溶血、肝酶升高和血小板减少综合征和肝酶升高、血小板减少综合征的危险因素、处理方法和结局。

Risk factors, management, and outcomes of hemolysis, elevated liver enzymes, and low platelets syndrome and elevated liver enzymes, low platelets syndrome.

机构信息

National Perinatal Epidemiology Unit, University of Oxford, Oxford, and Sunderland Royal Hospital, Sunderland, United Kingdom.

出版信息

Obstet Gynecol. 2014 Mar;123(3):618-627. doi: 10.1097/AOG.0000000000000140.

DOI:10.1097/AOG.0000000000000140

PMID:24499757

Abstract

OBJECTIVE

To describe the risk factors, management and outcomes of hemolysis, elevated liver enzymes, and low platelets (HELLP) and elevated liver enzymes, low platelets (ELLP) syndrome in the United Kingdom.

METHODS

A case-control study was conducted using the U.K. Obstetric Surveillance System between June 2011 and May 2012, including 129 women diagnosed with HELLP, 81 diagnosed with ELLP, and 476 control women.

RESULTS

Women with HELLP were more likely than those in the control group to be 35+ years old (33% compared with 22%, adjusted odds ratio [OR] 1.85, 95% confidence interval [CI] 1.12-3.06), nulliparous (67% compared with 43%, adjusted OR 4.16, 95% CI 2.48-6.98), have had a previous gestational hypertensive disorder (9% compared with 7%, adjusted OR 3.47, 95% CI 1.49-8.09), and have a multiple pregnancy (7% compared with 2%, adjusted OR 4.51, 95% CI 1.45-14.06). Women with ELLP were more likely than those in the control group to be nulliparous (79% compared with 43%, adjusted OR 8.35, 95% CI 3.88-17.95), and have had a previous gestational hypertensive disorder (7% compared with 7%, adjusted OR 4.66, 95% CI 1.37-15.89). Of the women diagnosed antenatally with HELLP or ELLP, 51% (71/138) had planned management of immediate delivery, 43% (60/138) had delivery planned within 48 hours, and 5% (7/138) had planned expectant (conservative) management. No differences were found between women who had delivery planned within 48 hours and those who had planned immediate delivery in terms of the proportion who received blood products (37% compared with 33%, P=.681); were admitted to the intensive care unit (57% compared with 61%, P=.652); experienced severe morbidity (10% compared with 4%, P=.300); or had a neonate with major complications (6% compared with 11%, P=.342).

CONCLUSION

A short delay in the delivery of women diagnosed antenatally with HELLP or ELLP syndrome may be considered. However, the rarity of the condition limits study power.

摘要

目的

描述英国溶血、肝酶升高和血小板减少（HELLP）和肝酶升高、血小板减少（ELLP）综合征的危险因素、处理方法和结局。

方法

本病例对照研究采用英国产科监测系统，于 2011 年 6 月至 2012 年 5 月纳入了 129 例确诊为 HELLP 患者、81 例确诊为 ELLP 患者和 476 例对照患者。

结果

与对照组相比，HELLP 患者更可能是 35 岁以上（33%比 22%，调整后优势比[OR]1.85，95%置信区间[CI]1.12-3.06）、未生育（67%比 43%，调整后 OR 4.16，95% CI 2.48-6.98）、有既往妊娠期高血压疾病（9%比 7%，调整后 OR 3.47，95% CI 1.49-8.09）和多胎妊娠（7%比 2%，调整后 OR 4.51，95% CI 1.45-14.06）。与对照组相比，ELLP 患者更可能是未生育（79%比 43%，调整后 OR 8.35，95% CI 3.88-17.95），有既往妊娠期高血压疾病（7%比 7%，调整后 OR 4.66，95% CI 1.37-15.89）。在产前诊断为 HELLP 或 ELLP 的患者中，51%（71/138）计划立即分娩，43%（60/138）计划在 48 小时内分娩，5%（7/138）计划期待（保守）治疗。在接受血液制品治疗的比例（37%比 33%，P=.681）、入住重症监护病房（57%比 61%，P=.652）、出现严重并发症（10%比 4%，P=.300）或新生儿出现严重并发症（6%比 11%，P=.342）方面，计划在 48 小时内分娩与计划立即分娩的患者之间无差异。