妊娠期肝衰竭的病因研究进展
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摘要
妊娠期肝衰竭是发生于妊娠期间的﹑由各种致病因素引起的严重肝损伤,是威胁孕产妇及胎儿生命的危重症之一。将妊娠期肝衰竭的病因归纳为病毒性因素、非病毒性因素、妊娠特发因素以及不明原因四大类,叙述了不同病因导致的妊娠期肝衰竭的发病率、病死率及地域分布特点等方面的研究进展,同时比较了不同病因之间临床特点的差异性。认为对不同病因导致的妊娠期肝衰竭,治疗方案及预后可截然不同,病因诊断对于该疾病的治疗具有重要的指导性意义,临床上对怀疑该病的重症孕产妇应及时进一步的检查以明确病因,并及早给予相应的治疗。
Liver failure during pregnancy is a serious liver injury caused by various pathogenic factors during pregnancy and is a critical disease that threatens the life of the mother and the fetus. The causes of liver failure during pregnancy are classified into viral factors,non-viral factors,pregnancy-specific factors,and unknown causes. This article describes the research advances in the incidence rates,deaths,and geographical distribution characteristics of liver failure during pregnancy of different etiologies and compares the clinical features of liver failure during pregnancy of different etiologies. It is pointed out that liver failure during pregnancy of different etiologies has entirely different treatment regimens and prognoses,and the etiological diagnosis has important guiding significance in the treatment of this disease. Further examination should be performed for critically ill pregnant women suspected of this disease to determine the etiology,and appropriate treatment should be given as early as possible.
Liver failure during pregnancy is a serious liver injury caused by various pathogenic factors during pregnancy and is a critical disease that threatens the life of the mother and the fetus. The causes of liver failure during pregnancy are classified into viral factors,non-viral factors,pregnancy-specific factors,and unknown causes. This article describes the research advances in the incidence rates,deaths,and geographical distribution characteristics of liver failure during pregnancy of different etiologies and compares the clinical features of liver failure during pregnancy of different etiologies. It is pointed out that liver failure during pregnancy of different etiologies has entirely different treatment regimens and prognoses,and the etiological diagnosis has important guiding significance in the treatment of this disease. Further examination should be performed for critically ill pregnant women suspected of this disease to determine the etiology,and appropriate treatment should be given as early as possible.
引文
[1]SEDHOM D,D'SOUZA M,JOHN E,et al.Viral hepatitis and acute liver failure:still a problem[J].Clin Liver Dis,2018,22(2):289-300.
[2]WU GX,ZHUANG XL.Severe hepatitis in pregnancy:A clinical analysis of 19 cases[J].Contemp Med,2013,19(4):74.(in Chinese)伍桂香,庄小兰.妊娠合并重症肝炎19例临床分析[J].当代医学,2013,19(4):74.
[3]HUANG JF,LIN S,WANG T,et al.Incidence and seasonal trend of viral hepatitis in China from 2004 to 2015[J].Chin J Zoonoses,2017,33(12):1144-1148.(in Chinese)黄娇凤,林苏,王挺,等.2004-2015年我国病毒性肝炎发病及季节性趋势分析[J].中国人兽共患病学报,2017,33(12):1144-1148.
[4]XU CF,LIU DL,DAI LZ.Etiological change of pregnancies with liver dysfunction during 2005-2014[J].J Sun Yat-Sen Univ:Medical Sciences,2016,32(6):943-949.(in Chinese)许成芳,刘东连,戴丽珍.2005-2014年妊娠期肝损害病因变迁分析[J].中山大学学报:医学科学版,2016,32(6):943-949.
[5]SHAO Z,AL TIBI M,WAKIM-FLEMING J.Update on viral hepatitis in pregnancy[J].Cleve Clin J Med,2017,84(3):202-206.
[6]MAHESHWARI A,RAY S,THULUVATH PJ.Acute hepatitis C[J].Lancet,2008,372(9635):321-332.
[7]YU YC,HOU JL.ACG Clinical guideline:liver disease and pregnancy[J].J Clin Hepatol,2016,32(4):619-627.(in Chinese)于乐成,侯金林.2016年美国胃肠病学院临床指南:肝脏疾病与妊娠[J].临床肝胆病杂志,2016,32(4):619-627.
[8]MANKA P,VERHEYEN J,GERKEN G,et al.Liver failure due to acute viral hepatitis(A-E)[J].Visc Med,2016,32(2):80-85.
[9]ALVES C,BRANCO C,CUNHA C.Hepatitis delta virus:a peculiar virus[J].Adv Virol,2013,2013:56010.
