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目的探讨妊娠急性脂肪肝(AFLP)的早期诊断方法和处理原则。方法对四川大学华西第二医院2003年1月至2006年12月收治的11例AFLP病例进行回顾性分析。结果(1)临床表现:患者出现恶心、呕吐、厌食、乏力、黄疸等临床表现;(2)实验室检查:肝功异常:丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)轻到中度升高,总胆红素、直接胆红素明显升高,白蛋白降低;肾功异常:肌酐、尿素氮明显升高;凝血功能障碍:凝血酶原时间延长、血小板降低、DIC;其他:部分患者白细胞增高,血糖降低;(3)影像学检查:超声诊断AFLP9例,CT诊断AFLP2例;(4)孕产妇及围生儿结局:孕产妇死亡1例;围生儿死亡1例。结论早期诊断和及时终止妊娠,并加强支持疗法是治疗AFLP的关键,可有效降低母婴死亡率。
Objective To investigate the early diagnosis and treatment principle of acute fatty liver of pregnancy (AFLP). Methods Retrospective analysis of 11 cases of AFLP admitted to West China Second Hospital of Sichuan University from January 2003 to December 2006. Results (1) Clinical manifestations: The patient showed nausea, vomiting, anorexia, fatigue, jaundice and other clinical manifestations; (2) laboratory tests: liver abnormalities: alanine aminotransferase (ALT), aspartate aminotransferase (AST) mild to moderate increase, total bilirubin, direct bilirubin was significantly increased, albumin decreased; renal abnormalities: creatinine, urea nitrogen was significantly increased; coagulation disorders: prothrombin time, platelets (3) imaging examination: ultrasound diagnosis of AFLP 9 cases, CT diagnosis of AFLP2 cases; (4) maternal and perinatal outcomes: maternal death in 1 case; perinatal One child died. Conclusion Early diagnosis and prompt termination of pregnancy, and to strengthen supportive care is the key to the treatment of AFLP, which can effectively reduce maternal and infant mortality.