Woudstra Douglas M, Chandra Sue, Hofmeyr G Justus, Dowswell Therese
Department of Obstetrics and Gynaecology, University of Alberta, 13619 - 108 Avenue, Edmonton, Alberta, Canada, T5M 2C7.
Cochrane Database Syst Rev. 2010 Sep 8(9):CD008148. doi: 10.1002/14651858.CD008148.pub2.
Pre-eclampsia is a relatively common complication of pregnancy. HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is a severe manifestation of pre-eclampsia with significant morbidity and mortality for pregnant women and their children. Corticosteroids are commonly used in the treatment of HELLP syndrome in the belief that they improve outcomes.
To determine the effects of corticosteroids on women with HELLP syndrome and their children.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2010).
Randomized controlled trials comparing any corticosteroid with placebo, no treatment, or other drug; or comparing one corticosteroid with another corticosteroid or dosage in women with HELLP syndrome.
Two review authors assessed trial quality and extracted data independently.
Eleven trials (550 women) compared corticosteroids with placebo or no treatment. There was no difference in the risk of maternal death (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.28 to 3.21), maternal death or severe maternal morbidity (RR 0.27, 95% CI 0.03 to 2.12), or perinatal/infant death (RR 0.64, 95% CI 0.21 to 1.97). The only clear effect of treatment on individual outcomes was improved platelet count (standardized mean difference (SMD) 0.67, 95% CI 0.24 to 1.10). The effect on platelet count was strongest for women who commenced treatment antenatally (SMD 0.80, 95% CI 0.25 to 1.35).Two trials (76 women) compared dexamethasone with betamethasone. There was no clear evidence of a difference between groups in respect to perinatal/infant death (RR 0.95, 95% CI 0.15 to 6.17) or severe perinatal/infant morbidity or death (RR 0.64, 95% CI 0.27 to 1.48). Maternal death and severe maternal morbidity were not reported. In respect to platelet count, dexamethasone was superior to betamethasone (MD 6.02, 95% CI 1.71 to 10.33), both when treatment was commenced antenatally (MD 8.10, 95% CI 6.23 to 9.97) and postnatally (MD 3.70, 95% CI 0.96 to 6.44).
AUTHORS' CONCLUSIONS: There was no clear evidence of any effect of corticosteroids on substantive clinical outcomes. Those receiving steroids showed significantly greater improvement in platelet counts which was greater for those receiving dexamethasone than those receiving betamethasone. There is to date insufficient evidence of benefits in terms of substantive clinical outcomes to support the routine use of steroids for the management of HELLP. The use of corticosteroids may be justified in clinical situations in which increased rate of recovery in platelet count is considered clinically worthwhile.
子痫前期是妊娠期相对常见的并发症。HELLP（溶血、肝酶升高、血小板减少）综合征是子痫前期的一种严重表现形式，对孕妇及其子女具有显著的发病率和死亡率。皮质类固醇常用于治疗HELLP综合征，人们认为其能改善治疗结果。
确定皮质类固醇对患有HELLP综合征的女性及其子女的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2010年6月30日）。
比较任何皮质类固醇与安慰剂、不治疗或其他药物的随机对照试验；或比较一种皮质类固醇与另一种皮质类固醇或剂量在患有HELLP综合征女性中的随机对照试验。
两位综述作者独立评估试验质量并提取数据。
11项试验（550名女性）比较了皮质类固醇与安慰剂或不治疗的效果。孕产妇死亡风险（风险比（RR）0.95，95%置信区间（CI）0.28至3.21）、孕产妇死亡或严重孕产妇发病风险（RR 0.27，95%CI 0.03至2.12）或围产期/婴儿死亡风险（RR 0.64，95%CI 0.21至1.97）均无差异。治疗对个体结局的唯一明确影响是血小板计数有所改善（标准化均数差（SMD）0.67，95%CI 0.24至1.10）。对于产前开始治疗的女性，对血小板计数的影响最为显著（SMD 0.80，95%CI 0.25至1.35）。两项试验（76名女性）比较了地塞米松与倍他米松的效果。在围产期/婴儿死亡（RR 0.95，95%CI 0.15至6.17）或严重围产期/婴儿发病或死亡（RR 0.64，95%CI 0.27至1.48）方面，两组之间没有明显差异的证据。未报告孕产妇死亡和严重孕产妇发病情况。在血小板计数方面，地塞米松优于倍他米松（平均差（MD）6.02，95%CI 1.71至10.33），无论是产前开始治疗（MD 8.10，95%CI 6.23至9.97）还是产后开始治疗（MD 3.70，95%CI 0.96至6.44）。
没有明确证据表明皮质类固醇对实质性临床结局有任何影响。接受类固醇治疗的患者血小板计数有显著更大程度的改善，接受地塞米松治疗的患者比接受倍他米松治疗的患者改善程度更大。就实质性临床结局而言，目前尚无足够证据支持常规使用类固醇治疗HELLP。在临床情况中，如果认为血小板计数恢复速度加快在临床上是值得的，那么使用皮质类固醇可能是合理的。
