Pawelec Malgorzata, Palczynski Boguslaw, Karmowski Andrzej
First Clinic of Gynecology and Obstetrics, Silesian Piasts University of Medicine in Wroclaw, Chalubinskiego, Wroclaw, Poland.
J Matern Fetal Neonatal Med. 2012 May;25(5):467-70. doi: 10.3109/14767058.2011.592875. Epub 2011 Aug 1.
To test the hypothesis that HELLP syndrome may be more likely to develop earlier, if a pregnant woman has aPL antibodies, and to observe clinical and laboratory factors preceding the occurrence of HELLP syndrome.
The study consisted in retrospective analysis, with updated verification, of HELLP syndrome in pregnancies below 26th week in our clinic in the years 1992-2010.
HELLP syndrome, if it occurred before the 26th week, occurred only in women with preeclampsia superimposed on chronic hypertension and in women with aPL antibodies. HELLP syndrome with aPL antibodies occurred with low level of platelets (mean 35.5 × 10(9)/L), lower level of AT III (mean 71.3%), lymphopenia, higher CRP (mean 9.1) and pale infarct of placenta (100%). The occurrence of HELLP syndrome was always preceded by surges in blood pressure resistant to antihypertensive drugs.
HELLP syndrome in early pregnancy may indicate the presence of aPL antibodies. It may also be a clinical symptom of APS. A surge in blood pressure is a clinical forerunner of the coming HELLP syndrome. HELLP syndrome in women with APS is characterized by low level of platelets.
验证如下假说：若孕妇存在抗磷脂抗体（aPL），则更有可能较早发生HELLP综合征，并观察HELLP综合征发生前的临床和实验室因素。
本研究包括对1992年至2010年期间在我院就诊的孕周小于26周的妊娠患者的HELLP综合征进行回顾性分析及更新验证。
若HELLP综合征发生在第26周之前，则仅发生于子痫前期合并慢性高血压的女性及存在aPL抗体的女性。伴有aPL抗体的HELLP综合征患者血小板水平较低（平均35.5×10⁹/L），抗凝血酶III水平较低（平均71.3%），淋巴细胞减少，C反应蛋白水平较高（平均9.1），胎盘苍白梗死（100%）。HELLP综合征发生前总是出现对降压药物有抵抗的血压骤升。
孕早期的HELLP综合征可能提示存在aPL抗体。它也可能是抗磷脂综合征（APS）的临床症状。血压骤升是即将发生HELLP综合征的临床先兆。伴有APS的女性发生的HELLP综合征的特征是血小板水平较低。