[10]SAHAI S,KIRAN R.Acute liver failure in pregnancy:Causative and prognostic factors[J].Saudi J Gastroenterol,2015,21(1):30-34.
[11]PREZ-GRACIA MT,SUAY-GARCA B,MATEOS-LINDE-MANN ML.Hepatitis E and pregnancy:current state[J].Rev Med Virol,2017,27(3):e1929.
[12]PATIL TB,DESHPANDE AS,GULHANE RV,et al.Clinical profile,maternal and fetal outcomes of acute hepatitis e in pregnancy[J].Ann Med Health Sci Res,2014,4(Suppl 2):s133-s139.
[13]BORKAKOTI J,HAZAM RK,MOHAMMAD A,et al.Does high viral load of hepatitis E virus influence the severity and prognosis of acute liver failare during pregnancg?[J].J Med Virol,2013,85(4):620-626.
[14]DONG YL.Herpes simplex virus infection during pregnancy and adverse pregnancy outcomes[J].Chin J Pract Gynecol Obstetr,2011,27(8):572-576.(in Chinese)董彦亮.妊娠期单纯疱疹病毒感染与不良妊娠结局[J].中国实用妇科与产科杂志,2011,27(8):572-576.
[15]MASADEH M,SHEN H,LEE Y,et al.A fatal case of herpes simplex virus hepatitis in a pregnant patient[J].Intractable Rare Dis Res,2017,6(2):124-127.
[16]BUNCHORNTAVAKUL C,REDDY KR.Acetaminophen(APAP or N-Acetyl-p-aminophenol)and acute liver failure[J].Clin Liver Dis,2018,22(2):325-346.
[17]BACAK SJ,THORNBURG LL.Liver failure in pregnancy[J].Crit Care Clin,2016,32(1):61-72.
[18]FRANKO KR,MEKEEL KL,WOELKERS D,et al.Accidental acetaminophen overdose results in liver transplant during second trimester of pregnancy:a case report[J].Transplant Proc,2013,45(5):2063-2065.
[19]THORNTON SL,MINNS AB.Unintentional chronic acetaminophen poisoning during pregnancy resulting in liver transplantation[J].JMed Toxicol,2012,8(2):176-178.
[20]FIROZ T,WEBBER D,ROWE H.Drug-induced fulminant hepatic failure in pregnancy[J].Obstet Med,2015,8(4):190-192.
[21]ORGUL G,OZKAN EU,CELIK HT,et al.Autoimmune hepatitis and pregnancy:report of two cases with different maternal outcomes[J].Clin Exp Hepatol,2017,3(4):212-214.
[22]WESTBROOK RH,YEOMAN AD,KRIESE S,et al.Outcomes of pregnancy in women with autoimmune hepatitis[J].J Autoimmun,2012,38(2-3):J239-J244.
[23]STRAVITZ RT,LEFKOMITCH JH,FONTANA RT,et al.Autoimmune acute liver failure:proposed clinical and histological criteria[J].Hepatology,2011,53(2):517-526.
[24]GRANT WJ,MCCASHLAND T,BOTHA JF,et al.Acute BuddChiari syndrome during pregnancy:surgical treatment and orthotopic liver transplantation with successful completion of the pregnancy[J].Liver Transpl,2003,9(9):976-979.
[25]LIU XY,WANG HF.Progress in research of etiology of liver failure[J].J Chin PLA Postgrad Med Sch,2011,32(1):15-17.(in Chinese)刘晓燕,王慧芬.肝衰竭病因研究进展[J].军医进修学院学报,2011,32(1):15-17.
[26]YU H.Hepatolenticular degeneration in late pregnancy:A case report and literature review[D].China Med Univ,2004.(in Chinese)于欢.晚期妊娠合并肝豆状核变性1例病例分析及文献复习[D].中国医科大学,2004.
[27]LIU J,GHAZIANI TT,WOLF JL.Acute fatty liver disease of pregnancy:updates in pathogenesis,diagnosis,and management[J].Am J Gastroenterol,2017,112(6):838-846.
[28]BUYTAERT IM,ELEWAUT GP,van KETS HE.Early occurrence of acute fatty liver in pregnancy[J].Am J Gastroenterol,1996,91(3):603-604.
[29]XU CF,LIU DL,DAI LZ.Clinical characteristics of pregnant women with hepatic failure[J].New Chin Med,2016,47(8):544-548.(in Chinese)许成芳,刘东连,戴丽珍.妊娠期肝衰竭的临床特点分析[J].新医学,2016,47(8):544-548.
