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产前和产后HELLP综合征的临床特征以及妊娠结局分析

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目的:分析分娩前后发生HELLP综合征孕产妇的临床特征以及妊娠结局的影响因素。方法:回顾性分析2010 年1 月至2021 年5 月南京医科大学附属苏州医院收治的126 例HELLP综合征患者,根据HELLP综合征发病时间不同分为产前HELLP组[n=108,合并重度子痫前期(SPE)98例]与产后HELLP组(n=18,合并SPE 15 例),比较不同发病时间及是否伴SPE的患者临床特征和妊娠结局的差异。结果:①与产后HELLP组比较,产前HELLP组孕晚期收缩压高、从子痫前期进展为HELLP综合征所需时间更短、肝功能异常升高、血小板更低、24 h尿蛋白更低,差异有统计学意义(P<0。05)。两组孕妇妊娠不良结局和新生儿预后各指标比较差异无统计学意义(P>0。05)。②伴SPE时,产前HELLP组较产后HELLP组子痫前期进展为HELLP综合征的时间更短、24 h尿蛋白更低、血小板更低、转氨酶更高,差异有统计学意义(P<0。05)。③不伴SPE时,产前HELLP组与产后HELLP组临床特征比较差异无统计学意义(P>0。05)。结论:产前与产后HELLP 综合征在病情进展速度,即从子痫前期进展为HELLP综合征所需时间上有差异,两者均可导致严重母儿并发症,临床上应早期识别。
Analysis of Clinical Features and Pregnancy Outcomes of Antenatal and Post-natal HELLP Syndrome
Objective:The clinical characteristics of pregnant women with HELLP syndrome before and after delivery and the risk factors of pregnancy outcomes were analyzed.Methods:A retrospective analysis was con-ducted on 126 cases of HELLP syndrome admitted to The Affiliated Suzhou Hospital of Nanjing Medical University from January 2010 to May 2021,divided into prenatal HELLP group[n=108,98 cases with severe preeclampsia(SPE)]and postpartum HELLP group(n=18,15 cases with SPE),to compare the differences in clinical charac-teristics and pregnancy outcomes between the two groups with the different onset time and whether they were complicated with SPE.Results:①Compared with the postpartum HELLP group,the prenatal HELLP group had higher systolic blood pressure in the third trimester of pregnancy,shorter time from preeclampsia to HELLP syn-drome,higher liver function abnormalities,lower platelet counts,and lower 24-hour urinary protein,with statistically significant differences(P<0.05).There was no statistically significant differences in adverse pregnancy outcomes and neonatal prognosis between the two groups(P>0.05).②When combined with SPE,the antenatal HELLP group had a shorter interval from preeclampsia to HELLP syndrome,lower platelet counts,and higher liver en-zymes than the postpartum HELLP group,with statistically significant differences(P<0.05).③There was no sig-nificant difference in clinical features between the antenatal HELLP group and the postpartum HELLP group when not complicated with SPE(P>0.05).Conclusions:There is only one difference between prenatal and postnatal HELLP syndrome in terms of the speed of disease progression,the time taken from preeclampsia to HELLP syn-drome,and both can lead to serious maternal and neonatal complications,which should be identified early in clini-cal practice.

HELLP syndromePreeclampsiaPregnancy outcomeInfluencing factors

李维、周丽屏、康苏娅

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南京医科大学附属苏州医院 苏州市立医院产科,江苏 苏州 215002

HELLP综合征 子痫前期 妊娠结局 影响因素

2024

实用妇产科杂志
四川省医学会

实用妇产科杂志

CSTPCD北大核心
影响因子:2.564
ISSN:1003-6946
年,卷(期):2024.40(11)