Meng Jinlai, Wang Shan, Gu Yongzhong, Lv Hong, Jiang Jinjiao, Wang Xietong
Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China.
Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong, China.
Arch Gynecol Obstet. 2016 Jun;293(6):1185-91. doi: 10.1007/s00404-015-3941-5. Epub 2015 Nov 2.
The purpose of this study was to describe some prenatal characteristics and laboratory findings of acute fatty liver of pregnancy (AFLP) and provide the clinicians with reasonable predictors and expectation in postpartum recovery.
At a tertiary referral center 43 patients with AFLP were entered into this retrospective study in 5 years based on the Swansea criteria. Emergent cesarean sections were performed within 24 h, and the criteria of recovery after operation was based on a uniform standard. All of them were hospitalized and treated at the same department of obstetrics and maternal intensive care unit.
Prenatally, all women with AFLP had elevated serum hepatic aminotransferase and serum bilirubin levels. Albumin level was decreased in 88 % women and hypoglycemia was documented in 56 % women. Plasma fibrinogen level of 93 % patients was less than 1.75 g/L and prothrombin time (PT) of 91 % was prolonged abnormally. The duration of recovery after delivery ranged from 5 to 20 days. Pearson correlation coefficient between duration of recovery and hyperbilirubinemia was 0.639 (P = 0.001). The levels of PT, plasma fibrinogen and platelet counts were also correlated with the recovery time (R = 0.459, P = 0.002; R = 0.427, P = 0.004; R = 0.435, P = 0.004). Elevated leukocytes, hypoglycaemia, hepatic aminotransferase and uric acid levels showed no value for predicting the prognosis of AFLP (P > 0.01).
AFLP is a rare but serious complication in the third trimester. Prenatal serum bilirubin, PT, plasma fibrinogen levels and platelet counts are the predictors of postpartum recovery, but some Swansea diagnosis criteria do not have the same prognostic significance as others.
本研究旨在描述妊娠急性脂肪肝（AFLP）的一些产前特征和实验室检查结果，并为临床医生提供产后恢复的合理预测指标和预期情况。
在一家三级转诊中心，根据斯旺西标准，5年内43例AFLP患者纳入本回顾性研究。在24小时内进行急诊剖宫产，术后恢复标准基于统一标准。所有患者均在同一产科和孕产妇重症监护病房住院治疗。
产前，所有AFLP女性血清肝转氨酶和血清胆红素水平均升高。88%的女性白蛋白水平降低，56%的女性有低血糖记录。93%患者的血浆纤维蛋白原水平低于1.75g/L，91%患者的凝血酶原时间（PT）异常延长。产后恢复时间为5至20天。恢复时间与高胆红素血症之间的Pearson相关系数为0.639（P = 0.001）。PT、血浆纤维蛋白原水平和血小板计数也与恢复时间相关（R = 0.459，P = 0.002；R = 0.427，P = 0.004；R = 0.435，P = 0.004）。白细胞、低血糖、肝转氨酶和尿酸水平升高对预测AFLP预后无价值（P > 0.01）。
AFLP是孕晚期一种罕见但严重的并发症。产前血清胆红素、PT、血浆纤维蛋白原水平和血小板计数是产后恢复的预测指标，但一些斯旺西诊断标准的预后意义不尽相同。