[30]FU LH,YI W,YI N,et al.Clinical analysis of hepatitis B virus during pregnancy and acute fatty liver of pregnancy related to liver failure[J/CD].Chin J Exp Clin Infect Dis:Electronic Edition,2015,9(4):520-523.(in Chinese)付丽华,易为,伊诺,等.妊娠期乙型肝炎病毒及妊娠急性脂肪肝相关肝功能衰竭患者的临床分析[J/CD].中华实验和临床感染病杂志:电子版,2015,9(4):520-523.
[31]WAND S,WAESCHLE RM,von AHSEN N,et al.Acute liver failure due to acute fatty liver of pregnancy[J].Minerva Anestesiol,2012,78(4):503-506.
[32]NATARAJAN S,IBDAH J.Role of 3-hydroxy fatty acid-induced hepatic lipotoxicity in acute fatty liver of pregnancy[J].Int JMol Sci,2018,19(1).pii:E322.
[33]DEKKER RR,SCHUTTE JM,STEKELENBURG J,et al.Maternal mortality and severe maternal morbidity from acute fatty liver of pregnancy in the netherlands[J].EJO&GRB,2011,157(1):27-31.
[34]HAY JE.Liver disease in pregnancy[J].Hepatology,2008,47(3):1067-1076.
[35]ELLINGTON SR,FLOWERS L,LEGARDY-WILLIAMS JK,et al.Recent trends in hepatic diseases during pregnancy in the United States,2002-2010[J].Am J Obstet Gynecol,2015,212(4):521-524.
[36]YOSHIHARA M,MAYAMA M,UKAI M,et al.Fulminant liver failure resulting from massive hepatic infarction associated with hemolysis,elevated liver enzymes,and low platelets syndrome[J].JObstet Gynaecol Res,2016,42(10):1375-1378.
[37]BERRY EL,IQBAL SN.HELLP syndrome at 17 weeks gestation:A rare and catastrophic phenomenon[J].J Clin Gynecol Obstet,2014,3(4):147-150.
[38]WU B,JIA J.Diagnosis and treatment of severe liver diseases in pregnancy[J].Liver Doctor,2012,1:21-22.(in Chinese)吴彪,贾杰.妊娠期重症肝病的诊断与治疗[J].肝博士,2012,1:21-22.
[39]ZHU B,LIU WZ,YOU SL.Research advances in liver failure of unknown etiology[J].J Clin Hepatol,2015,31(9):1509-1512.(in Chinese)朱冰,刘婉姝,游绍莉.不明原因肝衰竭的研究进展[J].临床肝胆病杂志,2015,31(9):1509-1512.
[40]CHANG LZ,ZHANG H,PANG QM.Safety and clinical management of pregnancy in pregnant women with liver cirrhosis[J].JChin Physician,2015,17(7):1070-1072.(in Chinese)常灵芝,张华,庞秋梅.妊娠合并肝硬化患者妊娠安全性及临床处理[J].中国医师杂志,2015,17(7):1070-1072.
[41]PALATNIK A,RINELLA ME.Medical and obstetric complications among pregnant women with liver cirrhosis[Z].Obstet Gynecol,2017,129(6):1118-1123.
[42]GEENES V,WILLIAMSON C.Liver disease in pregnancy[J].Best Pract Res Clin Obstet Gynaecol,2015,29(5):612-624.
[43]LIU JL.Pregnancy outcome and treatment of pregnancy complicated with cirrhosis[J].Clin Res,2018,26(2):64-66.(in Chinese)刘静莉.妊娠合并肝硬化的妊娠结局及孕产期处理研究[J].临床研究,2018,26(2):64-66.
[2]WU GX,ZHUANG XL.Severe hepatitis in pregnancy:A clinical analysis of 19 cases[J].Contemp Med,2013,19(4):74.(in Chinese)伍桂香,庄小兰.妊娠合并重症肝炎19例临床分析[J].当代医学,2013,19(4):74.
[3]HUANG JF,LIN S,WANG T,et al.Incidence and seasonal trend of viral hepatitis in China from 2004 to 2015[J].Chin J Zoonoses,2017,33(12):1144-1148.(in Chinese)黄娇凤,林苏,王挺,等.2004-2015年我国病毒性肝炎发病及季节性趋势分析[J].中国人兽共患病学报,2017,33(12):1144-1148.
[4]XU CF,LIU DL,DAI LZ.Etiological change of pregnancies with liver dysfunction during 2005-2014[J].J Sun Yat-Sen Univ:Medical Sciences,2016,32(6):943-949.(in Chinese)许成芳,刘东连,戴丽珍.2005-2014年妊娠期肝损害病因变迁分析[J].中山大学学报:医学科学版,2016,32(6):943-949.
