Crane Joan M G, Tabarsi Baharak, Hutchens Donna
Memorial University of Newfoundland, St. John's, NL, Canada.
J Obstet Gynaecol Can. 2003 Aug;25(8):650-5. doi: 10.1016/s1701-2163(16)30123-2.
To determine the more effective regime in improving hematologic abnormalities associated with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, by comparing two different antenatal dosing protocols for dexamethasone (given primarily for fetal lung maturity).
A retrospective cohort study of 30 women between 24 and 34 weeks' gestation, diagnosed with HELLP syndrome prior to delivery, who received 2 doses of dexa-methasone 12 mg intramuscularly, given either 24 hours apart or 12 hours apart.
There was a shorter time from the first corticosteroid dose to the beginning of improvement with the 12-hour regime for platelet count (11 hours [9, 25 hours] versus 69 hours [41, 112 hours], median [quartiles], P = 0.003) and for alkaline phosphatase (25 hours [5, 44 hours] versus 59 hours [31, 69 hours], median [quartiles], P = 0.02). Worsening recurred from 11 hours, for alanine aminotransferase (ALT) and aspartate transaminase (AST), to 32 hours, for uric acid, after initial improvement. Hematologic improvement occurred in 37% (for ALT) to 67% (for alkaline phosphatase) of women overall.
A temporary improvement in the hematologic parameters of HELLP syndrome can occur with antenatal dexa-methasone administration, with the 12-hour regime having quicker onset to improvement in platelet count and alkaline phosphatase.
通过比较两种不同的产前地塞米松给药方案（主要用于促进胎儿肺成熟），确定哪种方案在改善与HELLP（溶血、肝酶升高、血小板计数降低）综合征相关的血液学异常方面更有效。
一项回顾性队列研究，研究对象为30名妊娠24至34周、分娩前诊断为HELLP综合征的女性，她们接受了2剂12毫克的地塞米松肌肉注射，给药间隔分别为24小时或12小时。
血小板计数方面，12小时给药方案从首次使用皮质类固醇到开始改善的时间较短（11小时[9, 25小时]，中位数[四分位数]，而69小时[41, 112小时]，P = 0.003）；碱性磷酸酶方面也是如此（25小时[5, 44小时]与59小时[31, 69小时]，中位数[四分位数]，P = 0.02）。初始改善后，丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）在11小时后复发恶化，尿酸在32小时后复发恶化。总体而言，37%（ALT）至67%（碱性磷酸酶）的女性出现了血液学改善。
产前给予地塞米松可使HELLP综合征的血液学参数暂时改善，12小时给药方案在改善血小板计数和碱性磷酸酶方面起效更快。
