Tang Wan Xin, Huang Zhong Ying, Chen Ze Jun, Cui Tian Lei, Zhang Ling, Fu Ping
Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.
J Artif Organs. 2012 Jun;15(2):176-84. doi: 10.1007/s10047-011-0621-5. Epub 2011 Nov 26.
Acute fatty liver of pregnancy (AFLP) complicated by acute kidney injury (AKI) is serious and life-threatening for the mother. The present study aimed to determine the clinical efficacy of combined blood purification treatment (CBPT) in patients with AFLP complicated by AKI. The CBPT involves plasma exchange (PE) combined with continuous venovenous hemofiltration (CVVH). The subjects were 17 patients with AFLP complicated by AKI. The CBPT was implemented based on the timely termination of pregnancy and general treatment. Changes in clinical manifestations, laboratory tests, liver ultrasounds, as well as Sequential Organ Failure Assessment (SOFA) and Glasgow scores were evaluated. The efficacy and adverse reactions of the CBPT were also assessed. The CBPT was smoothly performed without any obvious adverse reaction. After treatment, the clinical manifestations, laboratory examinations, and liver ultrasonography significantly improved. Therefore, the SOFA scores correspondingly decreased 1 week after treatment [9 (range 5-11) vs. 3 (range 0-10), P = 0.002], and the median was close to normal by the second week. The clearance rate of the total bilirubin in PE was significantly higher than that in CVVH (37.2 vs. 7.9%, P = 0.000). The incidence of acute pulmonary edema in CVVH was less than that in PE (0 vs. 41.2%, P = 0.007). Finally, the maternal mortality was 5.88% (95% CI: 0-29%). Overall, we think that CBPT aids in the recovery of liver and kidney function. Different blood purification methods may be combined to integrate and maximize their advantages to improve the prognoses of patients with serious AFLP.
妊娠急性脂肪肝（AFLP）合并急性肾损伤（AKI）对母亲来说病情严重且危及生命。本研究旨在确定联合血液净化治疗（CBPT）对AFLP合并AKI患者的临床疗效。CBPT包括血浆置换（PE）联合连续性静脉-静脉血液滤过（CVVH）。研究对象为17例AFLP合并AKI患者。CBPT在及时终止妊娠和进行一般治疗的基础上实施。评估了临床表现、实验室检查、肝脏超声以及序贯器官衰竭评估（SOFA）和格拉斯哥评分的变化。还评估了CBPT的疗效和不良反应。CBPT顺利进行，未出现明显不良反应。治疗后，临床表现、实验室检查和肝脏超声均显著改善。因此，治疗1周后SOFA评分相应下降[9（范围5 - 11）对3（范围0 - 10），P = 0.002]，到第2周中位数接近正常。PE中总胆红素清除率显著高于CVVH（37.2%对7.9%，P = 0.000）。CVVH中急性肺水肿的发生率低于PE（0对41.2%，P = 0.007）。最后，孕产妇死亡率为5.88%（95%CI：0 - 29%）。总体而言，我们认为CBPT有助于肝肾功能的恢复。可联合不同的血液净化方法以整合并最大化其优势，从而改善重症AFLP患者的预后。
