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目的评估Swansea诊断标准在中国AFLP患者中的临床应用价值。方法回顾性分析首都医科大学附属北京地坛医院自1996年1月至2017年3月间出院诊断为AFLP的患者的临床资料,使用Swansea诊断标准进行评分,分析Swansea诊断标准对于AFLP诊断的准确性、不同评分阈值时母婴主要并发症和血液净化治疗的使用率。结果自1996年1月至2017年3月,共计70例患者出院诊断为AFLP。Swansea诊断标准评分≥6分的患者共计65例(92.8%),积分3～13分,平均(8.6±2.2)分。其中符合率较高的条目分别为:ALT或AST升高(69/70,占98.6%)、胆红素升高(67/70,95.7%)、白细胞升高(61/70,87.1%)、凝血功能障碍(60/70,85.7%)、尿酸升高(57/70,81.4%)、腹水或超声检查提示亮肝(50/70,71.4%)以及肾功能不全(50/70,71.4%)。研究发现,随着积分的增加,患者发生产后大出血、肝功能衰竭、急性肾损伤和肺部感染等严重并发症的发生率均逐渐升高,需要血液净化支持的患者比率逐渐增加。结论 Swansea诊断标准能较准确地诊断AFLP,其评分高低可反映疾病的严重程度及治疗干预的强度。
Objective To evaluate the clinical value of Swansea diagnostic criteria in patients with AFLP in China. Methods The clinical data of patients diagnosed as AFLP from Beijing Ditan Hospital, Capital Medical University from January 1996 to March 2017 were retrospectively analyzed. The Swansea diagnostic criteria were used to evaluate the accuracy of Swansea diagnostic criteria for AFLP diagnosis. Maternal and Child Primary Complications and Hepatic Purification Rates at Different Rating Thresholds. Results From January 1996 to March 2017, a total of 70 patients were discharged as AFLP. A total of 65 patients (92.8%) with Swansea diagnostic criteria ≥6 had a score of 3 to 13 with an average of (8.6 ± 2.2) points. Among them, the items with higher coincidence rates were elevated ALT or AST (69/70, 98.6%), elevated bilirubin (67/70, 95.7%), elevated white blood cells (61/70, 87.1%), , Coagulation disorders (60/70, 85.7%), elevated uric acid (57/70, 81.4%), ascites or ultrasonography showed bright liver (50/70, 71.4%) and renal dysfunction (50/70, 71.4 %). The study found that with the increase in points, patients with postpartum hemorrhage, liver failure, acute kidney injury and pulmonary infection and other serious complications were gradually increased the incidence of complications, and the need for blood purification support patients increased the proportion of patients. Conclusion Swansea diagnostic criteria can be more accurate diagnosis of AFLP, the level of the score can reflect the severity of the disease and the intensity of the therapeutic intervention.