状、黄疸、低蛋白血症;14例患者并发肝性脑病;10例患者并发肝肾综合征;15例患者并发感染;14例出现全身出血倾向。结论妊娠合并重症肝炎患者病情危重且变化快、并发症多,护理的关键在于密切观察病情、及早发现并发症及时处理,并注意做好患者心理护理、合理安排饮食,让患者得到充分休息,以降低孕产妇死亡率、提高围产儿存活率。

肝功能及凝血功能指标在妊娠合并重型肝炎预后预测中的作用

目的:探讨妊娠合并重型肝炎患者入院时的肝功能及凝血功能指标在预后预测中的作用。方法:回顾分析40例在我院住院治疗的妊娠合并重型肝炎患者的临床资料,其中存活组23例,死亡组17例,分析2组患者入院时肝功能指标及凝血功能指标与预后的关系。结果:存活组与死亡组入院时在总蛋白(TP)、白蛋白(ALB)、血清总胆固醇(CHOL)、凝血酶原时间(PT)及凝血酶原活动度(PTA)之间的差异显著。而谷草转氨酶(AST)、谷丙转氨酶(ALT)、谷草转氨酶/谷丙转氨酶比值(AST/ALT)、总胆红素(TBIL)、直接胆红素(DBIL)、直接胆红素/总胆红素比值(DBIL/TBIL)、总胆醇(TBA)、球蛋白(GLB)、白蛋白/球蛋白比值(A/G)两组间的差异无显著。TP<48g/L、ALB<22g/L、CHOL<2.0mmol/L或PTA<30%,均提示预后不良。结论:入院时的TP、ALB、CHOL、PT、PTA等指标与妊娠合并重型肝炎的预后密切相关,预测预后的指标主要是与肝脏合成功能和凝血功能有关。早期识别、及时转运、集中救治,是妊娠合并重型肝炎成功救治的重要条件之一。

影响妊娠合并重型肝炎预后的单因素研究

目的分析影响妊娠合并重型肝炎预后的单因素。方法对66例妊娠合并重型肝炎患者预后的单因素进行回顾性分析。结果①不同临床分型的病死率不同,急性型最高,慢性型最低;②Tch、PTA降低、Scr升高及WBC≥10×109/L、"胆酶分离"现象、肝脏缩小均提示病死率升高;③随着肝性脑病、肝肾综合征、出血、感染等并发症的增多,病死率升高,以上差异均有统计学意义。结论临床分型、Tch、PTA、Scr、WBC、"胆酶分离"现象、肝脏缩小及并发症等是影响妊娠合并重型肝炎预后的重要因素,动态监测上述指标,积极防治各类并发症是提高临床救治成功率的重要措施。

妊娠合并重型肝炎患者血糖水平与预后关系的临床探讨

目的:探讨妊娠合并重型肝炎患者血糖水平与预后的关系。方法:回顾性分析60例妊娠合并重型肝炎患者的空腹血糖,以血糖水平分组,分析评价其临床意义。结果:60例妊娠合并重型肝炎患者低血糖29例(48.3%),死亡17例(58.6%)。死亡组血糖明显低于存活组(P<0.05),急性重型肝炎血糖水平明显低于慢性重型肝炎(P<0.05)。结论:妊娠合并重型肝炎患者低血糖发生率较高,血糖水平与预后关系密切,血糖越低病死率越高。检测血糖水平对判断妊娠合并重型肝炎的危重程度、评价预后有重要价值。

血清胆固醇水平在妊娠合并重型肝炎预后判断中的临床意义

【目的】探讨血清胆固醇水平(CHOL)在妊娠合并重型肝炎预后判断中的临床意义。【方法】收集40例在我院治疗的妊娠合并重型肝炎患者的临床资料,按其预后分为存活组(22例)及死亡组(18例),回顾性分析CHOL与病情变化及预后的关系。【结果】妊娠合并重型肝炎存活组与死亡组的CHOL差异有统计学意义。CHOL≤1.6mmol/L、CHOL进行性下降或凝血酶原活动度(PTA)≤30%的同时CHOL≤2.0mmol/L,病死率高。CHOL与PTA间存在正相关(r=0.369)。【结论】CHOL可作为妊娠合并重型肝炎预后判断的临床联合指标之一,CHOL≤1.6mmol/L、CHOL进行性下降、PTA≤30%的同时CHOL≤2.0mmol/L,均提示预后不良。

