摘要
目的：为提高早期诊断和正确处理轻型妊娠急性脂肪肝（ＡＦＬＰ）。方法：对二年半中１２例经临床和病理确诊的ＡＦＬＰ进行回顾性研究。１２例ＡＦＬＰ患者分为两组：第１组：第１年发病有６例，诊断根据临床表现及实验室检查；第２组：第２年发病有６例，诊断根据肝组织穿刺。结果：１２例患者发病孕周平均为３４±３周，入院时均有乏力、食欲减退、恶心、上腹不适、黄疸等临床表现。全部患者肝酶升高（≤３００ＩＵ／Ｌ）、血清总胆红质升高（３２．５～５１０．８μｍｏｌ／Ｌ）、低蛋白血症、凝血酶原时间延长、部分凝血活酶时间延长、低纤维蛋白原（＜２．４ｇ／Ｌ）。并发症：肝性脑病９例、腹水９例、低血糖７例、呕血４例、肾功能衰竭３例、妊高症６例、急性胰腺炎１例、产后出血５例。有７例剖宫产。第１组，母儿死亡率各５０％；第２组，母儿均存活。结论：早期诊断轻型ＡＦＬＰ病例，迅速终止妊娠，经输大量新鲜冰冻血浆治疗，ＡＦＬＰ预后可明显改善。肝组织穿刺时间宜在产后ＤＩＣ好转、腹水明显减少后进行。
Objective: To investigate the early recognition and management of milder cases of acute fatty liver in pregnancy (AFLP). Methods: Tweleve cases of AFLP treated in our hosptial during the past two and half years were retrospectively studied with emphasis on symptoms, laboratory findings, liver biopsy and maternal complications. The 12 cases were classified into 2 groups. Group 1, 6 cases of advanced AFLP diagnosed clinically, were treated in the first year of the study. Group 2, 6 cases of milder AFLP diagnosed by postpartum liver biopsy, were treated during the last one and half years of the study. Results: The mean gestational age at onset was 34±3 weeks. In the early stage, all cases had malaise, nausea, loss of appetite and epigastric distress followed by jaundice in the third trimester of pregnancy. Laboratory findings included raised transaminases (≤300 IU/L) and total serum bilirubin (32.5～510.8 μmol/L) levels, hypoalbuminemia (18～30 g/L), hypofibrogenemia (<2.4 g/L), prolonged prothrombin time and prolonged partial thromboplastin time. Maternal complications were frequent including hepatic encephalopathy (9), ascites (9), hypoglycemia (7), renal failure (3), hematemesis (4), preeclampsia (6), and postpartum hemorrheage (5). Cesarean sections were performed in 7 cases. In group 2, both mother and fetuses had 100% survival. However, the mortality of the mothers and fetuses in group 1 were both 50%. Conclusions:With increasing awareness, especially in the early recognition of AFLP cases and prompt progressive management, including early termination of pregnancy and large dose infusion of fresh frozen plasma, the prognosis of AFLP is obviously improved. Percutaneous liver biopsy should be done when the coagulation tests became normal and the amounts of ascites decreased after delivery.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
1997年第2期74-77,共4页
Chinese Journal of Obstetrics and Gynecology
关键词
脂肪肝
妊娠并发症
病理
Fatty liver Pregnancy Complications
