Wallace Kedra, Harris Sharonda, Addison Augustina, Bean Cynthia
University of Mississippi Medical Center, Obstetrics & Gynecology, 2500 N. State St. Jackson Mississippi 39216, United States.
University of Florida College of Medicine Ringgold Standard Institution, Pharmacology and Therapeutics, Gainesville, Florida, United States.
Curr Pharm Biotechnol. 2018;19(10):816-826. doi: 10.2174/1389201019666180712115215.
HELLP syndrome is a disorder associated with serious maternal morbidity and mortality. Distinguishing HELLP from other pregnancy-related disorders is often challenging and may result in delay of treatment. Differential diagnoses include acute fatty liver of pregnancy, thrombotic thrombocytopenic purpura, antiphospholipid syndrome, and hemolytic uremic syndrome, and are reviewed in this chapter. While there is not any current treatment for HELLP, the mainstay of treatment involves maternal stabilization and timely delivery. Various treatment strategies have been attempted to help decrease the morbidity and mortality of HELLP, including the maternal use of corticosteroids. The authors review the studies and controversies surrounding the maternal use of corticosteroids, plasma exchange, and low molecular weight heparin for the treatment of HELLP, as well as the role of the complement system in HELLP. Further large, well-designed, randomized controlled trials are needed to address the role corticosteroids may play in the treatment of women with HELLP and to help improve maternal and fetal outcomes.
HELLP综合征是一种与严重孕产妇发病和死亡相关的疾病。将HELLP与其他妊娠相关疾病区分开来往往具有挑战性，可能导致治疗延误。鉴别诊断包括妊娠急性脂肪肝、血栓性血小板减少性紫癜、抗磷脂综合征和溶血尿毒综合征，本章将对此进行综述。虽然目前尚无针对HELLP的治疗方法，但治疗的主要支柱是孕产妇病情稳定和及时分娩。人们尝试了各种治疗策略来帮助降低HELLP的发病率和死亡率，包括孕产妇使用皮质类固醇。作者回顾了有关孕产妇使用皮质类固醇、血浆置换和低分子量肝素治疗HELLP的研究及争议，以及补体系统在HELLP中的作用。需要进一步开展大规模、设计良好的随机对照试验，以确定皮质类固醇在治疗HELLP女性患者中可能发挥的作用，并帮助改善母婴结局。
