妊娠期急性脂肪肝患者门诊筛查时机和筛查方案的探讨

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(P<0.05)。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。

Screening time and schedule for outpatients with acute fatty liver of pregnancy

Objective: To identify the screening time and prepare a screening schedule for outpatients with acute fatt y liver of pregnancy (AFLP).Methods: AFLP patients who admitted to Xiangya Hospital and the Second Xiangya Hospital,Central South University, Hunan, China between November, 2006 and December, 2013, wereretrospectively studied. The diagnosis of 78 AFLP patients met the domestic clinical and laboratorycriteria and the Swansea criteria. Clinical and laboratory data obtained on admission were usedfor analysis. Contrastive analysis was conducted within our data and other large medical centers orgeneral hospitals.Results: The difference between domestic clinical and laboratory criteria and Swansea criteria indiagnosing AFLP patients in the 2 hospitals mentioned above was significant (P<0.05). The maternalmortality was 14.10% (11/78) and perinatal mortality was 17.95 % (14/78). The mean gestationalage at delivery was 35.6 weeks. Based on the clinical and laboratory data, more than 85% of AFLPpatients showed abnormal levels of transaminase, bilirubin, and white blood cells, as well as coagulationdysfunction. Gastrointestinal symptoms, such as abdominal pain and vomiting, jaundice, renalimpairment and ascites or bright liver on ultrasound scan, were showed in 50%–85% of AFLP patients.Less than 50% of patients suffered from low blood sugar, high blood ammonia or hepatic encephalopathy.Conclusion: The 34th gestation week might be important time for screening AFLP outpatients.Gastrointestinal symptoms, blood routine, liver function, and coagulant function tests arerecommended as the first grade screening indicators. Renal function, blood sugar test, andabdominal ultrasound could be the second grade screening indicators for AFLP outpatients.