Clinical Features Analysis Of Acute Fatty Liver Of Pregnancy And HELLP Syndrome

Objective:To explore the differential diagnosis of acute fatty liver of pregnancy(AFLP)and the syndrome of hemolysis,elevated liver enzymes and low platelet counts(HELLP syndrome),which will further help early suspicion,prompt diagnosis of AFLP and HELLP syndrome in clinical work,reduce the uncertainty of the diagnosis of AFLP and HELLP syndrome,and analyze the clinical indicators of two diseases,provide decision-making basis and help for clinical diagnosis and treatment of two diseases.Methods:The data of 10 patients diagnosed AFLP and 11 patients diagnosed with HELLP syndrome was collected.All data came from the patients who hospitalized in the First Affiliated Hospital of Kunming Medical University from August 1th,2007 to August,31th,2017.The retrospective study and analysis was conducted.All patients were divided into two groups:AFLP group and HELLP syndrome group.Laboratory tests excluded viral hepatitis,drug-induced hepatitis,poisoning and other liver diseases during pregnancy.The information of the two groups from obstetric birth registration,obstetrics and ICU hospitalization in our hospital were collected:(1)The general situation of the two groups:date of admission,age,educational level,body mass idex(BMI),the number of pregnancies and deliveries,onset of gestational weeks,delivery of gestational weeks,multiple pregnancy and discharge diagnosis;(2)Clinical information of the two groups:Symptoms of onset,accompanying symptoms,signs,abdominal B ultrasound,prothrombin activity(PTA),prothrombin time(PT),fibrinogen(FIB),antithrombin?(AT-?A),total bilirubin(TBIL),indirect bilirubin(IBIL),direct bilirubin(IBIL),serum creatinine(Scr),glutaminase aminotransferase(ALT),aspartate aminotransferase(AST),leukocyte count(WBC),platelet count(PLT),hemoglobin(Hb),blood ammonia(Amon),blood gulucose(GLU),serum creatinine(Scr),urea nitrogen(BUN),uric acid(UA),lactate dehydrogenase(LDH)and so on;(3)Previous related history of disease;(4)The mode of delivery of the two groups:cesarean section or vaginal delivery,with or without postpartum hemorrhage,the treatment of postpartum hemorrhage(hysterectomy,placement of Bakri balloon,intrauterine packing with gauze,etc);(5)Maternal and infant outcome;(6)Hospital days,maternal complications,neonatal complications,the rate of newborns transferred into Pediatrics,and the sex of the fetus and so on.Analysed the characteristics of the two diseases,and clarified the identification of AFLP and HELLP syndrome.Results:(1)There were no significantly differences in BMI,twin pregnancy,pregnant male fetus,An irregular antenatal examination,educational level and occupation between the two groups(P>0.05);The onset for gestational weeks,delivery of gestational weeks,hospital days and ICU days in of the AFLP group were significantly higher than that of the HELLP syndrome group(P<0.05).(2)The occupation ratio for primipara and the number of pregnancies was equal to 1 of the AFLP group were significantly higher than that of the HELLP syndrome group;The occupation ratio for parturient and the number of pregnancies is more than of the AFLP group were significantly lower than that of the HELLP syndrome group(P<0.05).(3)There were no significantly differences at the incidence rates of symptoms of polydipsia and/or polyuria,epigastric discomfort,anorexia and/or fear of oil,gingival bleeding,antepartum eclampsia and edema between the two groups(P>0.05);The incidence rate of the symptoms for nausea and/or vomiting,Jaundice and/or dark urine and abdominal B-ultrasound positive of the AFLP group were significantly higher than that of the HELLP syndrome group(P<0.05);The incidence rates of the symptoms for headache and/or blurred vision and preeclampsia of the AFLP group were significantly lower than that of the HELLP syndrome group(P<0.05).(3)There were no significantly differences at the laboratory tests in WBC,AST,ALT,LDH,Hb,ALB,Scr and BUN between the two groups(P>0.05);The laboratory tests for PT,Amon,TBIL,IBIL and UA of the AFLP group were significantly higher than that of the HELLP syndrome group(P<0.05);The laboratory value for PTA,FIB,AT-IIIA and GLU of the AFLP group was significantly lower than that of the HELLP syndrome group(P<0.05).(4)There were no significantly differences in the incidence rates of the complications for postpartum hemorrhage,ascites,hematoma of surgical wound,MODS,eclampsia,DIC and the termination mode of pregnancy between the two groups(P>0.05);The incidence rate of complications for encephalopathy,coagulopathy,kidney dysfunction and infection of the AFLP group was significantly higher than that of the HELLP syndrome group(P<0.05).(5)There were no significantly differences in the incidence rate of neonatal asphyxia,fetal distress,preterm birth,placental abruption,the death of perinatal infants and maternal deaths between the two groups(P>0.05).Conclusions:?The clinical symptoms of AFLP group and HELLP syndrome group:The common presenting symptoms of the AFLP group was nausea and/or vomiting(70%),abdominal pain(particularly epigastric)(50%),jaundice and/or dark urine,many AFLP patients may have these symptoms a few days before hospitalization;The main symptoms of the HELLP syndrome group were headache and/or blurred vision(63.6%),severe preeclampsia(90.9%),a few showed eclampsia(18.2%),edema(18.2%)and abdominal pain(9.1%);? Laboratory test:PTA,FIB,AT-IIIA and GLU were all low in the AFLP group,PT was prolonged,however,the HELLP syndrome group tend to reach the reference range,but the HELLP syndrome group's platelet count decreased significantly.In the AFLP group,total bilirubin and indirect bilirubin were significantly elevated,approximately 10 times for the reference value,and uric acid was approximately 2-fold higher than the reference value,however,the HELLP syndrome group only slightly increased;?Complications:hepatic dysfunction,kidney dysfunction and coagulopathy may occur early in the AFLP group,if it cannot be diagnosed and treated in time,it will further be developing into hypoglycaemia,hepatic encephalopathy,DIC and MODS and so on.In the HELLP syndrome group,renal insufficiency was diagnosed late in the course of the disease,and complicating with placental abruption easily;?Abdominal ultrasonography may be used as an auxiliary examination for differential diagnosis of AFLP and HELLP syndrome(abdominal ultrasound manifests as "bright liver" in patients with AFLP)in clinical work,;?Platelet count,coagulation function(especially PTA),liver and kidney function should be closely monitored who high-riskiing pregnant women with previous medical history,advanced age,hypertension,and multiple pregnancy,pregnant.women with preeclampsia should monitor laboratory tests at least twice a week(blood routine,liver and kidney function,coagulation function and LDH,etc;?Improving clinicians'understanding of AFLP and HELLP syndrome;It is necessary to guide pregnant women to have correct,regular and effective prenatal examination;We should educate pregnant women so that they understand AFLP and HELLP syndromes,and seek medical attention when there are suspicious symptoms.Once the patient has suspicious symptoms,blood routine examination,blood coagulation function,liver and kidney function tests,abdominal ultrasonography and so on should be conducted immediately.Doubting or considering diagnosis,immediately admitted to hospital,closely observed,if necessary,terminate the pregnancy immediately to save the lives of mothers and infants,Early suspicion and prompt diagnosis is of great importance for improving maternal and infant outcomes.