妊娠期急性脂肪肝与HELLP综合征患者临床特征比较  

A comparison of clinical characteristics between acute fatty liver of pregnancy and hemolysis,elevated liver enzymes and low platelets syndrome

作　　者：代冬梅[1] 唐仕宇 许汪斌[1] 王雨平[1] 肖李乐云[1] 杨潇[1] 祝艳翠[1] 单可记[1] 万林骏[2] 朱明 Dai Dongmei;Tang Shiyu;Xu Wangbin;Wang Yuping;Xiaoli Leyun;Yang Xiao;Zhu Yancui;Shan Keji;Wan Linjun;Zhu Ming(Department of Critical Care Medicine,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan,China;Department of Critical Care Medicine,the Second Affiliated Hospital of Kunming Medical University,Kunming 650106,Yunnan,China;Department of Critical Care Medicine,Yan'an Hospital of Kunming City,Kunming 650051,Yunnan,China)

机构地区：[1]昆明医科大学第一附属医院重症医学科,云南昆明650032 [2]昆明医科大学第二附属医院重症医学科,云南昆明650106 [3]昆明市延安医院重症医学科,云南昆明650051

出　　处：《中华危重病急救医学》2022年第6期624-629,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金(82060343);云南省科技计划项目重大科技专项(2018ZF009)。

摘　　要：目的对比分析妊娠期急性脂肪肝(AFLP)与HELLP综合征(溶血、肝酶升高和血小板减少)患者临床特征的差异。方法回顾分析2016年1月1日至2021年12月31日云南省昆明市3家医院(昆明医科大学第一附属医院、昆明医科大学第二附属医院和昆明市延安医院)收治的13例AFLP患者和34例HELLP综合征患者的临床资料,根据Swansea及Tennessee诊断标准,将患者分为AFLP组和HELLP综合征组。比较两组的一般情况、临床症状、入院24 h内实验室检查、并发症和母婴结局等指标差异。结果①一般情况:与HELLP综合征组相比,AFLP组患者入院时体质量指数(BMI)及收缩压(SBP)和舒张压(DBP)均明显降低(均P<0.01)。②临床症状:AFLP组患者主要表现为皮肤黄疸、腹痛、恶心呕吐和水肿;HELLP综合征组患者主要表现为蛋白尿、血压升高、水肿和头痛。部分患者同时出现以上多种症状。③实验室检查:与HELLP综合征组相比,AFLP组患者入院24 h内血小板计数(PLT)、总胆红素(TBil)、直接胆红素(DBil)、γ-谷氨酰转肽酶(γ-GGT)、碱性磷酸酶(ALP)、总胆汁酸(TBA)和血肌酐(SCr)水平及国际标准化比值(INR)均明显升高〔PLT(×10^(9)/L):107.69±51.13比76.71±43.25,TBil(μmol/L):121.60(83.20,170.00)比15.25(7.22,29.05),DBil(μmol/L):86.50(58.60,104.00)比4.30(2.22,10.10),γ-GGT(U/L):87.00(37.00,127.00)比41.00(19.00,64.42),ALP(U/L):199.10(10^(9).00,349.20)比125.50(90.50,155.25),TBA(μmol/L):51.50(16.20,117.40)比4.15(2.02,6.95),SCr(μmol/L):155.80(129.00,237.00)比79.00(65.43,113.70),INR:1.28(1.17,1.63)比0.94(0.88,1.08),均P<0.05〕,凝血酶原时间(PT)明显延长〔s:16.10(14.50,19.20)比12.40(11.43,13.40),P<0.05〕,血糖(GLU)、纤维蛋白原(FIB)和抗凝血酶Ⅲ(ATⅢ)活性明显降低〔GLU(mmol/L):5.18±1.33比6.33±1.19,FIB(g/L):1.96±1.46比3.81±1.58,ATⅢ(%):40.61±25.84比66.39±24.11,均P<0.05〕;④并发症:与HELLP综合征组相比,AFLP组发生低血糖〔30.77%(4/13)比0%(0/34)〕、急Objective To compare and analyze the clinical characteristics between acute fatty liver of pregnancy(AFLP)and the hemolysis,elevated liver enzymes and low platelets(HELLP)syndrome.Methods This is a retrospective cohort study.The clinical data of 13 cases with AFLP and 34 cases with HELLP syndrome were collected from three tertiary referral centers in Yunnan(the First Affiliated Hospital of Kunming Medical University,the Second Affiliated Hospital of Kunming Medical University,and Yan'an Hospital of Kunming City)from January 2016 to December 2021.The patients were diagnosed to AFLP and HELLP syndrome according to the Swansea criteria and the Tennessee classification system.The general characteristics,clinical features,laboratory results within 24 hours after admission,complications,maternal and neonatal outcomes were compared to analysis the differences between the two groups.Results①Maternal characteristics:compared with HELLP syndrome group,AFLP group had lower body mass index(BMI)and blood pressure at admission(both P<0.01).②Clinical features:the most common symptoms in AFLP patients were skin jaundice,abdominal pain,nausea and vomiting,edema.The main manifestations of patients with HELLP syndrome were albuminuria,hypertension,edema,headache.Some patients had multiple symptoms concurrently.③Laboratory results:compared with HELLP syndrome group,the levels of platelet count(PLT),total bilirubin(TBil),direct bilirubin(DBil),γ-glutamyl transferase(γ-GGT),alkaline phosphatase(ALP),total bile acid(TBA),serum creatinine(SCr)and international standardized ratio(INR)in AFLP group were significantly increased within 24 hours after admission[PLT(×10^(9)/L):107.69±51.13 vs.76.71±43.25,TBil(μmol/L):121.60(83.20,170.00)vs.15.25(7.22,29.05),DBil(μmol/L):86.50(58.60,104.00)vs.4.30(2.22,10.10),γ-GGT(U/L):87.00(37.00,127.00)vs.41.00(19.00,64.42),ALP(U/L):199.10(10^(9).00,349.20)vs.125.50(90.50,155.25),TBA(μmol/L):51.50(16.20,117.40)vs.4.15(2.02,6.95),SCr(μmol/L):155.80(129.00,237.00)vs.79.00(65.43,113.70),INR:1.2

关 键 词：妊娠期急性脂肪肝 HELLP综合征 临床特征 实验室指标 并发症 

分 类 号：R714.25[医药卫生—妇产科学]