Retrospective study of seven cases with acute Fatty liver of pregnancy.
Retrospective study of seven cases with acute Fatty liver of pregnancy.
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DOI：
10.1155/2013/730569
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Runmei M
中科院分区：
文献类型：
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作者：
Dwivedi S;Runmei M
目标.目的探讨妊娠期急性脂肪肝（AFLP）患者的临床结局，评价早期诊断和治疗的效果。方法.回顾性分析2005年2月至2013年1月期间诊断为AFLP的7例患者。回顾AFLP患者的临床资料，分析其临床特征、实验室检查、母体和围生儿预后。常规实验室检查显示高胆红素血症，肝转氨酶中度升高，但血清肝炎病毒阴性。为了获得更多的证据，我们回顾性分析了126例AFLP病例，这些病例来自于同一时期基于Medline-based English and Chinese Knowledge Infrastructure的原始文献。结果7例AFLP患者均以胃肠道症状、厌食、恶心、呕吐、进行性黄疸为首发症状。并发症均为肾功能不全。4例（57.1%）出现肝功能衰竭、MODS、低血糖和DIC。出血性休克、急性呼吸窘迫综合征、肝性脑病3例（42.8%）。只有1例产妇死亡（14.2%），3例围产期死亡（30%）和1例产后死亡（10%）。结论AFLP发生于妊娠晚期，是一种罕见的临床综合征，发生于妊娠36周左右。早期诊断、及时终止妊娠是多学科协作管理的关键，综合治疗和有效预防有助于改善AFLP病例的预后和围生儿死亡。
Objectives. Our aim is to explore the clinical outcome of patients with acute fatty liver of pregnancy (AFLP), and evaluate the effect of early diagnosis and treatment. Methods. Seven patients who were diagnosed with AFLP were retrospectively analyzed from February 2005 to January 2013. The clinical records of the patients with AFLP were reviewed for clinical features, laboratory examinations, and maternal and perinatal prognosis. Routine laboratory evaluation revealed hyperbilirubinemia, moderately elevated liver transaminase, but negative serum hepatitis virus in each patient. For additional evidence, 126 cases of AFLP were reviewed retrospectively from original articles researched in A Medline-based English and Chinese Knowledge Infrastructure between the same periods. Results. The initial symptoms of all the 7 cases with AFLP were gastrointestinal symptoms; anorexia, nausea, vomiting, and progressive jaundice. Complications revealed with renal insufficiency in all 7 patients. Hepatic failure, MODS, hypoglycemia and DIC were seen in 4 patients (57.1%). Hemorrhagic shock, ARDS, and hepatic encephalopathy were seen in 3 patients (42.8%). There was only one case of maternal death (14.2%), three cases of perinatal death (30%) and one postnatal death (10%). Conclusion. AFLP occurs in late pregnancy is a rare clinical syndrome occurs at about 36 weeks of gestation. Early diagnosis and prompt termination of pregnancy is the key of management with multidisciplinary collaboration, comprehensive treatment and effective prevention are helpful to improve prognosis of the cases with AFLP and perinatal death.