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[妊娠急性脂肪肝——病例系列]

[Acute Fatty Liver of Pregnancy - Case Series].

作者信息

Brügge Martina, Pecks Ulrich, Iannaccone Antonella, Palz-Fleige Monika, Stepan Holger, Tauscher Anne

机构信息

Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany.

Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Essen, Essen, Germany.

出版信息

Z Geburtshilfe Neonatol. 2023 Dec;227(6):466-473. doi: 10.1055/a-2096-6230. Epub 2023 Jul 25.

Abstract

With a prevalence of 0,01-0,03%, acute fatty liver in pregnancy (AFLP) is a rare and dangerous complication of pregnancy and is difficult to distinguish from other, sometimes more common, pregnancy diseases such as HELLP syndrome, aHUS and TTP because of its mostly non-specific symptoms. Due to its rarity, AFLP is often not obvious to the obstetrician as a possible differential diagnosis. Yet early diagnosis and the fastest possible delivery is the only causal therapy and is important for the mortality rate. In the present manuscript, the pathophysiology, diagnosis and therapy of acute fatty liver in pregnancy are highlighted for the clinical routine based on case descriptions from three university hospitals, and reference is made to possible findings that are helpful in establishing the diagnosis. The angiogenic preeclampsia marker sFlt-1 plays a role and provides new opportunities to consider pathophysiological approaches.

摘要

妊娠急性脂肪肝(AFLP)的患病率为0.01%-0.03%,是一种罕见且危险的妊娠并发症,由于其症状大多不具特异性,因此很难与其他有时更为常见的妊娠疾病,如HELLP综合征、非典型溶血尿毒综合征(aHUS)和血栓性血小板减少性紫癜(TTP)相区分。由于其罕见性,AFLP作为一种可能的鉴别诊断,对产科医生来说往往并不明显。然而,早期诊断和尽快分娩是唯一的病因治疗方法,对死亡率至关重要。在本手稿中,基于三家大学医院的病例描述,重点介绍了妊娠急性脂肪肝的病理生理学、诊断和治疗方法,以供临床参考,并提及有助于确诊的可能发现。血管生成性子痫前期标志物可溶性血管内皮生长因子受体-1(sFlt-1)发挥作用,并为考虑病理生理学方法提供了新机会。

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