中国血液净化

›› 2006, Vol. 5 ›› Issue (12): 842-844.

• 人工肝 • 上一篇    下一篇

妊娠肝衰竭临床特征及影响预后的相关因素分析

戴 炜 禹 弘 王 东 邬 明 岳建荣 胡敏冬 李 炜 张振宇   

  1. 518020 深圳，广东省深圳市东湖医院重肝治疗中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-12-12 发布日期:2006-12-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-12-12 Published:2006-12-12

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摘要： 目的 探讨妊娠肝衰竭的临床特征及影响预后的相关因素。方法 应用EXCELL2000、STATA7.0软件和t检验分析广东省深圳市东湖医院重肝治疗中心11例妊娠肝衰竭临床资料及血液净化疗法对预后的影响。结果 妊娠肝衰竭主要发生在妊娠晚期患者(7/11)；以亚急性肝衰竭为多(6/11)；病因中以HBV感染(5/11)多见，平均HBV DNA水平6.32×10 7 copies/ml，死亡率也高于其他病因组；其次为病因不明(3/11)，急性妊娠脂肪肝、CMV感染及梅毒各1例；合并症或并发症中以低白蛋白血症(11/11)、腹水(10/11)、低血糖(9/11)及电解质紊乱(7/11)多见；其它为肝性脑病(6/11，4例是在终止妊娠后即刻发生)、DIC(5/11)、自发性腹膜炎(4/11)、肾衰竭及脑水肿(3/11)；6例接受血液净化治疗患者的治愈好转率为83.3%(5/6)，较单纯综合治疗组高40.0%(2/5)，神志转清率75.0%(3/4)，单纯综合治疗组中2例肝性脑病者治疗过程中神志无改善；单因素分析发现妊娠周期、临床分型及分期、乙型肝炎病毒(HBV)感染和其复制水平、脑水肿、弥散性血管内凝血(DIC)、凝血酶原活动度(PTA)、血清总胆红素(TBil)及血液净化治疗都是影响预后的因素；多因素分析显示PTA和TBil是影响预后的独立危险因素。 结论 ① HBV感染及高水平复制仍然是引起妊娠期间肝衰竭的重要原因之一且预后差；② 代谢紊乱可能是导致妊娠肝衰竭多种合并症及直接影响预后的重要原因；③ 血液净化治疗及时纠正机体的代谢紊乱与提高治愈好转率有密切关系。

关键词: 血液净化, 肝衰竭, 妊娠, 临床特征

Abstract: Objective To investigate the clinical characteristics of patients with liver failure in pregnancy and analyze the correlative factors of patients’prognosis. Methods The clinical data of patients suffered from liver failure during pregnant period were analyzed with EXCELL2000, STATA7.0 software and t test. Results Seven of eleven patients occurred in late pregnancy and 6 were subacute liver failure. Three of five patients with HBV infection were dead (one superinfected with HEV); 3 with unidentified diagnosis; another 3 were syphilis, acute fatty liver of pregnant and CMV infection. Among 11 patients the complications occured: low serum albumin(11), ascites (10), hypoglycemia(9) and metabolic disorder(7),hepatic encephalopathy(6 cases, among them 4 patients occurred after ending pregnancy) disseminated intravascular coagulation (DIC)(5), spontaneous bacterial peritonitis(SBP)(4),renal failure(3)and cerebral edema(3). The recovery rate among 6 patients given blood purification therapy was 72.7%, which was higher than that of patients just given internal manipulation(40%). Three of four patients with coma got conscious. Two patients with coma who just received internal therapy didn’t improve at all. Mono-factor analysis showed that the prognosis factors including pregnant period, clinical typing and clinical staging, HBV infection and HBV DNA level, cerebral edema, DIC, prothrombin activities (PTA), the serum total bilirubin (TBil) and therapy with blood purification. Poly-factors analysis showed PTA and TBil were the independent dangerous factors. Conclusions ① HBV infection is still one of the most important causes of liver failure in pregnancy and the prognosis is bad usually. ② Metabolic disorder is probably the main cause inducing the multi-complications in liver failure in pregnancy and affect the prognosis directly. ③Treated with blood purification can correct the body’metabolic disorder in time and it has close relationship with improved recovery rate.

Key words: Liver failure, Pregnancy, Clinical characteristic

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