36例妊娠期急性脂肪肝的临床特征和对母婴结局的影响

发布时间：2018-08-16 12:17

【摘要】：目的:探讨妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)的临床特征及其对母婴预后产生的影响,为临床上妊娠期急性脂肪肝患者的诊断以及治疗提供参考依据,提高妊娠期急性脂肪肝的救治水平。方法:回顾性分析选取成都医学院第一附属医院、四川省人民医院、锦江区妇幼保健院及西南医科大学附属医院在2002年1月至2015年12月收治的36例妊娠急性脂肪肝患者作为研究对象,孕妇平均年龄为28.21±8.03岁(18~40岁),发病时孕周平均为35.99±2.31周(29~39周),其中32例初产妇(88.89%),4例(11.11%)经产妇,并按凝血酶原活动度(PTA)分为三组:PTA正常组(A组):75%≤PTA≤100%;轻度降低组(B组),40%≤PTA75%;极度降低组(C组):PTA40%。分别观察终止妊娠前的实验室检查指标(血常规指标、血脂指标、肝酶指标、凝血功能指标等);分娩方式(阴道分娩、剖宫产);并发症和死亡情况;新生儿窒息率和围生儿死亡率。结果:1.AFLP患者发病孕周为(35.99±2.31)周,多为初产妇(88.89%),男胎多(66.67%),恶心和呕吐是最常见症状(69.44%)。2.肝功能指标显著升高:血清丙氨酸转氨酶(298.72±290.41 U/L)、天冬氨酸转氨酶(258.14±223.56 U/L)、乳酸脱氢酶(367.98±234.52 U/L)和直接胆红素(79.86±87.57μmol/L);凝血功能障碍:凝血酶原时间(17.85±9.63s)、纤维蛋白原水平(0.75±0.81 g/L)、D-二聚体(2.53±3.82 mg/L),和纤维蛋白降解产物(44.25±49.02 mg/L)水平异常;伴有不同程度的肌酐、尿酸、白细胞升高及血小板减少。3.AFLP孕产妇主要的并发症有低蛋白血症(55.6%)、凝血功能障碍(58.3%)、急性肾功能衰竭(44.4%)和弥漫性血管内凝血(DIC)(33.3%),按PTA分组发现B组、C组两组低蛋白血症、凝血功能障碍、急性肾功能衰竭、DIC、MODS等并发症的发生比例明显高于A组,差异具有统计学意义(p0.05);C组发生低蛋白血症、凝血功能障碍、急性肾功能衰竭、DIC的比例明显高于B组,差异具有统计学意义(P0.05)。4.AFLP孕妇共娩出新生儿42个,双胎6例,其中男婴26个,女婴16个,死亡6个(均为男婴),大多为早产(61.1%),多数发生于34-37周(41.7%),30.6%的新生儿产后即被送往ICU,有10例发生宫内胎儿窘迫,有6例新生儿在产后由于各种并发症死亡,有8例新生儿出生体重较正常新生儿体重偏低,其余新生儿均体健。结论:对于高度怀疑妊娠期急性脂肪肝的患者,加强产前检查,重视临床症状,结合实验室检查和影像学检查,对AFLP尽早确诊,尤其是对于PTA极度降低的患者,确诊后应及时终止妊娠、加强多学科的综合治疗,以减少对母婴预后的影响,提高妊娠期急性脂肪肝的救治水平。
[Abstract]:Objective: to investigate the clinical features of (acute fatty liver of precancerous fatty liver in pregnancy and its influence on the prognosis of mother and infant, and to provide a reference for the diagnosis and treatment of acute fatty liver in pregnancy. To improve the treatment level of acute fatty liver in pregnancy. Methods: the first affiliated Hospital of Chengdu Medical College and Sichuan Provincial people's Hospital were retrospectively analyzed. From January 2002 to December 2015, 36 patients with acute fatty liver of pregnancy were treated in the affiliated Hospital of Southwest Medical University and Maternal and Child Health Hospital of Jinjiang District. The average age of pregnant women was 28.21 卤8.03 years (1840 years), and the average gestational weeks at onset was 35.99 卤2.31 weeks (2939 weeks), of which 32 primipara (88.89%) had 4 cases (11.11%). According to prothrombin activity, (PTA) was divided into three groups: normal group (group A): 75% 鈮，

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