23例妊娠急性脂肪肝临床诊疗分析

摘要

Objective To investigate the early diagnosis and treatment methods of acute fatty liver of pregnancy.MethodsThe clinical data of 23 patients with AFLP delivered from January to October 2014 in Beijing Ditan Hospital afifliated to the Capital Medical University were retrospectively analyzed. According to bilirubin, the 23 patients were divided into two groups:> 171 μmol/L for heavy group,≤ 171 μmol/L for the light group, the complications of the two groups were statistical compared.ResultsThe 23 cases of patients with acute fatty liver of pregnancy were significantly gastrointestinal symptoms. In addition to the higher bilirubin and blood coagulation disorders, laboratory tests showed that uric acid and lactate dehydrogenase were increased abnormally. The cases of renal insufficiency, pulmonary infection and hypoalbuminemia were compared in the bilirubin light group and bilirubin heavy group,P values were 0.023, 0.033 and 0.019, respectively, with statistical significance.P values of other complications were between 0.071 and 1.000, with no statistical signiifcance.Conclusions Clinical symptoms, laboratory tests of uric acid and lactate dehydrogenase rise can be taken as reference indexes of the diagnosis of AFLP. Once diagnosed, pregnancy should be terminated, and multi-disciplinary integrated support treatment is the key to successful rescue. For high bilirubin patients, more attention should be paid to prevent infection.%目的：探讨妊娠急性脂肪肝的早期诊断和治疗方法。方法对2004年1月至2014年10月在首都医科大学附属北京地坛医院分娩的23例妊娠急性脂肪肝（acute fatty liver of pregnancy，AFLP）患者的临床资料进行回顾性分析。根据胆红素分为2组：＞171μmol/L为重型组，≤171μmol/L为轻型组，对两组并发症例数进行统计比较。结果23例妊娠急性脂肪肝患者均有明显消化道症状；实验室检查结果表明多数患者除胆红素升高及凝血功能障碍外，尿酸及乳酸脱氢酶存在异常升高；胆红素轻型组与胆红素重型组，发生肾功能不全，肺部感染及低蛋白血症的发病例数比较，P值分别为0.023，0.033和0.019，存在统计学意义，其他并发症P值介于0.071～1.000，无统计学意义。结论重视临床症状，结合实验室检查，尿酸及乳酸脱氢酶存在异常升高作为AFLP诊断的参考指标。一旦确诊AFLP后应积极终止妊娠，多学科综合支持治疗是抢救成功的关键。对于高胆红素的AFLP患者应尤其重视预防感染。