血浆置换在治疗妊娠期急性脂肪肝中的应用价值

doi:10.3877/cma.j.issn.2095-3259.2014.03.012

目的

探讨血浆置换在治疗妊娠期急性脂肪肝的中的应用价值。

方法

对2010年1月至2013年12月中山大学附属第三医院产科收治的17例采用血浆置换治疗妊娠期急性脂肪肝患者的临床资料进行回顾性分析，分析患者治疗前后的临床症状、体征、肝肾功能、凝血等指标，以及血浆置换出现的副作用。

结果

(1)患者治疗前后各项检查指标的比较：白细胞(20.2±9.1)×10⁹/L与(15.2±5.9)×10⁹/L、天冬氨酸转氨酶(304.3±312.6)U/L与(81.4±99.5)U/L、丙氨酸转氨酶(332.5±348.3)U/L与(116.7±198.9)U/L、总胆红素(130.5±113.6)μmol/L与(84.3±35.5)μmol/L、凝血酶原时间(22.5±6.3)s与(19.6±6.7)s、尿素(9.6±7.8) mmol/L与(7.6±4.2)mmol/L、尿酸(515.3±167.0)μmol/L与(380.0±219.4)μmol/L，均得到明显改善(P值均<0.05)；(2)血浆置换副作用小，未出现因不良反应而终止血浆置换治疗的病例。

结论

血浆置换用于治疗妊娠期急性脂肪肝具有安全、有效等特点，在及时终止妊娠后使用血浆置换可有效遏制病情的发展。

关键词: 脂肪肝, 急性病, 妊娠并发症, 血浆置换

Objective

To explore the application value of plasma exchange in treating acute fatty liver of pregnancy (AFLP).

Methods

This study collected the clinical data of 17 AFLP patients, who were treated with plasma exchange in the obstetrics department of The Third Affiliated Hospital of Sun Yat-sen University from January 2010 to December 2013. Symptoms, physical signs, hepatorenal function, coagulation function before and after treatment of plasma exchange and the adverse effects were retrospectively analyzed.

Results

(1) Compared with before treatment and after treatment, white blood cell, aspartate transaminase, alanine aminotransferase, total bilirubin, prothrombin time, urea and uric acid were obviously improved (P<0.05). Before treatment, white blood cell, aspartate transaminase, alanine aminotransferase, total bilirubin, prothrombin time, urea and uric acid were(20.2±9.1)×10⁹/L, (304.3±312.6)U/L, (332.5±348.3)U/L, (130.5±113.6)μmol/L, (22.5±6.3)s, (9.6±7.8)mmol/L, (515.3±167.0)μmol/L, respectively. After treatment, they were (15.2±5.9)×10⁹/L, (81.4±99.5)U/L, (116.7±198.9)U/L, (84.3±35.5)μmol/L, (19.6±6.7)s, (7.6±4.2)mmol/L, (380.0±219.4)μmol/L, respectively.(2) Adverse reactions during plasma exchange were generally mild and tolerable, and no patients discontinued treatment due to adverse events.

Conclusion

Plasma exchange is safe and effective for the AFLP patients, and timely application of plasma exchange after termination of pregnancy can effectively reverse the progression of AFLP.

Key words: Fatty Liver, Acute disease, Pregnancy complications, Plasma exchange

表1 17例AFLP患者血浆置换治疗前后实验室指标对比(±s)

组别	白细胞(×10⁹/L)	天冬氨酸转氨酶(U/L)	丙氨酸转氨酶(U/L)	碱性磷酸酶(U/L)	谷氨酰转肽酶(U/L)	白蛋白(g/L)	总胆红素(μmol/L)	直接胆红素(μmol/L)	胆碱酯酶(U/L)
血浆置换前	20.2±9.1	304.3±312.6	332.5±348.3	359.4±164.5	105.5±54.0	26.1±3.9	130.5±113.6	97.4±61.0	3 261.8±1001.2
血浆置换后	15.2±5.9	81.4±99.5	116.7±198.9	183.1±107.8	73.5±45.5	29.2±3.0	84.3±35.5	47.1±43.2	4 690.7±1031.4
t值	2.544	3.539	4.880	5.337	2.341	－3.103	3.273	0.031	－2.438
P值	<0.05	<0.01	<0.01	<0.01	<0.05	<0.01	<0.05	<0.01	<0.05
组别	血糖(mmol/L)	凝血酶原时间(s)	凝血酶原活动度(%)	活化部分凝血活酶时间(s)	纤维蛋白原(g/L)	尿素(mmol/L)	肌酐(μmol/L)	尿酸(μmol/L)
血浆置换前	3.7±1.1	22.5±6.3	47.6±25.4	81.6±16.1	1.5±1.2	9.6±7.8	158.6±63.0	515.3±167.0
血浆置换后	5.8±1.2	19.6±6.7	71.2±27.6	52.8±13.2	2.8±0.9	7.6±4.2	106.6±18.4	380.0±219.4
t值	－2.346	2.762	－4.121	1.747	－2.268	－1.020	2.059	4.045
P值	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	>0.05	<0.01