妊娠合并重型肝炎死亡病例20例分析

目的：总结分析妊娠合并重型肝炎死亡病例20例的临床资料，提高妊娠合并重型肝炎的救治成功率。方法：对1997年7月-2007年6月我院20例妊娠合并重型肝炎死亡病例进行回顾性分析。结果：20例妊娠合并重型肝炎死亡病例中，多数患者的首发症状为乏力、纳差、身目黄染，因缺乏特异性，未能引起重视；分娩前人我院的病例存活率高于外院分娩后转入我院的病例，差异有统计学意义；血清白蛋白（ALB）≤22g／L、血清总胆固醇（CHOL）≤1．6mmol／L、凝血酶原活动度（PTA）≤20％、肝脏缩小提示预后极为不良；肝性脑病、肝肾综合征、出血及感染是妊娠合并重型肝炎死亡病例的主要并发症，90％以上的病例于产后1周内死亡。结论：加强围产保健，提高全民认识，早期识别，及时转运，积极动态监测ALB、CHOL、PTA及肝脏大小等指标，早期防治肝性脑病、肝肾综合征、出血及感染，多学科协作，是现阶段降低妊娠合并重型肝炎病死率的重要措施。

重症病毒性肝炎的病原学分析

本文对165例重症病毒性肝炎的临床资料,病理组织学检查及血清病原学分型进行分析,确定为甲型肝炎病毒感染者5例;甲、乙型肝炎病毒重叠感染3例;乙型肝炎病毒感染112例;非甲非乙型肝炎42例;丁型肝炎病毒感染2例和CMV病毒感染1例。发现Delta病毒感染及重叠感染者预后不良。

妊娠中晚期重型肝炎对孕妇及胎儿预后影响的研究

目的研究妊娠中晚期重型病毒性肝炎(以下简称重肝)对孕妇及胎儿预后的影响。方法观察引起妊娠中晚期重肝的感染病原体,比较各型各期患者的病死率、存活组和死亡组之间各项指标、并发症发生的差异以及胎儿病死率与HBV感染的关系。结果HBV相关、HEV相关、重叠感染率分别为66.67%、25.93%、29.63%。总病死率为68.52%,急性、亚急性及慢性妊娠中晚期重肝在病死率方面比较差异无显著性(P>0.05);中期、晚期妊娠重肝患者病死率比较差异无显著性(P>0.05)。存活组和死亡组在凝血酶原时间(PT)、血清总胆固醇(TC)及肝脏体积缩小等指标上差异有显著性(P<0.05)。病死率随着并发症增加而升高。胎儿总病死率48.15%,其中HBV感染相关的病死率占55.56%。结论引起妊娠中晚期重肝的病原体以HBV、HEV为主;该组病例的孕产妇及胎儿病死率高;其孕妇转归与PT、TC、肝脏体积大小及并发症相关;胎儿预后可能与HBV感染有关。

日达仙治疗重型肝炎临床观察

目的:研究免疫调节剂日达仙治疗重型肝炎的临床效果。方法:40例重型肝炎患者,18例给予日达仙治疗与常规治疗,22例给予常规对照治疗,观察临床指标变化及预后。结果:常规疗法结合日达仙治疗可有效降低患者TBil水平,提高PTA,增加血Cho含量,且明显提高患者存活率;同时两组存活患者住院费用相比无显著性差异。结论:日达仙可有效治疗慢性重型肝炎,改善患者预后。

妊娠合并重型肝炎转运时机对预后的影响

目的:探讨妊娠合并重型肝炎转运时机对预后的影响。方法:分析28例妊娠合并重型肝炎病例资料,分为死亡组和存活组,对比两组由外院转来我院时的情况。数据分析采用卡方检验、t检验、u检验、秩和检验。结果:在转入我院时是否分娩对预后的影响有显著性差异;两组患者从起病到转入我院时间长短的差别有显著性;入院时两组在凝血酶原活动度、血清胆固醇、血清总胆红素、肝脏大小、肝性脑病、是否达重型肝炎诊断等方面有显著性差异,即转运时病情的轻重对预后的影响有显著性差异。结论:妊娠合并重型肝炎在产前、在病情较轻尚未发展到重型肝炎前及时转运到有条件的医院预后较好。