产前与产后HELLP综合征的临床特征分析

Comparison of clinical features in antepartum and postpartum HELLP syndrome

目的分析产前与产后溶血、肝酶升高和低血小板计数综合征(HELLP综合征)孕产妇的临床特征和妊娠结局。方法采用回顾性研究的方法,收集2009年4月至2019年3月于北京大学第一医院分娩的子痫前期并发HELLP综合征的孕产妇及新生儿信息。HELLP综合征的诊断依据田纳西标准,共纳入83例孕产妇,根据HELLP综合征的发病时间分为产前HELLP组和产后HELLP组。比较两组孕产妇的疾病特点、分型、症状和体征、实验室检查和妊娠结局。结果83例HELLP综合征孕产妇中,产前HELLP组占84%(70/83),产后HELLP组占16%(13/83)。产后HELLP组双胎或三胎妊娠率(6/13)高于产前HELLP组(6%,4/70),子痫前期发病孕周[分别为(35.8±3.0)和(31.5±5.2)周]及分娩孕周[分别为(36.7±2.3)和(32.2±5.0)周]晚于产前HELLP组,早发子痫前期发生率低于产前HELLP组[分别为2/13和64%(45/70)],分别比较,差异均有统计学意义(P均<0.05)。两组孕产妇的临床症状和体征分别比较,差异均无统计学意义(P均>0.05)。产前HELLP组24 h尿蛋白定量显著高于产后HELLP组[分别为(4.8±5.1)和(1.8±1.6)g,P=0.002],但其他实验室检查指标分别比较,差异均无统计学意义(P均>0.05)。两组孕产妇的严重妊娠并发症、输血治疗和不良妊娠结局发生率分别比较,差异均无统计学意义(P均>0.05)。结论产前与产后HELLP综合征仅发病时间不同,但具有类似的临床症状、体征和实验室检测指标结果,均会导致严重母体并发症,即使是产后出现的HELLP综合征,临床处理中也应予以重视。

Objective To analyze the clinical features and pregnancy outcomes in antepartum and postpartum hemolysis,elevated live enzymes,and low platelet count syndrome(HELLP syndrome).Methods A retrospective study was conducted to collect maternal and neonatal information of pre-eclampsia complicated with HELLP syndrome in Peking University First Hospital during the ten years from April 2009 to March 2019.A total of 83 pregnant women were included according to the Tennessee Classification System.They were then allocated into two groups based on the onset time of HELLP syndrome:antepartum HELLP syndrome group(n=70)and postpartum HELLP syndrome group(n=13).The clinical features,symptoms,laboratory biomarkers,and pregnancy outcomes were compared between the two groups.Results Among the 83 pregnant women with HELLP syndrome,70 occurred prenatally(84%,70/83)and 13 occurred postpartum(16%,13/83).The twin or triplet pregnancy rate in the postpartum HELLP syndrome group was significantly higher than that in the antepartum HELLP syndrome group[6/13 vs 6%(4/70),P=0.001].The gestational weeks for HELLP onset and delivery in the postpartum HELLP syndrome group were significantly later than those in the antepartum HELLP syndrome group[(35.8±3.0)vs(31.5±5.2)weeks,P=0.025;(36.7±2.3)vs(32.2±5.0)weeks,P=0.002].The incidence of early-onset pre-eclampsia in the antepartum HELLP syndrome group was significant higher than that in the postpartum HELLP syndrome group[64%(45/70)vs 2/13,P=0.002].The quantitative of 24-hour proteinuria was significant higher in the antepartum HELLP syndrome group than that in the postpartum HELLP syndrome group[(4.8±5.1)vs(1.8±1.6)g,P=0.002].But there were no statistical significances in the comparison of other laboratory test indexes(all P>0.05).There were no significant differences between the two groups in clinical symptoms,severe maternal complications,transfusion or adverse maternal outcomes(all P>0.05).Conclusions Antepartum and postpartum HELLP syndrome have similar clinical symptoms and laboratory characteristics.Both antepartum and postpartum HELLP syndrome could lead to severe maternal complications,which should be paid special attention in clinical practice,especially to the postpartum HELLP syndrome.