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妊娠期急性脂肪肝12例临床分析
Clinical features and diagnosis and treatment of acute fatty liver of pregnancy: a report of 12 cases
文章发布日期:2018年02月07日  来源:  作者:陈科第, 杨道锋, 陈广  点击次数:561次  下载次数:133次

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【摘要】:目的探讨妊娠期急性脂肪肝(AFLP)的临床特点及诊治方法。方法回顾性分析2012年4月-2017年3月于华中科技大学同济医学院附属同济医院感染科诊治的12例AFLP患者的临床资料,对其基本信息、临床表现、相关实验室检查指标、影像学检查、治疗及预后进行分析。结果12例AFLP患者均发生于妊娠晚期,临床表现以消化道症状、肝功能衰竭、黄疸和凝血功能障碍为主,12例均给予护肝、改善凝血、抗感染等综合治疗,11例行剖宫产终止妊娠,6例使用了血液滤过,5例行血浆置换治疗,孕产妇死亡1例,病死率8.3%,围生儿死亡5例,病死率357%。结论针对AFLP患者,早诊断、及时终止妊娠、最大限度地对症支持治疗、控制感染,并联合人工肝支持系统治疗是改善母婴预后的关键。
【Abstract】:ObjectiveTo investigate the clinical features and diagnosis and treatment of acute fatty liver of pregnancy (AFLP). Methods A retrospective analysis was performed for the clinical data of 12 patients with AFLP who were diagnosed and treated in Department of Infectious Diseases, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, from April 2012 to March 2017, including general data, clinical manifestations, laboratory markers, imaging examinations, treatment, and prognosis. ResultsAll 12 patients developed AFLP in late pregnancy, and major clinical manifestations included gastrointestinal symptoms, liver failure, jaundice, and coagulation disorder. All patients were given multimodality therapy to protect the liver, improve coagulation, and reduce infection; 11 patients underwent cesarean section; 6 underwent blood filtration; 5 underwent plasma exchange. One patient died, resulting in a mortality rate of 83%; 5 perinatal infants died, resulting in a mortality rate of 357%. ConclusionIn patients with AFLP, early diagnosis, timely termination of pregnancy, maximum symptomatic/supportive treatment, and control of infection, as well as the artificial liver support system, is the key to improving the prognosis of mothers and infants.
【关键字】:脂肪肝; 妊娠并发症; 早期诊断; 治疗
【Key words】:fatty liver; pregnancy complications; early diagnosis; treatment
【引证本文】:CHEN KD, YANG DF, CHEN G. Clinical features and diagnosis and treatment of acute fatty liver of pregnancy: a report of 12 cases[J]. J Clin Hepatol, 2018, 34(3): 558-561. (in Chinese)
陈科第, 杨道锋, 陈广. 妊娠期急性脂肪肝12例临床分析[J]. 临床肝胆病杂志, 2018, 34(3): 558-561.

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