63例妊娠期急性脂肪肝临床分析

doi:10.6040/j.issn.1671-7554.0.2019.071

摘要/Abstract

摘要： 目的探讨妊娠期急性脂肪肝的临床特点。方法对2014年1月至2018年8月在广州医科大学附属第三医院就诊的63例妊娠期急性脂肪肝(AFLP)患者的临床资料进行回顾性分析,根据凝血酶原国际比值(INR)分为2组:≥1.5为重型组(n=32),<1.5为轻型组(n=31),观察两组临床特征、实验室检查指标、并发症、孕产妇及胎儿结局等情况。结果妊娠期急性脂肪肝患者多存在消化道症状,更多见于初产妇,且多采用剖宫产终止妊娠;患者具有异常的检验指标,其中轻型组丙氨酸氨基转移酶(ALT)、血小板(PLT)、凝血酶原活动度(PTA)、纤维蛋白原(FBG)高于重型组(P<0.05),总胆红素(TBIL)、直接胆红素(DBIL)、白细胞(WBC)、肌酐(SCr)、INR低于重型组(P<0.05);重型组较轻型组更易并发子痫、低蛋白及急性肾损伤(AKI),P值分别为0.043、0.032、0.036。结论 AFLP患者具有异常的ALT、PLT、PTA、FBG、INR、TBIL、DBIL、WBC、SCr指标;应根据凝血等指标积极补充相关物质,明确诊断后及时终止妊娠,进一步提高AFLP患者救治率。

关键词: 妊娠, 急性脂肪肝, 临床分析

Abstract: Objective To investigate the clinical features of acute fatty liver of pregnancy(AFLP). Methods Clinical data of 63 patients with AFLP who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 2014 to August 2018 were retrospectively analyzed. According to prothrombin international ratio(INR), the patients were divided into the severe group(n=32), in which the INR value was ≥1.5, and the light group(n=31), in which the INR value was <1.5. Clinical characteristics, laboratory tests, complications, the outcome of the maternal and fetus were compared between the two groups. Results Most of AFLP patients existed many gastrointestinal symptoms, appeared more common in primipara, and were terminated by cesarean section. Compared with the severe group, propionate aminotransferase(ALT), platelet(PLT), prothrombin activity(PTA)and fibrinogen(FBG)levels were higher(all P<0.05), while total bilirubin(TBIL), direct bilirubin(DBIL), white blood cells(WBC), creatinine(SCr), and INR were lower in the light group(all P<0.05). Compared with the light group, the complications such as eclampsia, low protein and acute kidney injury(AKI)were more common in the severe group, with the P value being 0.043, 0.032 and 0.036, respectively. Conclusion AFLP patients have abnormal ALT, PLT, PTA, FBG, INR, TBIL, DBIL, WBC, and SCr indicators. Positively supplementing related substances according to indicators such as coagulation and timely terminating of pregnancy after diagnosis are necessary to further improve the rate of treatment in AFLP.

Key words: Pregnancy, Acute fatty liver, Clinical analysis

中图分类号:

R459.4

徐文婷,李静,贾明旺,彭芳,杨嘉琳. 63例妊娠期急性脂肪肝临床分析[J]. 山东大学学报 (医学版), 2019, 57(5): 110-115.

XU Wenting, LI Jing, JIA Mingwang, PENG Fang, YANG Jialin. Clinical analysis of acute fatty liver of pregnancy in 63 cases[J]. Journal of Shandong University (Health Sciences), 2019, 57(5): 110-115.