[5]SHAO Z,AL TIBI M,WAKIM-FLEMING J.Update on viral hepatitis in pregnancy[J].Cleve Clin J Med,2017,84(3):202-206.
[6]MAHESHWARI A,RAY S,THULUVATH PJ.Acute hepatitis C[J].Lancet,2008,372(9635):321-332.
[7]YU YC,HOU JL.ACG Clinical guideline:liver disease and pregnancy[J].J Clin Hepatol,2016,32(4):619-627.(in Chinese)于乐成,侯金林.2016年美国胃肠病学院临床指南:肝脏疾病与妊娠[J].临床肝胆病杂志,2016,32(4):619-627.
[8]MANKA P,VERHEYEN J,GERKEN G,et al.Liver failure due to acute viral hepatitis(A-E)[J].Visc Med,2016,32(2):80-85.
[9]ALVES C,BRANCO C,CUNHA C.Hepatitis delta virus:a peculiar virus[J].Adv Virol,2013,2013:56010.
[10]SAHAI S,KIRAN R.Acute liver failure in pregnancy:Causative and prognostic factors[J].Saudi J Gastroenterol,2015,21(1):30-34.
[11]PREZ-GRACIA MT,SUAY-GARCA B,MATEOS-LINDE-MANN ML.Hepatitis E and pregnancy:current state[J].Rev Med Virol,2017,27(3):e1929.
[12]PATIL TB,DESHPANDE AS,GULHANE RV,et al.Clinical profile,maternal and fetal outcomes of acute hepatitis e in pregnancy[J].Ann Med Health Sci Res,2014,4(Suppl 2):s133-s139.
[13]BORKAKOTI J,HAZAM RK,MOHAMMAD A,et al.Does high viral load of hepatitis E virus influence the severity and prognosis of acute liver failare during pregnancg?[J].J Med Virol,2013,85(4):620-626.
[14]DONG YL.Herpes simplex virus infection during pregnancy and adverse pregnancy outcomes[J].Chin J Pract Gynecol Obstetr,2011,27(8):572-576.(in Chinese)董彦亮.妊娠期单纯疱疹病毒感染与不良妊娠结局[J].中国实用妇科与产科杂志,2011,27(8):572-576.
[15]MASADEH M,SHEN H,LEE Y,et al.A fatal case of herpes simplex virus hepatitis in a pregnant patient[J].Intractable Rare Dis Res,2017,6(2):124-127.
[16]BUNCHORNTAVAKUL C,REDDY KR.Acetaminophen(APAP or N-Acetyl-p-aminophenol)and acute liver failure[J].Clin Liver Dis,2018,22(2):325-346.
[17]BACAK SJ,THORNBURG LL.Liver failure in pregnancy[J].Crit Care Clin,2016,32(1):61-72.
[18]FRANKO KR,MEKEEL KL,WOELKERS D,et al.Accidental acetaminophen overdose results in liver transplant during second trimester of pregnancy:a case report[J].Transplant Proc,2013,45(5):2063-2065.
[19]THORNTON SL,MINNS AB.Unintentional chronic acetaminophen poisoning during pregnancy resulting in liver transplantation[J].JMed Toxicol,2012,8(2):176-178.
[20]FIROZ T,WEBBER D,ROWE H.Drug-induced fulminant hepatic failure in pregnancy[J].Obstet Med,2015,8(4):190-192.
[21]ORGUL G,OZKAN EU,CELIK HT,et al.Autoimmune hepatitis and pregnancy:report of two cases with different maternal outcomes[J].Clin Exp Hepatol,2017,3(4):212-214.
[22]WESTBROOK RH,YEOMAN AD,KRIESE S,et al.Outcomes of pregnancy in women with autoimmune hepatitis[J].J Autoimmun,2012,38(2-3):J239-J244.
[23]STRAVITZ RT,LEFKOMITCH JH,FONTANA RT,et al.Autoimmune acute liver failure:proposed clinical and histological criteria[J].Hepatology,2011,53(2):517-526.
[24]GRANT WJ,MCCASHLAND T,BOTHA JF,et al.Acute BuddChiari syndrome during pregnancy:surgical treatment and orthotopic liver transplantation with successful completion of the pregnancy[J].Liver Transpl,2003,9(9):976-979.
[25]LIU XY,WANG HF.Progress in research of etiology of liver failure[J].J Chin PLA Postgrad Med Sch,2011,32(1):15-17.(in Chinese)刘晓燕,王慧芬.肝衰竭病因研究进展[J].军医进修学院学报,2011,32(1):15-17.
