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妊娠急性脂肪肝是一种罕见的疾病,在妊娠晚期可能发生致命的合并症。其病因仍有争议。妊娠复发性急性脂肪肝过去尚无记载,本文属首例报道并经肝脏活检证实。由于早期诊断,及时终止妊娠,使母婴转危为安。患者黑人37岁,孕_5产_3,妊娠30~+周,因恶心呕吐,厌食伴低烧2天,上腹部痛疼及胎动减少一天住院。患者诉说此症状与其16个月前曾患的妊娠急性脂肪肝及胎死宫内时症状完全相同。体检:巩膜轻度黄疸,体温37.8℃,腹软,宫底高22cm,单胎,胎心136次/分。化验:天门冬氨酸转氨酶790U/L,丙氨酸转氨酶865U/L,谷氨酸转肽酶342U/L(正常值5～55U/L),碱性磷酸酶362U/L,出血时间4分钟。
Acute fatty liver of pregnancy is a rare condition in which fatal comorbidities may occur during the third trimester of pregnancy. The cause is still controversial. Pregnancy recurrent acute fatty liver has not been documented in the past, this is the first case report and confirmed by liver biopsy. Due to early diagnosis, timely termination of pregnancy, so that mother and child are at risk. Patients 37-year-old black, pregnant _5 _3 production, pregnancy 30 ~ + weeks, due to nausea and vomiting, anorexia with low-grade fever for 2 days, upper abdominal pain and fetal movement decreased one day hospitalization. Patients complained of the same symptoms as the acute fatty liver of their pregnancy and their intrauterine fetal death that they had had 16 months earlier. Physical examination: mild scleral jaundice, body temperature 37.8 ℃, abdominal soft, high palace end 22cm, single child, fetal heart 136 times / min. Assay: Aspartate aminotransferase 790U / L, alanine aminotransferase 865U / L, glutamate transpeptidase 342U / L (normal 5 ~ 55U / L), alkaline phosphatase 362U / L, bleeding time 4 minutes .