妊娠早中期合并肝功能异常150例临床分析  

Clinical analysis of 150 cases of early and middle pregnancy complicated with abnormal liver function

作　　者：和沁园 岳欣[1] 陈艳[1] HE Qinyuan;YUE Xin;CHEN Yan(Department of Obstetrics and Gynecology,the Second Hospital of Nanjing/the Affiliated Nanjing Hospital to Nanjing University of Chinese Medicine,Nanjing 210003,China)

机构地区：[1]南京市第二医院(南京中医药大学附属南京医院)妇产科,江苏南京210003

出　　处：《东南大学学报（医学版）》2024年第3期445-450,共6页Journal of Southeast University(Medical Science Edition)

摘　　要：目的:探讨妊娠早中期(妊娠28周前)合并肝功能异常患者的病因、治疗方案及治疗效果。方法:收集2022年1月至2023年6月于南京市第二医院(南京中医药大学附属南京医院)就诊及住院治疗的150例妊娠早中期合并肝功能异常患者的临床资料,对孕周、病因、治疗用药及病情转归等情况进行回顾性分析。结果:150例患者中早孕期(妊娠未达14周)33例(22%),中孕期(妊娠14~27^(+6)周)117例(78%)。其中,妊娠合并病毒性肝炎63例(42%),妊娠剧吐20例(13.33%),药物性肝损伤17例(11.33%),自身免疫性肝病3例(2%),妊娠期糖尿病11例(7.33%),妊娠期高血压疾病5例(3.33%),早发型妊娠期肝内胆汁淤积症14例(9.33%),甲状腺功能异常10例(6.67%),原因不明7例(4.67%)。针对肝功能异常,血清转氨酶达到正常的4倍及以上的患者,使用复方甘草酸苷及谷胱甘肽联合静脉滴注。治疗前谷丙转氨酶(ALT)(436.85±276.54) U·L^(-1),谷草转氨酶(AST)(312.39±147.85) U·L^(-1)。其中,89例(59.33%)患者2周转氨酶降至正常(ALT≤40 U·L^(-1),AST≤35 U·L^(-1)),继续妊娠,13例(8.67%)胚胎停止发育,3例(2%)因胎死宫内实施引产。5例(3.33%)因肝功能异常加重终止妊娠,2例重症肝炎终止妊娠后转ICU进一步观察治疗,预后良好。21例(14%)妊娠晚期再次发生肝功能异常。结论:妊娠早中期合并肝功能异常原因多样,病毒性肝炎、药物性肝炎及妊娠剧吐是常见病因。针对病因,使用安全有效的保肝药物对此类孕妇进行治疗,效果较好。但不排除病情进展,发生胚胎停止发育或胎死宫内,亦有需医疗终止妊娠可能。重视对妊娠早中期的孕妇进行肝功能检查,正确判读检查结果,及时发现异常并积极治疗至关重要。Objective:To investigate the etiology,treatment and therapeutic effect of patients with abnormal liver function in the early and middle trimester of pregnancy(before 28 weeks of gestation).Methods:From January 2022 to June 2023,the clinical data of 150 patients with abnormal liver function in the early and middle trimesters of the Second Hospital of Nanjing(the Affiliated Nanjing Hospital to Nanjing University of Chinese Medicine) were collected,and the gestational age,etiology,medication and outcome were analyzed retrospectively.Results:Among the 150 patients,33(22%) in early trimester(less than 14 weeks of gestation) and 117(78%) in middle trimester(14-27~(+6) weeks of gestation).Among them,there were 63 cases(42%) of pregnancy complicated with viral hepatitis,20 cases(13.33%) of hyperemesis gravidarum,17 cases(11.33%) of drug-induced liver injury,3 cases(2%) of autoimmune liver disease,11 cases(7.33%) of gestational diabetes,5 cases(3.33%) of gestational hypertension.There were 14 cases(9.33%) with intrahepatic cholestasis during early pregnancy,10 cases(6.67%) with thyroid dysfunction,and 7 cases(4.67%) with unknown cause.For the patients with abnormal liver function and serum transaminase reaching 4 or more times the normal level,compound glycyrrhizin and glutathione were administered intravenously.Alanine aminotransferase(ALT) was(436.85±276.54) U·L~(-1) and aspartate aminotransferase(AST) was(312.39±147.85) U·L~(-1) before treatment.In 89 patients(59.33%),transaminase decreased to normal(ALT≤40 U·L~(-1),AST≤35 U·L~(-1)) at 2 weeks and pregnancy continued,13 patients(8.67%) embryo development stopped,and 3 patients(2%) were induced labor due to fetal death.5 cases(3.33%) had pregnancy termination for aggravated abnormal liver function,and 2 cases were transfered to ICU for further observation and treatment after pregnancy termination due to severe hepatitis,and the prognosis was good.Abnormal liver function recurred in 21 patients(14%) during the third trimester of pregnancy.Conclusion:The causes

关 键 词：妊娠 早中孕期 肝功能异常 保肝药 

分 类 号：R714.255[医药卫生—妇产科学]