Vigil-De Gracia P
Gynecology and Obstetric Unit, Complejo Hospitalario Metropolitano de la Caja de Seguro Social, Panama, Panama.
Int J Gynaecol Obstet. 2001 Jan;72(1):17-23. doi: 10.1016/s0020-7292(00)00281-2.
To determine the incidence of, and assess the relationship between liver enzymes and platelet counts with the severity of HELLP (hemolysis elevated liver enzymes and low platelet count) syndrome, and describe incidences of serious maternal complications.
Retrospective descriptive study of patients with pre-eclampsia-eclampsia complicated by HELLP syndrome that occurred over a 3-year period in Panama. The primary outcome included: platelet count; serum aspartate aminotransferase; serum alanine aminotransferase; symptoms and complications among class 1, 2, and 3 HELLP.
There were 558 pregnancies complicated by severe pre-eclampsia and 26 by eclampsia. The incidence of HELLP syndrome among women with severe pre-eclampsia in our population was 12% and among women with eclampsia was 34.6%, (P<0.0008); with a total incidence of 16%. Epigastric pain, visual symptoms and hematuria increased with the severity of HELLP syndrome. Hematuria was the fourth symptom, but was significantly (P=0.002) associated with class 1 HELLP. There were significant differences in the platelet count, and liver enzymes among the classes of HELLP syndrome. Abruptio placentae, acute renal failure and disseminated intravascular coagulation were the most frequent maternal complications. There were two maternal deaths.
This study supports the theory that HELLP syndrome is associated with increased maternal morbidity and mortality. Our data suggest that certain subgroups of patients with class 1 HELLP syndrome ('classic or true HELLP') are at increased risk for serious maternal complications, including those with: platelet counts below 50000/microl; lactic dehydrogenase> or = 2000 IU/l; aspartate aminotranferase> or = 500 IU/l; alanine aminotransferase> or = 300 IU/l; and hematuria.
确定肝酶和血小板计数与HELLP（溶血、肝酶升高和血小板减少）综合征严重程度之间的发生率及关系，并描述严重孕产妇并发症的发生率。
对巴拿马3年内发生的子痫前期-子痫并发HELLP综合征的患者进行回顾性描述性研究。主要观察指标包括：血小板计数；血清天冬氨酸氨基转移酶；血清丙氨酸氨基转移酶；1、2、3级HELLP的症状及并发症。
558例妊娠并发重度子痫前期，26例并发子痫。在我们的研究人群中，重度子痫前期患者中HELLP综合征的发生率为12%，子痫患者中为34.6%，（P<0.0008）；总发生率为16%。上腹部疼痛、视觉症状和血尿随着HELLP综合征严重程度的增加而增多。血尿是第四种症状，但与1级HELLP显著相关（P=0.002）。HELLP综合征各等级之间的血小板计数和肝酶存在显著差异。胎盘早剥、急性肾衰竭和弥散性血管内凝血是最常见的孕产妇并发症。有2例孕产妇死亡。
本研究支持HELLP综合征与孕产妇发病率和死亡率增加相关的理论。我们的数据表明，1级HELLP综合征（“典型或真正的HELLP”）的某些亚组患者发生严重孕产妇并发症的风险增加，包括那些：血小板计数低于50000/微升；乳酸脱氢酶>或=2000国际单位/升；天冬氨酸氨基转移酶>或=500国际单位/升；丙氨酸氨基转移酶>或=300国际单位/升；以及血尿的患者。
