血浆置换术联合低分子肝素钠对妊娠期急性脂肪肝患者凝血和肝肾功能及妊娠结局的影响

肝脏 ›› 2023, Vol. 28 ›› Issue (2): 238-241.

血浆置换术联合低分子肝素钠对妊娠期急性脂肪肝患者凝血和肝肾功能及妊娠结局的影响

袁小莉, 王德琴, 徐晓英

226600 南通大学附属海安医院血液透析中心(袁小莉,王德琴);南通大学附属海安医院妇产科(徐晓英)

收稿日期:2022-04-05 出版日期:2023-02-28 发布日期:2023-04-10
通讯作者: 袁小莉,Email:3555713882@qq.com
基金资助:
江苏省2018年度卫生健康委科研课题(H2018053)

Effects of plasma exchange combined with low-molecular-weight heparin sodium on coagulation, liver and kidney function and pregnancy outcomes in patients with acute fatty liver of pregnancy

YUAN Xiao-li¹, WANG De-qin¹, XU Xiao-ying²

1. Department of Hemodialysis Center,Haian Hospital Affiliated to Nantong University,226600, China;
2. Department of Obstetrics and Gynecology, Haian Hospital affiliated to Nantong University,226600, China

Received:2022-04-05 Online:2023-02-28 Published:2023-04-10
Contact: YUAN Xiao-li,Email:3555713882@qq.com

摘要/Abstract

摘要： 目的探讨对妊娠期急性脂肪肝(AFLP)患者采用血浆置换术(PE)联合低分子肝素钠治疗的效果和安全性。方法将2019年1月—2021年12月收治的55例AFLP患者分成两组,对照组给予常规支持和PE治疗,观察组在基础上加用低分子肝素钠治疗,观察两组的凝血功能、肝功能、肾功能指标的变化,妊娠结局和药物不良反应。结果治疗1周后,观察组的D-dimer和PT水平为1.73±0.34 mg/mL和12.43±1.72 s,低于对照组的1.91±0.42 mg/mL和14.16±2.04s;观察组的FIB和PLT水平为4.67±0.97 g/L和118.29±9.81×10⁹,高于对照组的3.58±0.72 g/L和100.45±9.13×10⁹,差异有统计学意义(t=6.876,7.583,7.821,7.295,均P<0.05)。观察组的ALT、TBil和DBil水平为79.58±6.53 U/L、82.34±7.71 μmol/L和81.47±5.73 μmol/L,低于对照组的96.45±8.42 U/L、97.52±8.65 μmol/L和97.52±7.68 μmol/L;观察组的Alb为34.82±3.78 g/L,低于对照组的32.67±3.72 g/L,差异有统计学意义(t=8.746,8.437,8.263,6.437,P<0.05)。观察组的Cr、UA和24小时尿蛋白量为128.15±7.14 μmol/L、227.64±11.42 μmol/L和2.54±0.32 g/24 h,低于对照组的142.43±7.96 μmol/L、289.52±13.29 μmol/L和2.83±0.38 g/24 h,差异有统计学意义(t=7.538,7.652,7.826,P<0.05)。观察组的新生儿重度窒息率、DIC发生率、产后出血量、围生期母婴死亡率和肝功能恢复时间等指标均显著低于对照组(P<0.05)。两组不良反应比较无差异(P＞0.05)。观察组未发生严重药物不良反应。结论采用PE联合低分子肝素钠治疗AFLP,能改善凝血功能,促进肝肾功能恢复,改善妊娠结局,用药安全性较高。

关键词: 妊娠期急性脂肪肝, 低分子肝素钠, 血浆置换, 凝血功能, 肝肾功能, 妊娠

Abstract: Objective To investigate the efficacy and safety of plasma exchange (PE) combined with low-molecular-weight heparin sodium(LMWH) in the treatment of patients with acute fatty liver of pregnancy (AFLP). Methods A total of 55 AFLP patients admitted from January 2019 to December 2021 were divided into two groups. The control group was given PE and supportive treatment, and the observation group was additionally treated with LMWH. The changes of coagulation parameters, liver and renal function , pregnancy outcomes and adverse drug reactions of the two groups were observed. Results After 1 week of treatment, D-dimer and PT levels in the observation group were lower than controls (1.73±0.34)mg/ mL vs (1.91±0.42)mg/mL; (12.43±1.72)s vs (14.16±2.04)s, all P<0.05). The levels of FIB and PLT were higher in the observation group compared with the control group( (4.67±0.97)g/L vs (43.58±0.72)g/L; (118.29±9.81)×10⁹/L vs (100.45±9.13)×10⁹/L, all P<0.05). Serum ALT, TBIl, DBIl and Alb levels in the observation group were lower than in the control group(( 79.58±6.53)U/L vs (96.45±8.42)U/L; (82.34±7.71)μmol/L vs (97.52±8.65)μmol/L; (81.47±5.73)μmol/L vs (97.52±7.68)μmol/L, (34.82±3.78)g/L vs (32.67±3.72)g/L, all P<0.05 ). The observation group also showed significantly lower levels of Cr, UA and 24-hour urinary protein compared with the control group ((128.15±7.14)μmol/L vs (142.43±7.96)μmol/L; (227.64±11.42)μmol/Lvs (289.52±13.29)μmol/L; (2.54±0.32)g/24 h vs (2.83±0.38)g/24 h, all P<0.05). The incidences of severe birth asphyxia and DIC, postpartum hemorrhage, maternal and neonatal peripartum mortality and liver function recovery time in the observation group were significantly lower than controls(P<0.05). There was no difference in adverse reactions between the two groups (P>0.05). No serious adverse drug reactions occurred in the observation group. Conclusion PE combined with LMWH in the treatment of AFLP can improve the coagulation function, promote the recovery of liver and kidney function, result in better pregnancy outcomes, representing a safe option.

Key words: Acute fatty liver of pregnancy, Low-molecular-weight heparin sodium, Plasmapheresis, Coagulation function, Liver and kidney function, Pregnancy outcomes

袁小莉, 王德琴, 徐晓英. 血浆置换术联合低分子肝素钠对妊娠期急性脂肪肝患者凝血和肝肾功能及妊娠结局的影响[J]. 肝脏, 2023, 28(2): 238-241.

YUAN Xiao-li, WANG De-qin, XU Xiao-ying. Effects of plasma exchange combined with low-molecular-weight heparin sodium on coagulation, liver and kidney function and pregnancy outcomes in patients with acute fatty liver of pregnancy[J]. Chinese Hepatolgy, 2023, 28(2): 238-241.

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