不同终止妊娠时间妊娠期急性脂肪肝的临床特征及超声学表现差异

摘要/Abstract

摘要： 目的分析不同终止妊娠时间妊娠期急性脂肪肝(AFLP)的临床特征及超声学表现差异。方法回顾性分析2019年1月～2024年6月本院医院信息系统中的39例AFLP患者临床资料,依据终止妊娠时间将AFLP患者分为延迟组、即刻组,比较两组临床资料,并分析两组超声学表现异同点。结果 AFLP患者临床症状包括消化道症状28例(71.8%)、皮肤巩膜黄染18例(46.1%)、水肿15例(38.5%)、乏力8例(20.5%)及皮肤瘙痒3例(7.7%),其中以消化道症状为主,包括恶心和呕吐24例(61.5%)、上腹痛17例(43.6%)、纳差15例(38.5%)、腹胀9例(23.1%)、腹泻2例(5.1%)。另外,AFLP患者中的合并症或并发症包括妊娠期高血压5例(12.8%)、子痫前期4例(10.2%)、妊娠期糖尿病6例(15.4%)、肾功能不全30例(76.9%)、肝性脑病3例(7.7%)、多器官功能障碍综合征5例(12.8%),呼吸衰竭、HELLP综合征和弥漫性血管内凝血各2例(5.1%),以及脓毒症及脓毒性休克各1例(2.6%)。入院后依据病情选择保肝治疗,尽量延长孕周为延迟组(n=30),选择即刻终止妊娠为即刻组(n=9)。比较临床资料,两组肝性脑病、PLT、TBil、SCr、INR、MELD评分和PI-AFLP评分差异具有统计学意义(P<0.05)。所有AFLP患者肝脏体积均出现不同程度增大、肝脏回声不均,与肝脏内脂肪沉积有关。除肝脏超声表现外,不同临床结局AFLP患者超声表现差异集中于肝外脏器。对纳入AFLP患者胆囊、胰腺、脾脏、肾脏、胸腔等超声变化进行汇总,比较延迟组、即刻组超声表现发现,即刻组中胆汁充盈不佳或无胆汁、脾大及胸腔积液等超声表现例数显著高于延迟组(P<0.05)。结论不同终止妊娠时间的AFLP患者PLT、TBil、INR、MELD评分和PI-AFLP指数存在显著差异,同时即刻终止妊娠AFLP患者多见胆汁充盈不佳或无胆汁、脾大及胸腔积液等超声表现,为临床早期识别高危患者、改善治疗方案提供依据。

关键词: 妊娠期急性脂肪肝, 终止妊娠, 超声

Abstract: Objective To analyze the clinical features and ultrasonic manifestations of patients with acute fatty liver in pregnancy (AFLP) at different termination time. Methods The clinical data of 39 patients with AFLP in our hospital information system between January 2019 and June 2024 were collected. According to the time of termination of pregnancy, AFLP patients were divided into delayed group and immediate group. The clinical data of the two groups were compared, and the similarities and differences of ultrasonic performance between the two groups were analyzed. Results The clinical symptoms of AFLP patients include digestive tract symptoms in 28 cases (71.8%), yellow staining of skin and sclera in 18 cases (46.1%), edema in 15 cases (38.5%), fatigue in 8 cases (20.5%) and skin itching in 3 cases (7.7%), among which the main symptoms are digestive tract symptoms, including nausea and vomiting in 24 cases (61.5%) and upper respiratory tract symptoms. In addition, complications of HELLP patients include pregnancy-induced hypertension in 5 cases (12.8%), preeclampsia in 4 cases (10.2%), gestational diabetes in 6 cases (15.4%), renal insufficiency in 30 cases (76.9%), hepatic encephalopathy in 3 cases (7.7%), multiple organ dysfunction syndrome in 5 cases (12.8%). After admission, liver protection treatment was selected according to the condition, and the delayed group was prolonged as far as possible (n=30), and the rest were immediately terminated (n=9). Comparing the clinical data, the differences of hepatic encephalopathy, PLT, TBil, Scr, INR, MELD and PI-AFLP between the two groups were statistically significant (P<0.05). All AFLP patients showed varying degrees of increase in liver volume and uneven liver echo, which was related to fat deposition in the liver. In addition to the ultrasonic manifestations of liver, the ultrasonic manifestations of AFLP patients with different clinical outcomes are mainly in extrahepatic organs. The ultrasonic changes of gallbladder, pancreas, spleen, kidney and chest cavity in patients with AFLP were summarized. By comparing the ultrasonic manifestations of delayed group and immediate group, it was found that the number of cases with poor or no bile filling, splenomegaly and pleural effusion in immediate group was significantly higher than that in delayed group (P<0.05). Conclusion There are significant differences in PLT, TBil, INR, MELD score and PI-AFLP index in different termination time of AFLP patients. At the same time, the ultrasonic manifestations of AFLP patients with immediate termination of pregnancy are poor or no bile, splenomegaly and pleural effusion, which provide basis for early identification of high-risk patients and improvement of treatment plan.

