O'Brien J M, Milligan D A, Barton J R
Perinatal Diagnostic Center, Central Baptist Hospital, Lexington, KY 40503, USA.
Am J Obstet Gynecol. 2000 Oct;183(4):921-4. doi: 10.1067/mob.2000.108869.
The purpose of this study was to determine whether corticosteroid administration to patients with antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome would alter laboratory values diagnostic for the disease.
Cases of 37 women with antepartum HELLP syndrome managed between March 1995 and July 1999 were reviewed. Patients were classified on the basis of exposure to corticosteroids and to the dose used. Group 1 did not receive corticosteroids. Group 2 received a standard corticosteroid dosage regimen for promotion of fetal lung maturation. Group 3 received a high-dose corticosteroid regimen of >24 mg/d (most frequently 10 mg dexamethasone as an intravenous bolus dose every 6 hours for 2 doses followed by 6 mg as an intravenous bolus dose every 6 hours for 2 to 4 doses). Antepartum changes in laboratory values from diagnosis to delivery were evaluated by means of the Kruskal-Wallis test.
Eleven patients did not receive corticosteroids, 15 were given a standard dose, and 11 received high-dose therapy. For each laboratory value assessed (platelet count, aspartate aminotransferase activity, and lactate dehydrogenase activity), the corticosteroid groups differed significantly from the no-treatment group (P </=.002 for all). A further, significantly greater improvement in platelet count was noted between the high-dose group (81%) and the standard-dose group (17%; P =.04). The interval from diagnosis to delivery was also longer for patients treated with the high-dose protocol (51 +/- 25 hours) than for both those treated with a standard regimen (26 +/- 20 hours) and those who received no treatment (13 +/- 11 hours; P <. 001).
Administration of corticosteroids to patients with antepartum HELLP syndrome improves platelet count, reduces liver enzyme abnormalities, and prolongs latency to delivery in a dose-dependent manner. Higher doses of corticosteroid than those traditionally prescribed for promotion of fetal pulmonary maturation should be considered for maternal and fetal benefits in cases of severe preeclampsia.
本研究旨在确定对产前HELLP（溶血、肝酶升高和血小板计数降低）综合征患者给予皮质类固醇是否会改变该疾病的诊断实验室值。
回顾了1995年3月至1999年7月间治疗的37例产前HELLP综合征女性病例。根据是否使用皮质类固醇及所用剂量对患者进行分类。第1组未接受皮质类固醇治疗。第2组接受促进胎儿肺成熟的标准皮质类固醇剂量方案。第3组接受大于24mg/d的高剂量皮质类固醇方案（最常见的是每6小时静脉推注10mg地塞米松，共2剂，随后每6小时静脉推注6mg，共2至4剂）。通过Kruskal-Wallis检验评估从诊断到分娩期间实验室值的产前变化。
11例患者未接受皮质类固醇治疗，15例给予标准剂量，11例接受高剂量治疗。对于评估的每个实验室值（血小板计数、天冬氨酸转氨酶活性和乳酸脱氢酶活性），皮质类固醇组与未治疗组有显著差异（所有P≤0.002）。高剂量组（81%）与标准剂量组（17%；P = 0.04）相比，血小板计数有进一步显著更大的改善。接受高剂量方案治疗的患者从诊断到分娩的间隔时间（51±25小时）也比接受标准方案治疗的患者（26±20小时）和未接受治疗的患者（13±11小时）更长（P<0.001）。
对产前HELLP综合征患者给予皮质类固醇可改善血小板计数，降低肝酶异常，并以剂量依赖方式延长分娩潜伏期。对于重度子痫前期病例，为了母婴利益，应考虑使用比传统用于促进胎儿肺成熟的剂量更高的皮质类固醇。