[26]YU H.Hepatolenticular degeneration in late pregnancy:A case report and literature review[D].China Med Univ,2004.(in Chinese)于欢.晚期妊娠合并肝豆状核变性1例病例分析及文献复习[D].中国医科大学,2004.
[27]LIU J,GHAZIANI TT,WOLF JL.Acute fatty liver disease of pregnancy:updates in pathogenesis,diagnosis,and management[J].Am J Gastroenterol,2017,112(6):838-846.
[28]BUYTAERT IM,ELEWAUT GP,van KETS HE.Early occurrence of acute fatty liver in pregnancy[J].Am J Gastroenterol,1996,91(3):603-604.
[29]XU CF,LIU DL,DAI LZ.Clinical characteristics of pregnant women with hepatic failure[J].New Chin Med,2016,47(8):544-548.(in Chinese)许成芳,刘东连,戴丽珍.妊娠期肝衰竭的临床特点分析[J].新医学,2016,47(8):544-548.
[30]FU LH,YI W,YI N,et al.Clinical analysis of hepatitis B virus during pregnancy and acute fatty liver of pregnancy related to liver failure[J/CD].Chin J Exp Clin Infect Dis:Electronic Edition,2015,9(4):520-523.(in Chinese)付丽华,易为,伊诺,等.妊娠期乙型肝炎病毒及妊娠急性脂肪肝相关肝功能衰竭患者的临床分析[J/CD].中华实验和临床感染病杂志:电子版,2015,9(4):520-523.
[31]WAND S,WAESCHLE RM,von AHSEN N,et al.Acute liver failure due to acute fatty liver of pregnancy[J].Minerva Anestesiol,2012,78(4):503-506.
[32]NATARAJAN S,IBDAH J.Role of 3-hydroxy fatty acid-induced hepatic lipotoxicity in acute fatty liver of pregnancy[J].Int JMol Sci,2018,19(1).pii:E322.
[33]DEKKER RR,SCHUTTE JM,STEKELENBURG J,et al.Maternal mortality and severe maternal morbidity from acute fatty liver of pregnancy in the netherlands[J].EJO&GRB,2011,157(1):27-31.
[34]HAY JE.Liver disease in pregnancy[J].Hepatology,2008,47(3):1067-1076.
[35]ELLINGTON SR,FLOWERS L,LEGARDY-WILLIAMS JK,et al.Recent trends in hepatic diseases during pregnancy in the United States,2002-2010[J].Am J Obstet Gynecol,2015,212(4):521-524.
[36]YOSHIHARA M,MAYAMA M,UKAI M,et al.Fulminant liver failure resulting from massive hepatic infarction associated with hemolysis,elevated liver enzymes,and low platelets syndrome[J].JObstet Gynaecol Res,2016,42(10):1375-1378.
[37]BERRY EL,IQBAL SN.HELLP syndrome at 17 weeks gestation:A rare and catastrophic phenomenon[J].J Clin Gynecol Obstet,2014,3(4):147-150.
[38]WU B,JIA J.Diagnosis and treatment of severe liver diseases in pregnancy[J].Liver Doctor,2012,1:21-22.(in Chinese)吴彪,贾杰.妊娠期重症肝病的诊断与治疗[J].肝博士,2012,1:21-22.
[39]ZHU B,LIU WZ,YOU SL.Research advances in liver failure of unknown etiology[J].J Clin Hepatol,2015,31(9):1509-1512.(in Chinese)朱冰,刘婉姝,游绍莉.不明原因肝衰竭的研究进展[J].临床肝胆病杂志,2015,31(9):1509-1512.
[40]CHANG LZ,ZHANG H,PANG QM.Safety and clinical management of pregnancy in pregnant women with liver cirrhosis[J].JChin Physician,2015,17(7):1070-1072.(in Chinese)常灵芝,张华,庞秋梅.妊娠合并肝硬化患者妊娠安全性及临床处理[J].中国医师杂志,2015,17(7):1070-1072.
[41]PALATNIK A,RINELLA ME.Medical and obstetric complications among pregnant women with liver cirrhosis[Z].Obstet Gynecol,2017,129(6):1118-1123.
[42]GEENES V,WILLIAMSON C.Liver disease in pregnancy[J].Best Pract Res Clin Obstet Gynaecol,2015,29(5):612-624.
[43]LIU JL.Pregnancy outcome and treatment of pregnancy complicated with cirrhosis[J].Clin Res,2018,26(2):64-66.(in Chinese)刘静莉.妊娠合并肝硬化的妊娠结局及孕产期处理研究[J].临床研究,2018,26(2):64-66.