妊娠期肝病142例临床研究

目的：了解妊娠期肝病住院患者的病因、临床类型的分布特征,对围生儿及产后结局的影响。方法：回顾性分析1990年～2006年我院收治的142例妊娠期肝病的孕产妇的病历资料,对病毒性肝炎的病因构成及临床类型构成、妊娠期特有肝病类型构成和妊娠期肝病对围生儿及产后结局的影响进行统计分析。结果：妊娠期肝病患者中,妊娠合并病毒性肝炎(VHP)106例(占74．65%),妊娠期肝内胆汁淤积症(ICP)26例(占18．31%),妊娠期急性脂肪肝(AFLP)6例(占4．23%)。VHP中乙肝100例(占94．34%)。肝损害与肝炎分度一致；新生儿Apgar评分及出生体重在轻中度组无明显改变,在重度组明显降低。ICP均发生于孕晚期,AFLP均发生于孕晚期(36w～38w)起病急骤,发展迅猛,多呈暴发性肝损害,对母儿影响较大。HELLP综合征发生于37周,肝功能全面损害,产后迅速恢复,对胎儿影响明显。结论：妊娠合并肝病以VHP、ICP及AFLP常见,VHP以乙肝居多,均可增加妊娠及分娩时母婴的危险性。

CLINICAL ANALYSIS OF 142 PREGNANT WOMEN WITH LIVER DYSFUNCTION

OBJECTIVE:To understand the pathogeny and clinical types of distribution,the influeneesto the perina- tal and obstetric outcomes in gravid patients with liver disorders.METHOD:The data of 142 pregnancies with hepatopathy ad- mitted in our hospital from 2002 to 2006 were reviewed,clinical types of viral hepatitis,hepatopathy especially related with pregnancy (HERP),influences to the perinatal and liver disorders in gestation and postpartum sequelae of these diseases were analyzed.RESULTS:There were 106 cases of viral hepatitis of pregnancy (VHP),26 of intracholestasis of pregnancy (ICP),6 of acute fatty liver of pregnancy (AFLP) in the group.The degree of liver injury was accordant to that of hepatitis. All ICP cases developed in the third trimester.AFLP often develops in the third trimester of pregnancy with sudden episode, rapid progress and fulminanthepatic injury which can cause severe results to the maternal and perinatal.The case of HELLP syndrome developed in 37 weeks of pregnancy mostly with massive injure to the liver,and recovered soon after birth.It can in- fluence the perinatal obviously.CONCLUSIONS:VHP ,ICP and AFLP are the most common types of hepatopathy of pregnan- cy.Hepatitis B is common to see in VHP.All would add the dangerous of the pregnancy and the maternal and perinatal.