参考文献

[1] Seyyed Majidi MR, Vafaeimanesh J. Plasmapheresis in acute Fatty liver of pregnancy: an effective treatment[J]. Case Rep Obstet Gynecol, 2013, 2013: 615975. doi: 10.1155/2013/615975.
[2] Natarajan SK, Ibdah JA. Role of 3-hydroxy fatty acid-induced hepatic lipotoxicity in acute fatty liver of pregnancy[J]. Int J Mol Sci, 2018, 19(1): E322. doi:10.3390/ijms19010322.
[3] Hartwell L, Ma T. Acute fatty liver of pregnancy treated with plasma exchange[J]. Dig Dis Sci, 2014, 59(9): 2076-2080.
[4] Xiong HF, Liu JY, Guo LM, et al. Acute fatty liver of pregnancy: over six months follow-up study of twenty-five patients[J]. World J Gastroenterol, 2015, 21(6): 1927-1931.
[5] Tonin AM, Amaral AU, Busanello EN, et al. Mitochondrial bioenergetics deregulation caused by long-chain 3-hydroxy fatty acids accumulating in LCHAD and MTP deficiencies in rat brain: a possible role of mPTP opening as a pathomechanism in these disorders?[J]. Biochim Biophys Acta, 2014, 1842(9): 1658-1667.
[6] Natarajan SK, Thangaraj KR, Goel A, et al. Acute fatty liver of pregnancy: an update on mechanisms[J]. Obstet Med, 2011, 4(3): 99-103.
[7] Chu YF, Meng M, Zeng J, et al. Effectiveness of combining plasma exchange with continuous hemodiafiltration on acute Fatty liver of pregnancy complicated by multiple organ dysfunction[J]. Artif Organs, 2012, 36(6): 530-534.
[8] Ronen J, Shaheen S, Steinberg D, et al. Acute fatty liver of pregnancy: a thorough examination of a harmful obstetrical syndrome and its counterparts[J]. Cureus, 2018, 10(2): e2164. doi:10.7759/cureus.2164.
[9] Bartha JL, Visiedo F, Fernández-Deudero A, et al. Decreased mitochondrial fatty acid oxidation in placentas from women with preeclampsia[J]. Placenta, 2012, 33(2): 132-134.
[10] Cichoz-Lach H. Pathogenesis of liver diseases associated with pregnancy[J]. Ginekol Pol, 2010, 81(8): 613-617.
[11] Meng J, Wang S, Gu Y, et al. Prenatal predictors in postpartum recovery for acute fatty liver of pregnancy: experiences at a tertiary referral center[J]. Arch Gynecol Obstet, 2016, 293(6): 1185-1191.
[12] Gao Q, Qu X, Chen X, et al. Outcomes and risk factors of patients with acute fatty liver of pregnancy: a multicentre retrospective study[J]. Singapore Med J, 2018, 59(8): 425-430.
[13] Al-Husban N, Al-Kuran O, Al Helou A. Postpartum acute fatty liver of pregnancy: a case report[J]. J Med Case Reports, 2018, 12: 67. doi:10.1186/s13256-018-1593-3.
[14] Goel A, Jamwal KD, Ramachandran A, et al. Pregnancy-related liver disorders[J]. J Clin Exp Hepatol, 2014, 4(2): 151-162.
[15] Zhang YP, Kong WQ, Zhou SP, et al. Acute fatty liver of pregnancy: a retrospective analysis of 56 cases[J]. Chin Med J(Engl), 2016, 129(10): 1208-1214.
[16] 朱特选,张卫社.妊娠期急性脂肪肝患者预后相关危险因素分析及预测模型建立[J].中国临床医学, 2016, 23(2): 152-156. ZHU Texuan, ZHANG Weishe. Prognostic value of different factors to predict death of acute fatty liver of pregnancy cases[J]. Chinese J of Clinical Medicine, 2016, 23(2): 152-156.
[17] Apaydin M, Ayik SO, Akhan G, et al. Carotid intima-media thickness increase in patients with habitual simple snoring and obstructive sleep apnea syndrome is associated with metabolic syndrome[J]. J Clin Ultrasound, 2013, 41(5): 290-296.
[18] Lanaspa MA, Cicerchi C, Garcia G, et al. Counteracting roles of AMP deaminase and AMP kinase in the development of fatty liver[J]. PLoS One, 2012, 7(11): e48801. doi:10.1371/journal.pone.0048801.
[19] Lanaspa MA, Epperson LE, Li NX, et al. Opposing activity changes in AMP deaminase and AMP-activated protein kinase in the hibernating ground squirrel[J]. PLoS One, 2015, 10(4): e0123509. doi:10.1371/journal.pone.0123509.
[20] 付丽华, 易为, 伊诺, 等. 妊娠期乙型肝炎病毒及妊娠急性脂肪肝相关肝功能衰竭患者的临床分析[J]. 中华实验和临床感染病杂志(电子版), 2015, 9(4): 520-523. FU Lihua, YI Wei, YI Nuo, et al. Clincal analysis of hepatitis B virus during pregnancy and acute fatty liver of pregnancy related to liver failure[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Version), 2015, 9(4): 520-523.
[21] Chatel P, Ronot M, Roux O, et al. Transient excess of liver fat detected by magnetic resonance imaging in women with acute fatty liver of pregnancy[J]. Am J Obstet Gynecol, 2016, 214(1): 127-129.
[22] Nelson DB, Yost NP, Cunningham FG. Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery[J]. Am J Obstet Gynecol, 2013, 209(5): 456.e1-456.e7. doi:10.1016/j.ajog.2013.07.006.
[23] Wang HY, Jiang Q, Shi H, et al. Effect of caesarean section on maternal and foetal outcomes in acute fatty liver of pregnancy: a systematic review and meta-analysis[J]. Sci Rep, 2016, 6: 28826. doi:10.1038/srep28826.
[24] Dwivedi S, Runmei M. Retrospective study of seven cases with acute Fatty liver of pregnancy[J]. ISRN Obstet Gynecol, 2013, 2013: 730569. doi:10.1155/2013/730569.
[25] Wu ZP, Huang P, Gong Y, et al. Treating acute fatty liver of pregnancy with artificial liver support therapy: systematic review[J]. Medicine(Baltimore), 2018, 97(38): e12473. doi:10.1097/MD.0000000000012473.
[26] 黄泽炳, 陈君, 漆敏, 等. 妊娠急性脂肪肝患者肺部感染的危险因素[J]. 中国感染控制杂志, 2018, 17(8): 693-696. HUANG Zebing, CHEN Jun, QI Min, et al. Risk factors for pulmonary infection in patients with acute fatty liver of pregnancy[J]. Chinese Journal of Infection Control, 2018, 17(8): 693-696.
[27] Vigil-de Gracia P, Montufar-Rueda C. Acute fatty liver of pregnancy: diagnosis, treatment, and outcome based on 35 consecutive cases[J]. J Matern Fetal Neonatal Med, 2011, 24(9): 1143-1146.
[28] 李传胜, 熊号峰, 刘景院, 等. 妊娠急性脂肪肝合并急性肾损伤患者的临床特点及治疗[J]. 中国肝脏病杂志(电子版), 2016, 8(4): 26-31. LI Chuansheng, XIONG Haofeng, LIU Jingyuan, et al. Clinical characteristics and treatment of pregnant women complicated with acute fatty liver and acute kidney injury[J]. Chinese Journal of Liver Diseases(Electronic Version), 2016, 8(4): 26-31.