Key words: Acute fatty liver of pregnancy, Termination time, Ultrasound

刘寺, 何荟. 不同终止妊娠时间妊娠期急性脂肪肝的临床特征及超声学表现差异[J]. 肝脏, 2025, 30(7): 992-995.

LIU Si, HE Hui. Clinical characteristics and prognostic factors of 39 cases with acute fatty liver in pregnancy at different termination time[J]. Chinese Hepatolgy, 2025, 30(7): 992-995.

/ 推荐

参考文献

[1] Siwatch S, De A, Kaur B, et al. Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy-a systematic review and meta-analysis[J]. Front Med (Lausanne), 2024, 11:1433324.
[2] Peng Q, Zhu T, Huang J, et al. Factors and a model to predict three-month mortality in patients with acute fatty liver of pregnancy from two medical centers[J].BMC Pregnancy Childbirth, 2024, 24(1):27.
[3] Chen C P, Wang L K, Wu F T, et al. High-level mosaic trisomy 21 at amniocentesis in a pregnancy associated with positive NIPT for trisomy 21, prenatal progressive decrease of the trisomy 21 cell line, acute fatty liver of pregnancy and intrauterine fetal death in late gestation[J]. Taiwan J Obstet Gynecol, 2023, 62(6):896-900.
[4] Tan J, Hou F, Xiong H, et al. Swansea criteria score in acute fatty liver of pregnancy[J]. Chin Med J (Engl), 2022, 135(7):860-862.
[5] Natarajan S K, Ibdah J A. Role of 3-hydroxy fatty acid-induced hepatic lipotoxicity in acute fatty liver of pregnancy[J]. Int J Mol Sci, 2018, 19(1):322.
[6] Eskelin P M, Laitinen K A, Tyni T A. Elevated hydroxyacylcarnitines in a carrier of LCHAD deficiency during acute liver disease of pregnancy - a common feature of the pregnancy complication?[J]. Mol Genet Metab, 2010, 100(2):204-206.
[7] Ch′ng C L, Morgan M, Hainsworth I, et al. Prospective study of liver dysfunction in pregnancy in Southwest Wales[J]. Gut, 2002, 51(6):876-880.
[8] Peng Q, Zhu T, Huang J, et al. Factors and a model to predict three-month mortality in patients with acute fatty liver of pregnancy from two medical centers[J]. BMC Pregnancy Childbirth, 2024, 24(1):27.
[9] Gao Q, Ma Y, Qu X, et al. Risk factors in patients with acute fatty liver of pregnancy: the role of abortion, total bilirubin and serum creatinine[J]. Arch Gynecol Obstet, 2024, 310(1):153-159.
[10] Devarbhavi H, Venkatachala P R, Devamsh G N, et al. Swansea criteria evaluation in acute fatty liver of pregnancy, hemolysis elevated liver enzyme and low platelet syndrome, pre-eclampsia, and viral acute liver failure in pregnancy[J]. Int J Gynaecol Obstet, 2023, 163(3):1030-1032.
[11] Sinha S, Yadav J, Pradhan T. A case report on acute fatty liver of pregnancy: a difficult differential diagnosis of liver disorder[J]. Cureus, 2023, 15(7):e42733.
[12] Zhong Y, Zhu F, Ding Y. Early diagnostic test for acute fatty liver of pregnancy: a retrospective case control study[J]. BMC Pregnancy Childbirth, 2020, 20(1):162.
[13] 刘从丽, 陈敦金, 陈楚仪, 等. 妊娠期急性脂肪肝86例临床分析[J]. 中华妇产科杂志, 2023, 58(12):896-902.
[14] Chang L, Wang M, Liu H, et al. Pregnancy outcomes of patients with acute fatty liver of pregnancy: a case control study[J]. BMC Pregnancy Childbirth, 2020, 20(1):282.
[15] 代冬梅, 唐仕宇, 许汪斌, 等. 妊娠期急性脂肪肝与HELLP综合征患者临床特征比较[J]. 中华危重病急救医学, 2022, 34(6):624-629.
[16] Shen Y, Wang X, Yao Y, et al. Acute fatty liver of pregnancy causing multiple organ dysfunction syndrome in a Chinese intensive care unit[J]. Nurs Crit Care, 2023, 28(6):1170-1175.