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目的:分析不同病因的妊娠晚期肝损害对妊娠结局的影响。方法:将2010~2012年在南通地区多家医院产科住院分娩的486例妊娠晚期肝损害患者按照不同病因进行分组,并随机选取同期肝功能正常的230例孕产妇作为对照组,比较不同病因的妊娠晚期肝损害对妊娠结局的影响。结果:486例资料完整的妊娠晚期肝损害患者中,妊娠期肝内胆汁淤积症(ICP)组剖宫产、早产、胎儿宫内窘迫及胎膜早破发生率均高于对照组,差异均有统计学意义(P<0.05);重度子痫前期组剖宫产、产后出血、胎儿宫内窘迫及早产发生率与对照组相比,差异均有统计学意义(P<0.05);妊娠期急性脂肪肝(AFLP)组共9例患者,其中孕产妇死亡2例,围产儿死亡2例;HELLP综合征组有1例胎死宫内;妊娠期病毒性肝炎(VHP)组胎儿宫内窘迫发生率高于对照组(P<0.01);非酒精性脂肪肝(NAFLD)、胆系疾病、感染中毒性及病因不明组的各项妊娠结局与对照组相比,差异均无统计学意义(P>0.05)。结论:ICP主要增加围产儿不良事件的发生,对孕产妇无明显不良影响;重度子痫前期对母婴均存在明显不良影响;轻中度VHP对母婴影响甚微;NAFLD对母婴无明显影响;而AFLP病情凶险,会增加母婴死亡的风险。
Objective: To analyze the different etiology of late pregnancy induced liver damage on pregnancy outcome. Methods: A total of 486 pregnant women with pregnancy-induced liver damage who were hospitalized in hospitals of Nantong from 2010 to 2012 were divided into different causes according to different causes. 230 pregnant women with normal liver function during the same period were randomly selected as the control group, Effect of liver damage in late pregnancy on pregnancy outcomes. Results: The incidence of cesarean section, prematurity, fetal distress and premature rupture of membranes in 486 pregnant women with incomplete pregnancy was significantly higher than that of the control group (P <0.05). The incidences of cesarean section, postpartum hemorrhage, fetal distress and preterm birth in severe preeclampsia group were significantly different from those in control group (P <0.05). Pregnancy Acute fatty liver (AFLP) group of 9 patients, including maternal death in 2 cases, 2 cases of perinatal death; HELLP syndrome group 1 case of fetal death; viral hepatitis during pregnancy (VHP) group of fetal distress (P <0.01) .Non-alcoholic fatty liver disease (NAFLD), gallbladder disease, infectious toxicity and unexplained group of pregnancy outcomes compared with the control group, the difference was not statistically significant ( P> 0.05). CONCLUSION: ICP mainly increases the incidence of perinatal adverse events without significant adverse effects on pregnant women; severe preeclampsia has obvious adverse effects on both mother and infant; mild to moderate VHP has little effect on mother and infant; NAFLD has no obvious effect on maternal and infant Affect; and AFLP dangerous, will increase the risk of maternal death.