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目的分析妊娠期急性脂肪肝(AFLP)的临床特征并探讨该病预后不良的相关因素。方法将2011年8月至2016年1月四川大学华西第二医院收治的36例AFLP患者纳入研究,依据临床结局分为两组:预后良好组(n=30)和预后不良组(n=6)。比较两组患者的一般资料、临床资料、实验室辅助检查、治疗措施等。结果临床特征的指标中产前患有妊娠期糖尿病的比例,产后出现宫缩乏力的比例,合并弥散性血管内凝血(DIC)、肝性脑病的比例,血浆置换率两组间比较差异具有统计学意义(P<0.05);入院时辅助检查的实验室指标中凝血酶原时间(PT)、活化的部分凝血酶时间(APTT)、血糖(Glu)、总胆红素(TBIL)、直接胆红素(DBIL)、总蛋白(TP)两组间比较差异具有统计学意义(P<0.05)。结论 AFLP是妊娠晚期的严重并发症,发病凶险,母婴死亡率高。AFLP患者预后不良多与起病后迅速出现凝血功能严重异常、血糖水平降低、TBIL水平增高和TP降低,且多并发消化道出血、肝性脑病等因素有关。
Objective To analyze the clinical features of acute fatty liver in pregnancy (AFLP) and explore the related factors of poor prognosis of the disease. Methods Thirty-six AFLP patients admitted to the Second West China Hospital of Sichuan University from August 2011 to January 2016 were enrolled in the study. The patients were divided into two groups according to the clinical outcome: good prognosis group (n = 30) and poor prognosis group (n = 6 ). The two groups of patients were compared with the general information, clinical data, laboratory auxiliary examination, treatment measures. Results The clinical characteristics of the indicators of prenatal diagnosis of gestational diabetes mellitus, the proportion of postpartum uterine atony, combined disseminated intravascular coagulation (DIC), hepatic encephalopathy ratio, plasma exchange rate difference between the two groups with statistics (P <0.05). The indexes of laboratory tests such as prothrombin time (PT), activated partial thromboplastin time (APTT), blood glucose (Glu), total bilirubin (TBIL) There was significant difference between the two groups (P <0.05) of DBIL and TP. Conclusion AFLP is a serious complication in the third trimester of pregnancy. It is an extremely dangerous disease with high maternal and infant mortality. AFLP patients with poor prognosis and rapid onset of severe coagulation abnormalities, lower blood glucose levels, elevated TBIL levels and TP decreased, and more complicated by gastrointestinal bleeding, hepatic encephalopathy and other factors.