Martin James N, Rose Carl H, Briery Christian M
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA.
Am J Obstet Gynecol. 2006 Oct;195(4):914-34. doi: 10.1016/j.ajog.2005.08.044. Epub 2006 May 2.
Antepartum or postpartum HELLP syndrome constitutes an obstetric emergency that requires expert knowledge and management skills. The insidious and variable nature of disease presentation and progression challenges the clinician and complicates consensus on universally accepted diagnostic and classification criteria. A critical review of published research about this variant form of severe preeclampsia, focused primarily on what is known about the pathogenesis of this disorder as it relates to patient experience with corticosteroids for its management, leads to the conclusion that there is maternal-fetal benefit realized when potent glucocorticoids are aggressively used for its treatment. Although acknowledging the need for definitive multicenter trials to better define the limits of benefit and the presence of any maternal or fetal risk, and given an understanding of the nature of the disorder with its potential to cause considerable maternal morbidity and mortality, we recommend for the present that aggressively used potent glucocorticoids constitute the cornerstone of management for patients considered to have HELLP syndrome.
产前或产后HELLP综合征是一种产科急症，需要专业知识和管理技能。疾病表现和进展的隐匿性及多变性给临床医生带来了挑战，也使得关于普遍接受的诊断和分类标准难以达成共识。对已发表的关于这种重度子痫前期变体形式的研究进行批判性综述，主要关注该疾病发病机制与患者使用皮质类固醇治疗经验的相关情况，得出的结论是，积极使用强效糖皮质激素治疗可实现母婴获益。尽管认识到需要进行确定性的多中心试验，以更好地界定获益限度以及是否存在任何母体或胎儿风险，并且鉴于对该疾病本质及其可能导致相当高的孕产妇发病率和死亡率的了解，我们目前建议，积极使用强效糖皮质激素是被认为患有HELLP综合征患者管理的基石。
