Swansea诊断标准在妊娠期急性脂肪肝诊断及病情评估中的价值  

Values of Swansea criteria on diagnosis and severity evaluation of acute fatty liver of pregnancy

作　　者：李艳萍[1] 王珊[1] 李善玲[1] 王谢桐[1] 孟金来[1] 

机构地区：[1]山东大学附属省立医院产科,济南250021

出　　处：《中华围产医学杂志》2014年第8期559-562,共4页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金（81100447、81170590）;山东省自然科学基金（ZR2009CQ005、5ZR2011HM040）

摘　　要：目的 探讨Swansea诊断标准在妊娠期急性脂肪肝（acute fatty liver of pregnancy,AFLP）诊断及病情评估中的应用价值.方法 2000年1月1日至2011年12月31日,山东大学附属省立医院产科共收治临床诊断AFLP患者52例.根据Swansea诊断标准对52例患者的诊断进行复核.同时,根据Swansea诊断标准符合项目的数量对病例进行分组,结合患者预后及是否需要连续性血液净化治疗,评价轻型及重型患者.组间比较采用x2检验或t检验.Swansea诊断标准符合项目的数量与产后出血量、住院天数的关系采用双变量相关分析. 结果 经Swansea诊断标准复核,31例可诊断AFLP（符合≥7项者20例,符合6项者11例）,另21例不能诊断（符合5项者16例,符合4项者3例,符合3项者2例）.符合5项Swansea诊断标准的16例患者结合产后随访结果可确认诊断AFLP.5例符合4或3项Swansea诊断标准者,由于病情不能用其他疾病解释,也可确认诊断AFLP.符合Swansea诊断标准≥7项的患者胎死宫内发生率和需要连续性血液净化治疗的比例分别为40％（8/20）和65％（13/20）,均高于符合＜7项者,分别为9％（3/32）和28％（9/32）,差异有统计学意义（x2=6.921,P=0.014; x2=6.857,P=0.011）.患者产后出血量与Swansea诊断标准符合项目的数量呈正相关（r2=0.286,P=0.040）. 结论 Swansea诊断标准诊断AFLP可适当放宽至5项,且该标准可用于AFLP的病情评估.Objective To explore the value of Swansea criteria on diagnosis and severity evaluation of acute fatty liver of pregnancy （AFLP）.Methods Fifty-two AFLP patients were admitted to Shandong Provincial Hospital Affiliated to Shandong University between January 1,2000 and December 31,2011.All these cases were retrospectively reassessed by Swansea criteria.According to the severity,prognosis and whether continuous blood purification treatment was needed,these cases were classified as mild and severe cases.Differences between groups were detected by x2 or t test.Bivariate correlation analysis was used for Swansea criteria compliance and postnatal hemorrhage and days in hospital.Results After reassessing by Swansea criteria,31 cases could be diagnosed as AFLP （20 cases met seven or more criteria,11 cases met six criteria）and the other 21 cases could not （16 cases met five criteria,three cases met four,and two cases met three）.For the 16 cases that met five Swansea criteria,they were confirmed as AFLP based on postnatal follow-up.The five cases that met four or three criteria were confirmed as AFLP because no other disease could explain their status.Among the patients who met seven or more Swansea criteria,the incidence of intrauterine fetal death was 40％ （8/20）,and 65％ （13/20） needed continuous blood purification.These were higher than in patients who met six or fewer Swansea criteria [9％ （3/32） and 28％ （9/32）,x2=6.921 and 6.857,P=0.014 and 0.011].Postpartum hemorrhage was positively correlated with Swansea criteria compliance （r2=0.286,P=0.040）.Conclusion Patients who meet five Swansea criteria can be diagnosed as AFLP.Swansea criteria can be applied to the severity evaluation of AFLP.

关 键 词：妊娠并发症 脂肪肝 疾病严重程度指数 

分 类 号：R714.25[医药卫生—妇产科学]