A prospective national study of acute fatty liver of pregnancy in the UK
A prospective national study of acute fatty liver of pregnancy in the UK
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DOI：
10.1136/gut.2008.148676
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发表时间：
2008-07-01
期刊：
影响因子：
24.5
通讯作者：
Brocklehurst, P.
中科院分区：
文献类型：
--
作者：
Knight, M.;Nelson-Piercy, C.;Brocklehurst, P.
目的：确定全国性妊娠期急性脂肪肝 (AFLP) 女性人群队列，评估提出的诊断标准，准确记录该病的发病率、治疗和结果。 对象和方法：这是一项基于人群的描述性研究，使用英国产科监测系统，在英国所有 229 家设有顾问领导的妇产科的医院进行。参与者包括 2005 年 2 月至 2006 年 8 月期间在英国诊断为 AFLP 的 57 名妇女，估计有 1 132 964 名产妇（分娩妇女）。结果：估计 AFLP 发病率为每 100 000 名产妇 5.0 例（95% CI 为每 100 000 名产妇 3.8 至 6.5 例）。 55 例 (90%) 病例通过诊断标准和临床评估得到确诊，2 例 (3%) 仅通过临床评估确诊，符合 97%（kappa 统计 = 0.78）。 18% 的女性怀有双胞胎，20% 的女性体重不足（体重指数 (BMI) < 20）。 60% 的女性被送往重症监护室，15% 被送往肝脏专科病房。一名妇女接受了肝脏移植手术。一名妇女死亡（病死率 1.8%，95% CI 0% 至 9.4%）。 67 名婴儿中有 7 人死亡（围产期死亡率为每 1000 名新生儿 104 人，95% CI 43 至 203）。结论：迄今为止最大的基于人群的 AFLP 女性队列已经确定。先前提出的诊断标准与临床诊断基本一致。这项研究的发病率估计值低于早期医院研究记录的发病率，但孕产妇和新生儿的结局比以前报道的要好，这可能与确定的改进有关。双胎妊娠的女性似乎面临更高的风险，但需要进一步研究来调查与低体重指数相关的风险。
Objectives: To identify a national, population-based cohort of women with acute fatty liver of pregnancy (AFLP), to evaluate proposed diagnostic criteria and to document accurately the incidence, management and outcomes of the condition.Subjects and methods: This was a population-based descriptive study using the UK Obstetric Surveillance System, carried out in all 229 hospitals with consultant-led maternity units in the UK. The participants comprised 57 women in the UK diagnosed with AFLP between February 2005 and August 2006 in an estimated cohort of 1 132 964 maternities (women delivering).Results: The estimated incidence of AFLP was 5.0 cases per 100 000 maternities (95% CI 3.8 to 6.5 per 100 000). Fifty-five cases (90%) were confirmed by diagnostic criteria and clinical assessment, two (3%) by clinical assessment alone, representing 97% agreement (kappa statistic = 0.78). 18% of women had twin pregnancies and 20% were underweight (body mass index (BMI) < 20). 60% of women were admitted to intensive care and 15% to a specialist liver unit. One woman received a liver transplant. One woman died (case fatality rate 1.8%, 95% CI 0% to 9.4%). There were seven deaths among 67 infants (perinatal mortality rate 104 per 1000 births, 95% CI 43 to 203).Conclusions: The largest population-based cohort of women with AFLP to date has been identified. Diagnostic criteria previously proposed agree substantially with clinical diagnosis. The incidence estimate from this study is lower than documented by earlier hospital-based studies, but maternal and neonatal outcomes are better than previously reported, possibly related to improved ascertainment. Women with twin pregnancies appear to be at higher risk, but further studies are needed to investigate the risk associated with low BMI.