A 20-Year Single-Center Experience with Acute Liver Failure During Pregnancy: Is the Prognosis Really Worse?
A 20-Year Single-Center Experience with Acute Liver Failure During Pregnancy: Is the Prognosis Really Worse?
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DOI：
10.1002/hep.22493
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发表时间：
2008-11-01
期刊：
影响因子：
13.5
通讯作者：
Acharya, Subrat Kumar
中科院分区：
文献类型：
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作者：
Bhatia, Vikram;Singhal, Amit;Acharya, Subrat Kumar
急性肝功能衰竭（ALF）孕妇被认为比急性肝功能衰竭的非孕妇和男性预后更差。然而，支持这一假设的客观数据很少。因此，本研究比较了ALF在孕妇和女孩与年龄匹配的非孕妇和女孩、男性和男孩之间的结局、并发症和原因。从1986年1月到2006年12月，在新德里全印度医学科学研究所连续收治的1500名育龄期ALF患者被纳入研究。共有249名（38.5%）妇女怀孕。他们与341名未怀孕的妇女和女孩以及425名年龄在15至45岁之间的男性和男孩进行了比较。孕妇和女孩的死亡率（53.8%）与年龄匹配的非孕妇和女孩（57.2%）以及男性和男孩（57.9%）相似；P = 0.572。三组患者的临床生化特征、病情严重程度及并发症也相似。与未怀孕妇女和女孩（30.4%）以及男性和男孩（23.1%）相比，怀孕妇女和女孩（59.4%）中由戊型肝炎病毒（HEV）引起的ALF比例明显更高；P < 0.001。然而，hev相关ALF的结局与患者的性别和妊娠状态无关（P = 0.103）。孕妇和女童HEV-ALF和非HEV-ALF患者的死亡率分别为51%（74/145）和54.7% (52/95)（P < 0.05）。妊娠期ALF患者的预后也与妊娠期无关。非hev相关ALF在孕妇和女孩（54.7%）、年龄匹配的非孕妇和女孩（61.7%）、男性和男孩（62.8%）之间的死亡率也相似（P < 0.1）。结论：妊娠期ALF患者的死亡率与非妊娠期女性和女童、男性和男童相似，且与病因或妊娠期无关。妊娠本身不应被视为ALF患者预后不良的因素。(肝脏病学48:1577 2008;1585)。
Pregnant patients with acute liver failure (ALF) are believed to have a worse outcome than nonpregnant women and men with ALF. However objective data supporting this supposition are scant. Therefore, the current study compared the outcome, complications, and causes of ALF among pregnant women and girls with age-matched nonpregnant women and girls and men and boys with ALF. One thousand fifteen consecutive ALF patients in the reproductive age group, admitted at the All India Institute of Medical Sciences, New Delhi, from January 1986 to December 2006, were included in the study. A total of 249 (38.5%) women were pregnant. They were compared with 341 nonpregnant women and girls and 425 men and boys, aged 15 to 45 years. The mortality rate of pregnant women and girls (53.8%) was similar to age-matched nonpregnant women and girls (57.2%), and men and boys (57.9%); P = 0.572. The clinical and biochemical features, disease severity, and complications were also similar in the three groups. A significantly higher proportion of ALF was attributable to hepatitis E virus (HEV) among women and girls who were pregnant (59.4%), as compared with both nonpregnant women and girls (30.4%), and men and boys (23.1%); P < 0.001. However, the outcome of HEV-related ALF was independent of the sex and pregnancy status of the patients (P = 0.103). Mortality in HEV-ALF and non-HEV-ALF patients in pregnant women and girls was 51% (74/145) and 54.7% (52/95) (P > 0.1), respectively. The outcome of pregnant ALF patients was also unrelated to the trimester of pregnancy. The mortality of non-HEV-related ALF among the pregnant women and girls (54.7%), age-matched nonpregnant women and girls (61.7%), and men and boys (62.8%) were also similar (P > 0.1). Conclusion: The mortality of pregnant patients with ALF is similar to that of nonpregnant women and girls and men and boys and is independent of the cause or trimester. Pregnancy per se should not be regarded as a poor prognostic factor for a patient with ALF. (HEPATOLOGY 2008;48:1577-1585.)