早发型子痫前期合并HELLP综合征的临床分析

Clinical Comparative Analysis of Early-Onset Preeclampsia Combined with HELLP Syndrome

目的探讨早发型子痫前期患者合并HELLP综合征的临床特点,提高及早诊疗能力。方法回顾性收集2014年3月–2021年10月于浙江大学医学院附属妇产科医院就诊的70例早发型子痫前期合并HELLP综合征(HELLP组)及年龄匹配的140例未合并HELLP综合征早发型子痫前期(对照组)患者一般临床资料、发病特点及实验室检查结果,分析比较两组围产结局。结果①两组患者的孕次、产前体质量指数、距前次分娩年限及糖尿病/高血压家族史差异无统计学意义;②与对照组相比,HELLP组孕期最高收缩压、最高舒张压及分娩后住院天数均高于对照组(P<0.001);HELLP组诊断为子痫前期的孕周及分娩孕周早于对照组(P<0.001),且血压升高至分娩的孕周差(P<0.001)、确诊早发型子痫前期至分娩的孕周差均低于对照组(P=0.027);HELLP组子痫发作及胸、腹水的发生率多于对照组(P<0.05)。③HELLP组新生儿入住NICU、发生青紫/苍白窒息的概率更高(P<0.001)。④HELLP组终止妊娠前的谷丙转氨酶、谷草转氨酶、总胆红素、肌酐、尿素、随机葡萄糖、乳酸脱氢酶、活化部分凝血活酶时间及最后一次24 h尿蛋白定量高于对照组(P均<0.05);血小板低于对照组(P<0.001)。⑤孕中期血小板计数与HELLP综合征的发生具有显著的相关性(P=0.006),ROC曲线下面积为0.746(95%CI:0.596~0.897)。结论早发型子痫前期合并HELLP综合征者较非HELLP综合征者确诊子痫前期的孕周更早,且具有更高的血压、更易发生严重并发症,产后住院时间更长以及新生儿结局亦较差。密切监测早发型子痫前期患者的孕中期血小板计数情况有助于后续HELLP综合征的预测。

Objective To explore the clinical characteristics of early-onset preeclampsia(PE)combined with HELLP(hemolysis,elevated liver enzymes,and low platelets)syndrome,and to improve the capacity for early diagnosis and treatment.Methods Pregnant women who received treatment at Women’s Hospital,School of Medicine,Zhejiang University between March 2014 and October 2021 were retrospectively enrolled.There were two patient groups,the HELLP group consisting of 70 cases of early-onset PE combined with HELLP syndrome and the control group consisting of 140 cases of early-onset PE without HELLP syndrome.Patients in the two groups were matched by age.The general clinical data,characteristics of pathogenesis,and laboratory findings of the patients were collected and the perinatal outcomes of the two groups were compared and analyzed.Results 1)There was no significant difference in gravidity,pre-delivery body mass index,years from the last delivery,and family history of diabetes mellitus and hypertension between the two groups.2)The highest systolic blood pressure,highest diastolic blood pressure during the pregnancy,and the postpartum hospital length-of-stay(P<0.001)in the HELLP group were higher than those in the control group.The gestational age at the time of the diagnosis of PE(P=0.001)and the gestational age at delivery(P<0.001)in the HELLP group were significantly earlier than those in the control group.The difference between the gestational age at the time of blood pressure elevation and that at the time of delivery(P<0.001),and the gestational age difference between the diagnosis of early-onset PE and delivery(P=0.027)were lower than those in the control group.The incidences of eclampsia in the HELLP group,pleural effusion,and ascites were higher than those of the control group.3)Neonates in the HELLP group had a higher probability of being admitted to NICU and developing cyanotic/pale asphyxia(P<0.001).4)Before the termination of pregnancy,the HELLP group had higher levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin,creatinine,urea,random glucose,lactate dehydrogenase,activated partial thromboplastin time,and the last 24-hour urine protein quantification than those of the control group(all P<0.05),while the platelet(PLT)counts were significantly lower than those of the control group(P<0.001).5)There was a significant correlation between PLT counts in the second trimester and the onset of HELLP syndrome(P=0.006),with the area under the ROC curve reaching 0.746(95%CI:0.596-0.897).Conclusion In comparison with early-onset PE patients without HELLP syndrome,patients with early-onset PE combined with HELLP syndrome are diagnosed for PE at an earlier gestational age,have higher blood pressure,are more prone to serious pregnancy complications,and have longer postpartum hospital length-of-stay and worse neonatal outcomes.Close monitoring of PLT counts of early-onset PE patients in the second trimester may help predict subsequent HELLP syndrome.