妊娠合并严重肝病的临床研究

目的：分析71例妊娠合并严重肝损害住院患者的临床类型、发病率、发病与孕周的关系、辅助检查、对母儿的影响，探讨其发病机理。方法：复习2002年-2004年重庆医科大学临床学院收治的71例妊娠合并肝病孕产妇的病历资料，在临床类型、发病率、发病与孕周的关系、发病机理、辅助检查、对母儿的影响等方面进行研究。结果：妊娠合并肝病患者中妊娠合并肝炎（VHP）53例（74．65％），妊娠胆汁瘀积综合征（ICP）6例（8．45％），急性妊娠脂肪肝（AFLP）3例（4．23％）。VHP中乙肝50例（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），HELLP综合征发生于37周，肝功能全面损害，产后迅速恢复。结论：妊娠合并肝病以VHP、ICP及AFLP常见。VHP以乙肝居多，妊娠各期均可发病，晚期好发。ICP好发于孕晚期，AFLP好发于孕晚期，起病急骤，发展迅猛，多呈暴发性肝损害表现，对母儿影响极大。HELLP综合征患者发生于孕晚期，肝损害明显，产后迅速恢复，对胎儿影响明显。

Retrospective studying inpatient cases of serious hepatopathy during pregnancy

Objective: To study the clinical types,morbidity,relationships between episode and pregnant weeks,laboratory examinations and the influences to the perinatal and maternal,and to discuss the possibile mechanisms of hepatopathy in 71 pregnancies.Methods: The data of 71 pregnancies with hepatopathy admitted in Chongqing University of Medical Science from 2002 to 2004 were reviewed,and the clinical types,morbidity,relationships between episode and pregnant weeks,mechanisms,laboratory examinations,influences to the perinatal and maternal were explored.Results: There were 53 cases of viral hepatitis of pregnancy(VHP),6 of intracholestasis of pregnancy(ICP),3 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 developed all in the third trimester.The case of HELLP syndrome developed in 37 weeks of pregnancy with liver function disorder and recovered soon after birth.Conclusions: VHP,ICP and AFLP are the most common types of hepatopathy of pregnancy.Hepatitis B is common to see in VHP.They can happen in each trimester of pregnancy but the third trimester does more.ICP often develops in the third trimester of pregnancy with obvious inflammation of hepatocytes but no obvious jaundice,while congestion exists.No obvious influence to the perinatal or the maternal is seen.AFLP often develops in the third trimester of pregnancy with sudden episode,rapid progress and fulminant hepatic injury which can cause severe results to the maternal and perinatal.HELLP syndrome develops in the third trimester of pregnancy mostly with massive injure to the liver,and recovered soon after birth.It can influence the perinatal obviously.