摘要目的 探讨妊娠急性脂肪肝(AFLP)患者临床特点、终止妊娠前后实验室指标的变化特征. 方法 选取重庆医科大学附属第二医院和重庆市江北区人民医院妇产科2007-2018年间收治的AFLP患者,收集患者诊治过程中临床特点及其并发症、凝血功能和肝肾功能变化、产后病情恢复情况等资料进行回顾性分析. 结果 共计收治54例AFLP患者,均为妊娠晚期,平均发病孕周(35.0±1.7)周,临床以尿黄和恶心呕吐等消化道症状最为常见,均存在胆红素升高,90.7％患者伴有凝血功能改变,68.5％有血肌酐升高.终止妊娠后,患者转氨酶在1～2d内迅速下降,但总胆红素恢复较慢,6～8d后缓慢恢复;血肌酐和尿素氮产后略有升高,3～4d达高峰,随后开始下降;分娩后凝血酶原时间、纤维蛋白原等凝血指标不再恶化,5 ～6d后恢复至正常水平.急性肾损伤、肝衰竭、产后出血、弥散性血管内凝血是最常见的几种并发症,发生率分别为74.1％、42.6％、40.7％、33.3％.54例患者中有23例(42.6％)进展为急性肝衰竭,AFLP并发急性肝衰竭患者较非肝衰竭患者病程明显延长,且病情严重程度明显增加,病死率增加为17.4％ (4/23),非肝衰竭患者为0,差异有统计学意义. 结论 早期诊断、终止妊娠是决定妊娠急性脂肪肝患者预后的关键因素,终止妊娠后凝血功能不再恶化,肾功能4d后开始恢复,肝功能恢复偏后,控制并发症是决定患者预后的重要因素.

abstractsObjective To investigate the changes in clinical characteristics and laboratory indexes before and after the termination of pregnancy in patients with acute fatty liver of pregnancy (AFLP).Methods Patients with acute fatty liver of pregnancy who had been admitted to the Department of Obstetrics and Gynecology at the Second Affiliated Hospital of Chongqing Medical University and Chongqing Municipal People's Hospital of Jiangbei District between 2007 and 2018 were selected.Clinical characteristics and complications during diagnosis and treatment,changes in blood coagulation,liver and kidney function,and postpartum recovery were collected for retrospectively analysis.Results 54 cases with average gestational age of 35.0±1.7 weeks at third trimester of pregnancy with AFLP were treated.The most common gastrointestinal symptoms were yellow urine,nausea and vomiting.All patients had elevated bilirubin.90.7％ patients had changes in blood coagulation function and 68.5％ had elevated serum creatinine.Transaminase levels were dropped rapidly within 1-2 days after the termination of pregnancy.Total bilirubin recovery was slow and partially recovered after 6-8 days.Serum creatinine and BUN increased slightly after delivery,reaching a peak at 3-4 days and then began to deplete.There was slight change in prothrombin time and fibrinogen after delivery,but returned to normal level after 5-6 days.The most common complications were AKI (74.1％),LF (42.6％),PPH (40.7％) and DIC (33.3％).Twenty-three of the 54 eases (42.6％) progressed to acute liver failure.AFLP complicated with ALF course was significantly longer than healthy controls,and the disease severity was significantly increased,with a mortality rate of 17.4％ (4/23),and 0 in healthy controls.The difference was statistically significant.Conclusion Early diagnosis and termination of pregnancy are the key factors to determine the prognosis of pregnant patients with acute fatty liver.Blood coagulation function does not deteriorate after termination of pregnancy and renal function begins to recover after 4 days with slight restoration of liver function.The control of complications is an important factor to determine the prognosis of patients.