近20年妊娠急性脂肪肝患者预后变化和死亡原因分析  

Changes of prognosis and causes of death of patients with acute fatty liver of pregnancy in the past two decades

作　　者：刘海霞[1] 朱云霞[2] 段忠辉[3] 赖曼[1] 陈煜[4] Liu Haixia;Zhu Yunxia;Duan Zhonghui(Department of Critical Care Medicine of Liver Diseases,You’an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院重症医学科,北京市100069 [2]首都医科大学附属北京佑安医院产科中心,北京市100069 [3]首都医科大学附属北京佑安医院急诊科,100069 [4]首都医科大学附属北京佑安医院肝病第四中心,北京市100069

出　　处：《实用肝脏病杂志》2023年第1期55-58,共4页Journal of Practical Hepatology

摘　　要：目的分析近20年我科诊治的妊娠急性脂肪肝(AFLP)患者的临床特征.方法2002年1月~2011年12月北京佑安医院收治AFLP患者25例(A组),2012年1月~2022年1月收治28例(B组),对比分析两组临床表现、并发症、病死率变化和死亡原因.结果A组和B组血清总胆红素水平分别为(239.8±104.2)μmol/l和[(161.9±107.7)μmol/l,P=0.052],A组肝功能异常率为12.0%,显著低于B组的42.9%(P=0.006);A组剖宫产率为76.0%,显著低于B组的100.0%(P=0.020);A组与B组DIC(40.0%对3.6%,P=0.001)和失血性休克发生率(24.0%和3.6%,P=0.028)存在显著性差异,而产后出血(48.0%对25.0%,P=0.081)无显著性差异;B组产妇病死率为3.6%而胎儿无死亡,显著低于A组的24.0%和12.1%(P<0.05).结论DIC和大出血是10年前AFLP产妇的主要死亡原因,近10年AFLP母婴病死率明显下降,但肝衰竭进展仍较常见,仍需早期识别和处理.Objective The prognosis of patients with acute fatty liver of pregnancy(AFLP)have dramatically improved,and the main purpose of this study was to summarize the clinical feature shift of the entity in the past two decades.Method The clinical data of patients with AFLP in Beijing You'an Hospital were retrospectively analyzed,and 25 patients in group A were encountered in this hospital between January 2002 and December 2011,and other 28 patients in group B were from January 2012 to January 2022.The clinical manifestations,complications and mortalities in the two groups were compared,and the causes of death were analyzed.Results There was no significant difference respect to serum bilirubin levels in the two groups[(239.8±104.2)μmol/l vs.(161.9±107.7)μmol/l,P=0.052],while the incidence of abnormal liver function tests in group A was 12.0%,significantly lower than 42.9%(P=0.006)in group B,the cesarean section in group A was 76.0%,much lower than 100.0%(P=0.020)in group B,the incidences of disseminated intravascular coagulation(DIC,40.0%vs.3.6%,P=0.001)and the hemorrhagic shock(24.0%vs.3.6%,P=0.028)were significantly different;the maternal fatality in group B was 3.6%,much lower than 24.0%in group A.Conclusion The leading causes of maternal death in patients with AFLP ten years ago were DIC and massive hemorrhage,while the liver failure is common in recent ten years although the mortality falls dramatically,and the early diagnosis and management is still important.

关 键 词：妊娠急性脂肪肝 产后出血 弥散性血管内凝血 肝衰竭 病死率 

分 类 号：R714.255[医药卫生—妇产科学]