妊娠急性脂肪肝22例临床分析

目的:探讨妊娠急性脂肪肝(AFLP)的诊断方法和处理原则。方法:对1990年以来中文文献报告的AFLP 22例病例进行综合分析。结果:AFLP的发病率为1:20 540,86.4%的患者有临床症状。体征为黄疸(86.4％)、水肿(27.3％)和腹水(27.3%)。AFLP的产科并发症为产后出血(77.3%)、弥漫性血管内凝血(77.3%)、肾功能衰竭(63.6%)、肝性脑病(50.0%)、胎儿窘迫(40.9%)、死胎(13.6%)和新生儿窒息(59.1%)。化验检查谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素、间接胆红素、尿素氮、肌酐、尿酸和白细胞升高、血小板降低。12例患者剖宫产终止妊娠,占54.5％。其中5例因子宫出血行子宫次全切除术,占22.7%。有6例行肾透析治疗,占肾功能衰竭者的42.86%。孕产妇死亡5例,占22.7％。结论:AFLP是一种严重的少见的妊娠并发症,及时诊断和正确处理可降低孕产妇死亡率。

22 cases of acute fatty liver of pregnancy

Objective: To explore the diagnosis and treatment of acute fatty liver of pregnancy. Methods: 22 cases of acute fatty liver of pregnancy in Chinese literature were reviewed. Results: The incidence of acute fatty liver of pregnancy was 1:20 540. The signs of AFLP were jaundice (86. 4%), edema (27. 3%) and ascitis (27. 3%) . Laboratory abnormality were elevated ALT, AST, total bilirubin, direct bilirubin, indirect bilirubin, BUN, creatinine, urine acid, Lexukocytosis and low platelet count. The complications of acute fatty liver of pregnancy were postpartum hemorrhage (77.3%), DIC (77.3%), renal failure (42.86%), hepatic failure (50.0%), fetal distress (40.9%), fetal death (13.6%) and neonatal asphyxia (59.1%), Kidney dialysis were performed in 6 cases. Cesarean delivery were performed in 54.5% of cases. Subhysterectomy were performed 22.7% of cases. Conclusion: Acute fatty liver of pregnancy is a rare and severe pregnancy complication. Correct diagnosis and treatment may decrease maternal mortality.