妊娠急性脂肪肝并发急性肝衰竭12例临床分析

目的分析妊娠急性脂肪肝（acute fatty liver of pregnancy。AFLP）并发急性肝衰竭（acute liver failure，AtY）的Il缶床特征。方法以我院1996年9月-2009年2月收治的12例APLP合并ALF患者为研究对象，回顾性分析其临床表现、实验室检查及治疗等相关资料。结果12例年龄23～33（28．0＋3．2）岁。发病时孕周34～38（35．8±1．4）周，均为妊娠晚期发病。主要症状有恶心、乏力、呕吐和纳差。主要实验室检查指标异常，12例均WBC、TBIL、ALT或AST、Cr升高及PTA降低，9例PLT降低。主要并发症为急性肾衰竭（10例）、低血糖（10例）、弥散性血管内凝血（disseminated intravascular coagulation，DIC）（9例）、产后出血（7例）和肝性脑病（5例）。10例痊愈出院，2例死亡，新生儿死亡2例。结论AFLP并发ALF易发生急性肾衰竭和DIC等多脏器功能衰竭。早诊断、及早进行剖宫产手术及加强对症支持治疗可改善预后。经过治疗，大部分患者肝、肾功能可恢复正常。

Clinical analysis of 12 cases of acute fatty liver of pregnancy complicated by acute liver failure

Objective To evaluate the clinical characteristics of acute fatty liver of pregnancy （AFLP） complicated by acute liver failure （ALF）. Methods Twelve AFLP patients with ALF, who were admitted to our hospital from Sept. 1996 to Feb. 2009, were included in the study. The data including clinical manifestations, laboratory findings and treatment were analyzed retrospectively. Results The 12 paitents ranged from 23-33 （28.0±3.2） years old. ALF occurred in all the patients at 34-38 weeks of gestation （35.8±1.4 weeks） （the third trimester）. Nausea, fatigue, vomiting and anorexia were the most common symptoms. The main laboratory mark- ers were abnormal. White blood cell counts and the levels of total bilirubin, transaminase and creatinine increased, and prothrombin activity decreased in all the 12 patients, and platelet counts decreased in 9 patients. As the main complications, acute kidney failure and hypoglycemia were identified in 10 patients, disseminated intravascular coagulation （DIC） in 9, postpartum hemorrhage in 7, and hepatic encephalopathy in 5. Ten patients were cured and discharged from hospital, the other two died, and 2 neonates died as well. Conclusions AFLP patients with ALF easily develop multiple organ failure such as acute kidney failure and DIC. Early diagnosis, cesarean section performed early and symptomatic treatment are essential for improving the prognosis. After treatment, most patients may have full recovery of liver and kidney function.