妊娠期急性脂肪肝42例临床分析  

Clinical analysis of 42 cases with acute fatty liver during pregnancy

作　　者：孙秀荣[1] 张杰生 苏放明[1] Sun Xiurong;Zhang Jiesheng;Su Fangmin(Department of Obsterics,Shenzhen People,s Hospital,Second Clinical Medical College,Jinan University,Shenzhen 518020,China)

机构地区：[1]暨南大学第二临床医学院附属深圳市人民医院产科,518020

出　　处：《国际医药卫生导报》2020年第20期3092-3094,共3页International Medicine and Health Guidance News

摘　　要：目的探讨妊娠期急性脂肪肝的临床特点、早期诊断以及治疗措施。方法选取2015年1月至2019年12月期间在本院收治的42例AFLP患者临床资料进行回顾性分析,根据患者入院时检测凝血酶原活动度(PTA)将其分为两组,PTA<40.0%为重型组(n=19),PTA≥40.0%为轻型组(n=23);分析两组患者临床特征、实验室检测指标、母胎妊娠结局等。结果两组患者AST、PT、UA、LDH、NH3指标比较,差异均无统计学意义(均P>0.05);重型组AT-Ⅲ、PLT、PTA、Fb、Glu、ALT指标分别为(38.36±20.03)%、(139.44±89.69)109/L、(31.96±7.32)%、(0.92±0.63)g/L、(3.56±1.09)mmol/L、(186.27±169.33)U/L,均低于轻型组(59.16±23.32)%、(183.46±79.14)109/L、(93.40±28.96)%、(1.93±1.06)g/L、(5.53±1.22)mmol/L、(297.46±168.69)U/L,TBIL、DBIL、WBC、Cr指标分别为(172.59±106.61)μmol/L、(142.06±79.36)μmol/L、(17.59±4.36)109/L、(151.49±49.66)μmol/L,均高于轻型组(54.46±46.86)μmol/L、(46.39±40.89)μmol/L、(11.36±7.69)109/L、(119.45±41.69)μmol/L,差异均有统计学意义(均P<0.05);重型组较轻型组更易并发子痫前期、低蛋白血症、低血糖、肝肾功能衰竭、DIC、肺部感染等,差异均有统计学意义(均P<0.05)。结论妊娠期急性脂肪肝是一种严重的妊娠期并发症,多发于妊娠晚期,大多伴有上消化道症状、肝肾功能异常和凝血功能障碍,严重危害母胎生命;在临床诊治过程中,应高度重视患者的临床症状,早期识别、早期诊断,及时终止妊娠,积极血浆置换,改善母胎预后。Objective To investigate the clinical features,early diagnosis,and treatment of acute fatty liver of pregnancy(AFLP).Methods The clinical data of 42 pregnant women with acute fatty liver treated at our hospital from January,2015 to December,2019 were collected and analyzed.According to their prothrombin activities(PTA),the patients were divided into a severe group(n=19),whose PTA value was<40%,and a mild group(n=23),whose PTA value was≥40%.The clinical characteristics,laboratory tests,the outcomes of the maternal and fetus were compared between the two groups.Results There were no statistical differences in the levels of AST,PT,UA,LDH,and NH3 between the two groups(all P>0.05).The levels of AT-Ⅲ,PLT,PTA,Fb,Glu,and ALT were lower and the levels of TBIL,DBIL,WBC,and Cr were higher in the severe group than in the mild group[(38.36±20.03)%vs.(59.16±23.32)%,(139.44±89.69)109/L vs.(183.46±79.14)109/L,(31.96±7.32)%vs.(93.40±28.96)%,(0.92±0.63)g/L vs.(1.93±1.06)g/L,(3.56±1.09)mmol/L vs.(5.53±1.22)mmol/L,(186.27±169.33)U/L vs.(297.46±168.69)U/L,(172.59±106.61)μmol/L vs.(54.46±46.86)μmol/L,(142.06±79.36)μmol/L vs.(46.39±40.89)μmol/L,(17.59±4.36)109/L vs.(11.36±7.69)109/L,and(151.49±49.66)μmol/L vs.(119.45±41.69)μmol/L;all P<0.05].Of these 42 cases with AFLP,41 cases occurred upper gastrointestinal symptoms.The complications,such as eclampsia,low protein,low glucose,failure of liver and kidney,DIC,and lung infection were more common in the severe group than in the mild group(all P<0.05).Conclusions AFLP is a severe complication of pregnancy,which occurs in the third trimester of pregnancy and has a high risk for both mothers and fetus.During the clinical procedures,more attention should be paid to the patients in order to make early diagnosis and active treatment;timely termination and plasma exchange can improve the outcomes.

关 键 词：急性脂肪肝 妊娠期 早期诊断 血浆置换 

分 类 号：R714.255[医药卫生—妇产科学]