Martin James N, Thigpen Brad D, Rose Carl H, Cushman Julie, Moore Amanda, May Warren L
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA.
Am J Obstet Gynecol. 2003 Sep;189(3):830-4. doi: 10.1067/s0002-9378(03)00763-4.
We compared maternal outcomes for patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome treated with or without high-dose corticosteroids to ameliorate maternal disease.
An analysis of data for patients with HELLP syndrome (platelets, <or=100,000/microL; lactate dehydrogenase level, >or=600 IU/L; aspartate aminotransferase and/or alanine aminotransferase level, >or=70 IU/L) who were treated during the 7-year epochs before and after the clinical trials in 1992 and 1993 demonstrated maternal benefit with high-dose dexamethasone.
Corticosteroid use increased from 16% (39/246 patients) for fetal indication from 1985 to 1991 to 90% (205/228 patients) for maternal-fetal indications from 1994 to 2000. Significantly reduced composite maternal disease from 1994 to 2000 was evidenced by improvements in laboratory parameters, disease progression to class 1 HELLP syndrome, the degree of hypertension, the need for antihypertensive therapy, the use of transfusion, and the presence of maternal morbidity (P<.05). Indices of postpartum recovery also were shortened significantly (P<.001).
Routine early initiation of high-dose intravenous corticosteroids for patients with HELLP syndrome significantly lessened maternal disease, reduced maternal morbidity, and expedited recovery.
我们比较了接受或未接受大剂量皮质类固醇治疗以改善母体疾病的HELLP（溶血、肝酶升高和血小板计数降低）综合征患者的母体结局。
对1992年和1993年临床试验前后7年期间接受治疗的HELLP综合征患者（血小板计数≤100,000/μL；乳酸脱氢酶水平≥600 IU/L；天冬氨酸转氨酶和/或丙氨酸转氨酶水平≥70 IU/L）的数据进行分析，结果表明大剂量地塞米松对母体有益。
皮质类固醇的使用从1985年至1991年因胎儿指征的16%（39/246例患者）增加到1994年至2000年因母婴指征的90%（205/228例患者）。1994年至2000年，实验室参数改善、疾病进展为1级HELLP综合征、高血压程度、抗高血压治疗需求、输血使用情况以及母体发病情况的改善均表明母体综合疾病显著减少（P<0.05）。产后恢复指标也显著缩短（P<0.001）。
对于HELLP综合征患者，常规早期开始大剂量静脉注射皮质类固醇可显著减轻母体疾病、降低母体发病率并加速恢复。
