Tompkins M J, Thiagarajah S
Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia, USA.
Am J Obstet Gynecol. 1999 Aug;181(2):304-9. doi: 10.1016/s0002-9378(99)70552-1.
The purpose of this study was to determine the effect of corticosteroids on platelet counts and liver functions in women with pregnancies complicated by the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.
The study group consisted of 93 patients between 24 and 34 weeks' gestation diagnosed with HELLP syndrome. All were given intramuscular injections of either betamethasone or dexamethasone. The 3 most common regimens used were 12 mg of intramuscular betamethasone administered twice 12 hours apart, 12 mg of intramuscular betamethasone administered twice 24 hours apart, and 6 mg of intramuscular dexamethasone administered 4 times 6 hours apart. Precorticosteroid and postcorticosteroid platelet counts and liver function test results were compared. The differences in improvement in hematologic abnormalities among the 3 corticosteroid regimens were also analyzed.
The hematologic abnormalities seen in the 93 patients with HELLP syndrome improved after the administration of corticosteroids. The platelet count increased by 23.3 x 10(3)/microL (P <.001). A statistically significant decrease was seen in liver enzyme levels. The alanine aminotransferase decreased by 31.6 IU/L, the aspartate aminotransferase decreased by 52.1 IU/L, and the alkaline phosphatase decreased by 7.6 IU/L. Of the 3 regimens used, 2 doses of 12 mg of intramuscular betamethasone given every 12 hours improved the liver function to the greatest degree.
This study demonstrates that corticosteroids produce a significant improvement in the hematologic abnormalities associated with HELLP syndrome. Two doses of betamethasone given 12 hours apart was the most effective corticosteroid regimen.
本研究旨在确定皮质类固醇对妊娠合并HELLP（溶血、肝酶升高和血小板减少）综合征女性血小板计数和肝功能的影响。
研究组由93例妊娠24至34周被诊断为HELLP综合征的患者组成。所有患者均接受了倍他米松或地塞米松的肌肉注射。使用的3种最常见方案为：间隔12小时肌肉注射12 mg倍他米松两次；间隔24小时肌肉注射12 mg倍他米松两次；间隔6小时肌肉注射6 mg地塞米松4次。比较了使用皮质类固醇前和使用后的血小板计数及肝功能测试结果。还分析了3种皮质类固醇方案在血液学异常改善方面的差异。
93例HELLP综合征患者在使用皮质类固醇后血液学异常得到改善。血小板计数增加了23.3×10(3)/微升（P<.001）。肝酶水平出现统计学上的显著下降。谷丙转氨酶下降了31.6 IU/L，谷草转氨酶下降了52.1 IU/L，碱性磷酸酶下降了7.6 IU/L。在使用的3种方案中，每12小时肌肉注射2剂12 mg倍他米松对肝功能的改善程度最大。
本研究表明，皮质类固醇能显著改善与HELLP综合征相关的血液学异常。间隔12小时给予2剂倍他米松是最有效的皮质类固醇方案。
