Zhou M, Luo X D, Yang Y
Department of Obstetrics and Gynecology, Hospital of Chongqing Red Cross Society(People's Hospital of Jiangbei District), Chongqing 400020, China.
Obstetrics and Gynecology Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
Zhonghua Gan Zang Bing Za Zhi. 2019 Aug 20;27(8):638-642. doi: 10.3760/cma.j.issn.1007-3418.2019.08.010.
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). 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. 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 cases (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. 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.
探讨妊娠急性脂肪肝（AFLP）患者终止妊娠前后临床特征及实验室指标的变化。选取2007年至2018年期间在重庆医科大学附属第二医院妇产科及重庆市江北区人民医院收治的妊娠急性脂肪肝患者。收集诊断和治疗期间的临床特征及并发症、凝血功能、肝肾功能变化及产后恢复情况进行回顾性分析。对54例妊娠晚期平均孕周为35.0±1.7周的AFLP患者进行治疗。最常见的胃肠道症状为尿黄、恶心和呕吐。所有患者胆红素均升高。90.7%的患者凝血功能有变化，68.5%的患者血清肌酐升高。终止妊娠后1 - 2天内转氨酶水平迅速下降。总胆红素恢复缓慢，6 - 8天后部分恢复。产后血清肌酐和尿素氮略有升高，3 - 4天达到峰值后开始下降。产后凝血酶原时间和纤维蛋白原略有变化，但5 - 6天后恢复正常水平。最常见的并发症为急性肾损伤（AKI，74.1%）、肝衰竭（LF，42.6%）、产后出血（PPH，40.7%）和弥散性血管内凝血（DIC，33.3%）。54例患者中有23例（42.6%）进展为急性肝衰竭。AFLP合并急性肝衰竭病程明显长于健康对照组，疾病严重程度明显增加，死亡率为17.4%（4/23），健康对照组为0。差异有统计学意义。早期诊断和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无恶化，肾功能4天后开始恢复，肝功能略有恢复。并发症的控制是决定患者预后的重要因素。
