Yu Cheng-Bo, Chen Jia-Jia, Du Wei-Bo, Chen Ping, Huang Jian-Rong, Chen Yue-Mei, Cao Hong-Cui, Li Lan-Juan
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2014 Apr;13(2):179-83. doi: 10.1016/s1499-3872(14)60028-x.
Acute fatty liver of pregnancy (AFLP) in the third trimester or early postpartum period can lead to fatal liver damage. Its traditional therapy is not very effective in facilitating hepatic recovery. The safety and effect of plasma exchange (PE) in combination with continuous renal replacement therapy (CRRT) (PE+CRRT) for AFLP still needs evaluation.
Five AFLP patients with hepatic encephalopathy and renal failure were subjected to PE+CRRT in our department from 2007 to 2012. Their symptoms, physical signs and results were observed, and all relevant laboratory tests were compared before and after PE+CRRT.
All the 5 patients were well tolerated to the therapy. Four of them responded to the treatment and showed improvement in clinical symptoms/signs and laboratory results, and they were cured and discharged home after the treatment. One patient succeeded in bridging to transplantation for slowing down hepatic failure and its complications process after 2 treatment sessions. Intensive care unit stay and hospital stay were 9.4 (range 5-18) and 25.0 days (range 11-42), respectively.
PE+CRRT is safe and effective and should be used immediately at the onset of hepatic encephalopathy and/or renal failure in patients with AFLP.
妊娠晚期或产后早期的急性脂肪肝（AFLP）可导致致命的肝损伤。其传统治疗方法在促进肝脏恢复方面效果不佳。血浆置换（PE）联合持续肾脏替代疗法（CRRT）（PE+CRRT）治疗AFLP的安全性和疗效仍需评估。
2007年至2012年，我科对5例合并肝性脑病和肾衰竭的AFLP患者进行了PE+CRRT治疗。观察患者的症状、体征及治疗效果，并比较PE+CRRT治疗前后的所有相关实验室检查结果。
5例患者对治疗耐受性良好。其中4例治疗有效，临床症状/体征及实验室检查结果均有改善，治疗后治愈出院。1例患者在接受2次治疗后成功过渡到肝移植，以延缓肝衰竭及其并发症的进程。重症监护病房停留时间和住院时间分别为9.4天（范围5-18天）和25.0天（范围11-42天）。
PE+CRRT安全有效，应在AFLP患者出现肝性脑病和/或肾衰竭时立即使用。