相关文章 15

[1]	艾星子·艾里,郭铮宇,张晓霏. 子宫腺肌病高强度聚焦超声消融治疗研究进展[J]. 山东大学学报 (医学版), 2022, 60(7): 36-42.
[2]	吴日超,刘红,王泽,高姗姗,李秀芳,石玉华. 40岁及以上女性行体外受精-胚胎移植助孕的妊娠结局分析[J]. 山东大学学报 (医学版), 2022, 60(6): 35-39.
[3]	曹丹凤,刘宗花,王君芝,张国翔. 女性儿童期家庭功能障碍对成年后妊娠期抑郁症状的独立和累积作用[J]. 山东大学学报 (医学版), 2022, 60(6): 97-101.
[4]	李燕,刘静,李娟,杨秋红. 50例孕产妇血流感染临床特征及胎盘病理分析[J]. 山东大学学报 (医学版), 2022, 60(1): 48-54.
[5]	张建平,罗莺儿. 抗凝药物在反复不良妊娠治疗中的应用进展[J]. 山东大学学报 (医学版), 2021, 59(8): 14-19.
[6]	陈伟,郭情情,徐金,方园,孙梅,盛燕. 自然周期联合黄体期卵巢刺激助孕和双重刺激助孕效果的对比分析[J]. 山东大学学报 (医学版), 2021, 59(8): 61-66.
[7]	邬晓琳,李萍. 激动剂长方案下促性腺激素使用时长对体外受精胚胎移植妊娠结局的影响[J]. 山东大学学报 (医学版), 2021, 59(7): 32-37.
[8]	龙宇晗,罗霞,姜洁. 妊娠期异常高脂血症2例报告并文献复习[J]. 山东大学学报 (医学版), 2021, 59(3): 103-106.
[9]	萧阳,陶宇,王方怡,梁俞秀,张晋,季晓康,王志萍. 山东省部分地区PM_2.5和PM₁₀暴露与妊娠期糖尿病的关联性分析[J]. 山东大学学报 (医学版), 2021, 59(12): 101-109.
[10]	贾明旺,廖广园,熊明媚,徐文婷,王银玲,王懿春. 84例妊娠合并肺高血压患者预后的临床分析[J]. 山东大学学报 (医学版), 2021, 59(1): 34-39.
[11]	霍素霞,刘薇,王鑫. 86例Ⅲ型瘢痕妊娠诊治体会[J]. 山东大学学报 (医学版), 2021, 59(1): 40-44.
[12]	梁荔,孙斌,张洪战,叶方之,冯宪光,张锎. 基于不同病理分级的48例胆囊腺瘤临床特点分析[J]. 山东大学学报 (医学版), 2021, 59(1): 59-63.
[13]	陈擎仪,张烜,王娟,孙继伟,曹丹凤, 曹枫林. 妊娠期女性自杀意念的危险因素及其累积效应[J]. 山东大学学报 (医学版), 2021, 59(1): 91-94.
[14]	曹明雅,赵晗洁,冯腾飞,贾蕊,赵志明,郝桂敏. 孕早期行减胎术对胚胎移植助孕患者围产期母婴的影响[J]. 山东大学学报 (医学版), 2020, 58(11): 65-70.
[15]	于娜,郭情情,孙梅,盛燕,马增香,秦莹莹. 甲状腺癌术后行IVF/ICSI-ET助孕临床结局[J]. 山东大学学报 (医学版), 2018, 56(9): 54-58.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed