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Objective:To compare and analyze the clinical characteristics between acute fatty liver of pregnancy (AFLP) and the hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome.Methods:This is a retrospective cohort study. The clinical data of 13 cases with AFLP and 34 cases with HELLP syndrome were collected from three tertiary referral centers in Yunnan (the First Affiliated Hospital of Kunming Medical University, the Second Affiliated Hospital of Kunming Medical University, and Yan'an Hospital of Kunming City) from January 2016 to December 2021. The patients were diagnosed to AFLP and HELLP syndrome according to the Swansea criteria and the Tennessee classification system. The general characteristics, clinical features, laboratory results within 24 hours after admission, complications, maternal and neonatal outcomes were compared to analysis the differences between the two groups.Results:① Maternal characteristics: compared with HELLP syndrome group, AFLP group had lower body mass index (BMI) and blood pressure at admission (both P < 0.01). ②Clinical features: the most common symptoms in AFLP patients were skin jaundice, abdominal pain, nausea and vomiting, edema. The main manifestations of patients with HELLP syndrome were albuminuria, hypertension, edema, headache. Some patients had multiple symptoms concurrently. ③ Laboratory results: compared with HELLP syndrome group, the levels of platelet count (PLT), total bilirubin (TBil), direct bilirubin (DBil), γ-glutamyl transferase (γ-GGT), alkaline phosphatase (ALP), total bile acid (TBA), serum creatinine (SCr) and international standardized ratio (INR) in AFLP group were significantly increased within 24 hours after admission [PLT (×10 9/L): 107.69±51.13 vs.76.71±43.25, TBil (μmol/L): 121.60 (83.20, 170.00) vs.15.25 (7.22, 29.05), DBil (μmol/L): 86.50 (58.60, 104.00) vs. 4.30 (2.22, 10.10), γ-GGT (U/L): 87.00 (37.00, 127.00) vs. 41.00 (19.00, 64.42), ALP (U/L): 199.10 (109.00, 349.20) vs. 125.50 (90.50, 155.25), TBA (μmol/L): 51.50 (16.20, 117.40) vs. 4.15 (2.02, 6.95), SCr (μmol/L): 155.80 (129.00, 237.00) vs. 79.00 (65.43, 113.70), INR: 1.28 (1.17, 1.63) vs. 0.94 (0.88, 1.08), all P < 0.05], prothrombin time (PT) was significantly prolonged [seconds: 16.10 (14.50, 19.20) vs. 12.40 (11.43, 13.40), P < 0.05]. The level of blood glucose (GLU), fibrinogen (FIB) and the activity of antithrombin Ⅲ (ATⅢ) decreased significantly [GLU (mmol/L): 5.18±1.33 vs. 6.33±1.19, FIB (g/L): 1.96±1.46 vs. 3.81±1.58, ATⅢ (%): 40.61±25.84 vs. 66.39±24.11, all P < 0.05]; ④ Complications: compared with HELLP syndrome group, the incidence of patients with hypoglycemia [30.77% (4/13) vs. 0% (0/34)], acute liver failure [53.85% (7/13) vs. 5.88% (2/34)], acute renal insufficiency [69.23% (9/13) vs. 8.82% (3/34)], coagulopathy [76.92% (10/13) vs. 38.24% (13/34)], disseminated intravascular coagulation (DIC) [53.85% (7/13) vs. 5.88% (2/34)], and multiple organ dysfunction syndrome (MODS) [53.85% (7/13) vs. 5.88% (2/34)] were significantly higher in AFLP group (all P < 0.05). ⑤ Maternal and neonatal outcome: all patients delivered after admission. The total length of hospital and intensive care unit stay were significantly longer in the AFLP group than in the HELLP syndrome group [days: 17.00 (11.00, 25.00) vs. 9.00 (7.00, 12.00), 12.00 (4.00, 22.00) vs. 3.91 (0, 7.00), both P < 0.01]. Two AFLP patients died, including one due to intracranial venous thrombosis and one due to multiple organ failure and cardiopulmonary arrest. There were no deaths in the HELLP syndrome group. Conclusions:There are significant differences in maternal characteristics, laboratory results and complications between AFLP and HELLP syndrome. TBil, γ-GGT, SCr, FIB, INR and ATⅢ activity may help to distinguish the two diseases.
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Objective To develop a clinical laboratory information system to execute information sharing.Methods The system realized information sharing between the third-party clinical laboratory facility and HIS with Oracle 10g database and Powerbuilder 9.0.Results The system implemented information sharing and informatized storing of the delivery specimen clinical laboratory results in the hospital.Conclusion The system fulfills seamless interface between the third-party clinical laboratory information system and HIS so as to provide the doctor and patient access to information and enhance the accuracy and timeliness of diagnosis.
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ObjectiveTo explore the role of parameters of organ function during heat stroke (HS) on the prognosis, and to form the treatment strategy through an analysis of parameters of organ function during HS. Methods A retrospective study was conducted. Thirty-seven patients with HS (HS group) and 54 patients with mild-to-moderate stroke (stroke group) admitted to Zhejiang Xiaoshan Hospital from 2011 to 2014 were enrolled. The experimental results of organs function indicators for patients were recorded including:① cardiac markers:troponin I (TnI);② myocardium zymogram: creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST);③ renal function indexes: blood urea nitrogen (BUN), uric acid (UA), and serum creatinine (SCr);④ electrolyte: serum K+, Na+, and Cl-;⑤coagulation function: prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), and D-dimer;⑥ blood gas analysis: pH value, arterial partial pressure of carbon dioxide (PaCO2), base excess (BE), standard bicarbonate (SB), and actual bicarbonate (AB);⑦ routine blood test: blood platelet count (PLT);⑧ hepatic function: alanine aminotransferase (ALT). Abnormal rates of laboratory parameters of 37 HS patients were statistically analyzed. Various laboratory parameters of organs function as well as the initial value and extreme value (maximum or minimum value) during treatment of CK and PLT in HS patients were compared between two groups.Results The abnormal rates of 37 HS patients were more than 70%, including incipient value of TnI, CK, LDH, AST, serum Na+, ALT, D-dimer, PaCO2, AB, maximum value of CK, and minimum value of PLT, the abnormal rates being 73.0%, 70.3%, 81.1%, 78.4%, 78.4%, 70.3%, 70.3%, 70.3%, 75.7%, 81.1%, 75.7%, respectively. The abnormal rates of other parameters were less than 70%. There were significant differences in incipient value of TnI, CK, LDH, AST, serum K+, serum Na+, D-dimer, and PLT between HS group and mild-to-moderate stroke group [TnI (μg/L): 0.087 (0.026, 0.306) vs. 0.007 (0.004, 0.110),Z = -7.017,P = 0.000;CK (U/L): 392.30 (287.60, 524.10) vs. 137.10 (106.33, 607.80),Z = -7.930,P = 0.000; LDH (U/L): 317.98±122.74 vs. 207.85±57.71, t = 1.678,P = 0.000; AST (U/L): 94.90 (52.80, 155.80) vs. 26.10 (18.13, 317.40),Z = -6.157, P = 0.000; serum K+ (mmol/L): 3.46±0.65 vs. 3.86±0.57,t = 1.662,P = 0.001; serum Na+ (mmol/L): 129.75±7.34 vs. 138.79±4.26,t = 1.674,P = 0.000; D-dimer (mg/L): 2.53 (0.63, 6.00) vs. 0.30 (0.21, 9.71),Z = -5.084, P = 0.000; PLT (×109/L): 144.62±86.14 vs. 219.48±64.76,t = 1.669,P = 0.000]. There were also statistically significant differences in the initial value and extreme value of CK and PLT between HS group and mild-to-moderate stroke group [CK (U/L): 392.30 (287.60, 524.10) vs. 721.50 (546.30, 964.10),Z = -6.351,P = 0.000; PLT (×109/L):132.40±82.55 vs. 68.24±44.62,t = 1.688,P = 0.000].Conclusions HS can impair several organs and systems, having complications, and it is a heavy insult for body. Increasing of CK and decreasing of PLT has some value to assess illness changes. It is helpful of laboratory results for doctors to estimate complications on time.