妊娠期急性脂肪肝86例临床分析  

Clinical analysis of 86 cases of acute fatty liver of pregnancy

作　　者：刘从丽 陈敦金[1] 陈楚仪 周秀花 江源 刘菁榆 陈月娥 胡橙燃 董金菊 李萍 温敏 李艳慧 张慧丽[1] Liu Congli;Chen Dunjin;Chen Chuyi;Zhou Xiuhua;Jiang Yuan;Liu Jingyu;Chen Yue'e;Hu Chengran;Dong Jinju;Li Ping;Wen Min;Li Yanhui;Zhang Huili(Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Guangzhou Medical University,Guangdong Provincial Key Laboratory of Major Obstetric Diseases,Guangzhou 510150,China;Department of Obstetrics and Gynecology,the Third Clinical College of Guangzhou Medical University,Guangzhou 511436,China;Department of Obstetrics and Gynecology,the Maternal and Child Health Hospital of Hunan Province,Changsha 410028,China;Department of Obstetrics and Gynecology,the Fourth People's Hospital of Guiyang,Guiyang 550007,China;Department of Obstetrics and Gynecology,the First People's Hospital of Yulin,Yulin 537000,China;Department of Obstetrics and Gynecology,Xiangyang No.1 People's Hospital,Hubei University of Medicine,Xiangyang 441000,China)

机构地区：[1]广州医科大学附属第三医院妇产科广东省产科重大疾病重点实验室,广州510150 [2]广州医科大学第三临床学院,广州511436 [3]湖南省妇幼保健院产科,长沙410028 [4]贵阳市第四人民医院妇产科,贵阳550007 [5]广西壮族自治区玉林市第一人民医院妇产科,玉林537000 [6]湖北医药学院附属襄阳市第一人民医院妇产科,襄阳441000

出　　处：《中华妇产科杂志》2023年第12期896-902,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：广州医科大学第三临床学院2022—2023年度大学生科研项目(2022A024)。

摘　　要：目的探讨妊娠期急性脂肪肝(AFLP)孕妇的临床特点及母儿预后。方法收集2017年9月至2022年8月广州医科大学附属第三医院收治的86例AFLP孕妇的临床资料,对其一般资料、临床特点、实验室检查及母儿结局进行回顾性分析。结果(1)一般情况:86例AFLP孕妇的年龄为(30.8±5.4)岁,体重指数为(21.0±2.5)kg/m^(2);初产妇50例(58.1%,50/86),经产妇36例(41.9%,36/86);单胎妊娠64例(74.4%,64/86),双胎妊娠22例(25.6%,22/86)。(2)临床特点:AFLP孕产妇的主诉以消化道症状为主,包括上腹痛(68.6%,59/86)、恶心(47.7%,41/86)、纳差(46.5%,40/86)、呕吐(39.5%,34/86),非消化道症状主要为皮肤和(或)巩膜黄染(54.7%,47/86)、水肿(38.4%,33/86)、乏力(19.8%,17/86)、出血倾向(16.3%,14/86)、多饮或多尿(14.0%,12/86),皮肤瘙痒(8.1%,7/86),另有17.4%(15/86)AFLP孕妇无明显症状。(3)实验室检查:AFLP孕妇肝肾功能损害、凝血功能异常的发生率高,血氨、乳酸脱氢酶及乳酸水平升高,血红蛋白、血小板和白蛋白水平降低,但仅有24例(27.9%,24/86)AFLP孕妇影像学检查提示脂肪肝。(4)妊娠结局:①AFLP孕妇的妊娠合并症或并发症发生率高,主要包括:肾功能不全(95.3%,82/86)、早产(46.5%,40/86)、妊娠期高血压疾病(30.2%,26/86)、妊娠合并糖尿病(36.0%,31/86)、胎儿窘迫(24.4%,21/86)、肺部感染(23.3%,20/86)、弥漫性血管内凝血(16.3%,14/86)、多器官功能障碍综合征(16.3%,14/86)、肝性脑病(9.3%,8/86)、胎儿宫内死亡(2.3%,2/86)。②AFLP孕妇的治疗及转归:AFLP孕妇的重症监护病房转入率为66.3%(57/86),82例经治疗后病情好转出院,2例转外院进行后续治疗,2例(2.3%,2/86)死亡。③新生儿结局:除外2例胎儿宫内死亡,共分娩新生儿106例,发生新生儿窒息39例(36.8%,39/106),转入新生儿重症监护病房63例(59.4%,63/106),新生儿死亡3例(2.8%,3/106)。结论AFLP是一种严重的产科并发症,对母儿危害性大,在临床诊治过程中,应重视�Objective To investigate the clinical characteristics and maternal and fetal prognosis of pregnant women with acute fatty liver of pregnancy(AFLP).Methods The clinical data of 86 AFLP pregnant women admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to August 2022 were collected,and their general data,clinical characteristics,laboratory tests and maternal and fetal outcomes were retrospectively analyzed.Results(1)General information:the age of the 86 pregnant women with AFLP was(30.8±5.4)years,and the body mass index was(21.0±2.5)kg/m^(2).There were 50 primiparas(58.1%,50/86)and 36 multiparas(41.9%,36/86).There were 64 singleton pregnancies(74.4%,64/86)and 22 twin pregnancies(25.6%,22/86).(2)Clinical characteristics:the main complaints of AFLP pregnant women were gastrointestinal symptoms,including epigastric pain(68.6%,59/86),nausea(47.7%,41/86),anorexia(46.5%,40/86),vomiting(39.5%,34/86).The main non-gastrointestinal symptoms were jaundice of skin and/or scleral(54.7%,47/86),edema(38.4%,33/86),fatigue(19.8%,17/86),bleeding tendency(16.3%,14/86),polydipsia or polyuria(14.0%,12/86),skin itching(8.1%,7/86),and 17.4%(15/86)AFLP pregnant women had no obvious symptoms.(3)Laboratory tests:the incidence of liver and kidney dysfunction and abnormal coagulation function in AFLP pregnant women was high,and the levels of blood ammonia,lactate dehydrogenase and lactic acid were increased,and the levels of hemoglobin,platelet and albumin decreased.However,only 24 cases(27.9%,24/86)of AFLP pregnant women showed fatty liver by imageology examination.(4)Pregnancy outcomes:①AFLP pregnant women had a high incidence of pregnancy complications,mainly including renal insufficiency(95.3%,82/86),preterm birth(46.5%,40/86),hypertensive disorders in pregnancy(30.2%,26/86),gestational diabetes mellitus(36.0%,31/86),fetal distress(24.4%,21/86),pulmonary infection(23.3%,20/86),disseminated intravascular coagulation(16.3%,14/86),multiple organ dysfunction syndrome(16.3%,14/86),hepatic encephalo

关 键 词：妊娠并发症 脂肪肝 急性病 妊娠结局 

分 类 号：R714.255[医药卫生—妇产科学]