妊娠期急性脂肪肝患者门诊筛查时机和筛查方案的探讨

发布时间：2019-04-15 23:09

【摘要】：目的:探讨妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)患者的门诊筛查时机、指标和方案。方法:回顾性分析2006年1月至2013年12月间中南大学湘雅医院和湘雅二医院收治的、符合国内临床诊断和英国Swansea诊断标准的AFLP患者的病例资料(n=78);并与国内外其他大型医疗中心或三级综合性医院报道的AFLP临床资料进行对比分析。结果:国内临床诊断和英国Swansea诊断标准对本组AFLP患者的诊断效率差异有统计学意义(P0.05)。孕产妇病死率为14.10%(11/78),围产儿病死率为17.95%(14/78)。平均终止妊娠的孕龄为35.6周。85%以上的患者入院时有转氨酶、胆红素、白细胞总数和凝血功能的异常;50%~85%的患者有消化道症状、黄疸、肾功能受损和超声示肝脏声像改变或腹水;50%以下的患者出现低血糖、高血氨和肝性脑病等表现。结论:妊娠34周后可开始AFLP患者门诊筛查,血常规、肝功能联合凝血功能的检测可作为AFLP门诊筛查的一线指标和方案,消化道症状、肾功能、腹部超声可作为门诊筛查的二线指标和方案。
[Abstract]:Objective: to explore the time, index and scheme of out-patient screening for acute fatty liver in pregnancy (acute fatty liver of pregnancy,AFLP) patients. Methods: the clinical data of AFLP patients admitted to Xiangya Hospital and Xiangya second Hospital of Central South University from January 2006 to December 2013 were retrospectively analyzed, which met the criteria of clinical diagnosis and Swansea diagnosis in the UK (n = 78). The clinical data of AFLP reported by other large medical centers or level 3 general hospitals at home and abroad were compared and analyzed. Results: there was a significant difference in the diagnostic efficiency between domestic clinical diagnosis and Swansea diagnostic criteria in this group of AFLP patients (P0.05). The maternal mortality rate was 14.10% (11 / 78) and the perinatal mortality was 17.95% (14 / 78). The average gestational age of terminating pregnancy was 35.6 weeks. 85% of the patients had abnormal transaminase bilirubin leukocyte count and coagulation function on admission. Fifty-five percent of the patients had digestive tract symptoms, jaundice, impaired renal function and sonographic changes in the liver or ascites; hypoglycemia, hyperammonia and hepatic encephalopathy were found in less than 50% of the patients. Conclusion: AFLP patients can be screened after 34 weeks of pregnancy. Blood routine and liver function combined with coagulation function can be used as the first-line index and program for AFLP outpatients screening, digestive tract symptoms, renal function, and so on. Abdominal ultrasound can be used as a second-line indicator and program for out-patient screening.
【作者单位】：中南大学湘雅医院妇产科;中南大学湘雅医学院临床医学系;中南大学湘雅二医院妇产科;
【基金】：国家“十二五”科技支撑计划项目(2014BAI05B05) 中南大学湘雅医院临床科研基金(2013L10) 中南大学湘雅临床大数据建设项目(87)~~
【分类号】：R714.2

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