Kawabata Ikuno, Nakai Akihito, Takeshita Toshiyuki
Department of Obstetrics and Gynecology, Tama Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-City, Tokyo 206-8512, Japan.
Arch Gynecol Obstet. 2006 Aug;274(5):303-9. doi: 10.1007/s00404-006-0175-6. Epub 2006 May 6.
Early structural and functional changes in the systemic vasculature have been proposed to play a major pathogenetic role in HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Our objective was to assess whether the evaluation of maternal hepatic blood supply is instructive to the prediction of onset of HELLP syndrome.
Prospective observation study.
Fifty-eight women with severe preeclampsia and 60 healthy pregnant controls at 25-36 weeks gestation.
Angle-corrected time-averaged flow velocity and the cross-sectional area of common hepatic artery and portal vein were measured by using Doppler ultrasonography in 58 women with severe preeclampsia and in 60 healthy pregnant controls at 25-36 weeks gestation. Intravascular flow volumes were calculated from the product of the time-averaged velocity and the cross-sectional area. The total liver blood flow was taken as the sum of flow volumes in the hepatic artery and portal vein.
The total liver blood flow decreased significantly to about 40% of control in 9 women with severe preeclampsia who developed HELLP syndrome within 4 days after the examination, but not in 49 women with severe preeclampsia without HELLP syndrome.
The results indicated that the decrease in dual hepatic blood supply preceded the onset of HELLP syndrome.
有观点认为，全身血管系统早期的结构和功能变化在HELLP（溶血、肝酶升高和血小板减少）综合征的发病机制中起主要作用。我们的目的是评估评估孕产妇肝脏血液供应对预测HELLP综合征的发病是否具有指导意义。
前瞻性观察研究。
58例重度子痫前期孕妇和60例妊娠25 - 36周的健康孕妇作为对照。
采用多普勒超声测量58例重度子痫前期孕妇和60例妊娠25 - 36周的健康孕妇对照组肝总动脉和门静脉的角度校正时间平均流速及横截面积。血管内血流量由时间平均流速与横截面积的乘积计算得出。肝脏总血流量为肝动脉和门静脉血流量之和。
9例在检查后4天内发生HELLP综合征的重度子痫前期孕妇肝脏总血流量显著下降至对照组的约40%，而49例未发生HELLP综合征的重度子痫前期孕妇肝脏总血流量未下降。
结果表明，肝脏双重血液供应减少先于HELLP综合征的发病。