表1 17例AFLP患者血浆置换治疗前后实验室指标对比(±s)

组别	白细胞(×10⁹/L)	天冬氨酸转氨酶(U/L)	丙氨酸转氨酶(U/L)	碱性磷酸酶(U/L)	谷氨酰转肽酶(U/L)	白蛋白(g/L)	总胆红素(μmol/L)	直接胆红素(μmol/L)	胆碱酯酶(U/L)
血浆置换前	20.2±9.1	304.3±312.6	332.5±348.3	359.4±164.5	105.5±54.0	26.1±3.9	130.5±113.6	97.4±61.0	3 261.8±1001.2
血浆置换后	15.2±5.9	81.4±99.5	116.7±198.9	183.1±107.8	73.5±45.5	29.2±3.0	84.3±35.5	47.1±43.2	4 690.7±1031.4
t值	2.544	3.539	4.880	5.337	2.341	－3.103	3.273	0.031	－2.438
P值	<0.05	<0.01	<0.01	<0.01	<0.05	<0.01	<0.05	<0.01	<0.05
组别	血糖(mmol/L)	凝血酶原时间(s)	凝血酶原活动度(%)	活化部分凝血活酶时间(s)	纤维蛋白原(g/L)	尿素(mmol/L)	肌酐(μmol/L)	尿酸(μmol/L)
血浆置换前	3.7±1.1	22.5±6.3	47.6±25.4	81.6±16.1	1.5±1.2	9.6±7.8	158.6±63.0	515.3±167.0
血浆置换后	5.8±1.2	19.6±6.7	71.2±27.6	52.8±13.2	2.8±0.9	7.6±4.2	106.6±18.4	380.0±219.4
t值	－2.346	2.762	－4.121	1.747	－2.268	－1.020	2.059	4.045
P值	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	>0.05	<0.01

[1]	曹泽毅. 中华妇产科学(临床版)[M]. 北京：人民卫生出版社，2010: 290-291.
[2]	Papafragkakis H, Singhal S, Anand S, et al. Acute fatty liver of pregnancy[J]. South Med J, 2013, 106(10):588-593.
[3]	Ch′ng CL, Morgan M, Hainsworth I, et al. Prospective study of liver dysfunction in pregnancy in Southwest Wales[J]. Gut, 2002, 51(6):876-880.
[4]	Tank PD, Nadanwar YS, Mayadeo NM, et al. Outcome of pregnancy with severe liver disease[J]. Int J Gynaecol Obstet, 2002, 76(1):27-31.
[5]	Holzman RS, Riley LE, Aron E, et al. Perioperative care of a patient with acute fatty liver of pregnancy[J]. Anesth Analg, 2001, 92(5):1268-1270.
[6]	Knight M, Nelson-Piercy C, Kurinczuk JJ, et al. A prospective national study of acute fatty liver of pregnancy in the UK[J]. Gut, 2008, 57(7):951-956.
[7]	Rajasri AG, Srestha R, Mitchell J, et al. Acute fatty liver of pregnancy (AFLP)--an overview[J]. J Obstet Gynaecol, 2007, 27(3):237-240.
[8]	Wei Q, Zhang L, Liu X, et al. Clinical diagnosis and treatment of acute fatty liver of pregnancy: a literature review and 11 new cases[J]. J Obstet Gynaecol Res, 2010, 36(4):751-756.
[9]	Martin JN Jr, Briery CM, Rose CH, et al. Postpartum plasma exchange as adjunctive therapy for severe acute fatty liver of pregnancy[J]. J Clin Apher, 2008, 23(4):138-143.
[10]	Tang W, Huang Z, Wang Y, et al. Effect of plasma exchange on hepatocyte oxidative stress, mitochondria function, and apoptosis in patients with acute fatty liver of pregnancy[J]. Artif Organs, 2012, 36(3):E39-47.
[11]	Jin F, Cao M, Bai Y, et al. Therapeutic effects of plasma exchange for the treatment of 39 patients with acute fatty liver of pregnancy[J]. Discov Med, 2012, 13(72):369-373.
[12]	Remiszewski P, Pawlak J, Skwarek A, et al. Orthotopic liver transplantation for acute liver failure resulting from " acute fatty liver of pregnancy" [J]. Ann Transplant, 2003, 8(3):8-11.
[13]	Westbrook RH, Yeoman AD, Joshi D, et al. Outcomes of severe pregnancy related liver disease: refining the role of transplantation[J]. Am J Transplant, 2010, 10(11):2520-2526.

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Clinical value of plasma exchange in treating patients with acute fatty liver of pregnancy

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