妊娠期急性脂肪肝。目前的概念)。

Revista medica de Panama Pub Date : 1997-05-01
P Vigil-De Gracia
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摘要

急性妊娠肝脂肪(APLF)是一种只发生在怀孕期间的疾病。它的原因尚不清楚,只出现在怀孕的后半段,特别是在32到36周之间。APLF症状通常在住院前1 ~ 2周开始,伴有恶心、呕吐、全身不适、黄疸、上腹痛等症状。实验室方面:白细胞计数、胆红素、转氨酶、凝血期、氨气增高;另一方面,血小板、血红蛋白、血糖、凝血酶原和抗凝血酶III降低。对于非典型病例应留下肝活检。超声和CAT扫描不能证明诊断的准确性,但它们仍然有助于忽略任何其他肝脏病变。由于最近在发达国家和不发达国家进行的研究都没有发现产妇死亡,因此在过去十年中,产妇的结局有了很大改善。胎儿预后也有所改善,但仍有20%的死亡率。早期诊断、妊娠中断和特殊护理处理或治疗并发症已导致良好的母胎结果。
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[Acute fatty liver in pregnancy. Current concepts].

The acute pregnancy liver fat (APLF) is an illness that occurs exclusively during pregnancy. Its cause is unknown and it only appears during the second half of pregnancy, specially between 32 and 36 weeks. Usually the APLF symptoms starts one to two weeks before hospitalization with nausea, emesis, general uneasiness, jaundice, epigastric pain and other symptoms. As to the laboratories: white cells count, bilirubin, transaminase, coagulation period and amonio increases; on the other hand, the platelets, hemoglobin, glycemia, fybrinogen and antitrombin III decreases. The hepatic biopsy should be left for those atypical cases. The ultrasonogram and the CAT scan does not evidences precision in the diagnoses, yet still they are useful to disregard any other hepatic pathologies. The maternal outcome has improved enormously during the last decade, since recent studies performed in developed and underdeveloped countries have coincided in not finding maternal death. Fetal prognosis has also improved, nevertheless there is a mortality rate of 20%. Early diagnosis, pregnancy interuption and handling in special care or treating complications has lead to good materno-fetal results.

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