Celal Bayar University Faculty of Medicine, Emergency Medicine Department, Manisa, Turkey.
Giresun University, Medical Faculty of Gastroenterology Department, Giresun, Turkey.
Am J Emerg Med. 2020 Mar;38(3):459-462. doi: 10.1016/j.ajem.2019.02.014. Epub 2019 Feb 12.
HELLP (hemolysis, elevated liver enzyme levels, low platelet counts)-syndrome is a rare but dramatic pregnancy-related illness. The difficult part of this syndrome is the lack of standardised diagnostic criterias and tests to be used to predict it. The aim of this study is determining the role of APRI score in the diagnosis of HELLP syndrome.
In this cross sectional, retrospective study, patients with HELLP syndrome as case group and age-matched healthy pregnants at the similar pregnancy trimester as control group were included between January 12,017 and May 31, 2018. Data including sex, age, laboratory values, prognosis were recorded from the computerized system of the hospital. The p-value <0.05 was considered statistically significant.
40 patients with HELLP syndrome and 124 age-matched healthy pregnants included in the study. There was a statistically significant difference between control group and HELLP patients in terms of the mean urinary protein, platelet count, ALT, AST, creatinin, D dimer levels and also the mean APRI score. In the multivariate regression analysis, APRI score was found a better predictor than AST and both were in a good significant in predicting HELLP. On the ROC curve in order to distinguish the patients with HELLP from the control group for AST and APRI score, the sensitivity was found to be 71.7% and 82.6%, specificity to be 91.2% and 87.6% respectively. Maternal mortality rate of HELLP syndrome was 10%.
We concluded that the APRI score was robustly predicted HELLP syndrome than AST alone in this study. Further studies are needed to support our data with prospective, multicentre, larger patient groups.
HELLP（溶血、肝酶水平升高、血小板计数降低）综合征是一种罕见但严重的妊娠相关疾病。该综合征的难点在于缺乏标准化的诊断标准和检测方法来预测它。本研究旨在确定 APRI 评分在 HELLP 综合征诊断中的作用。
在这项横断面、回顾性研究中，我们将 2017 年 1 月 12 日至 2018 年 5 月 31 日期间，将 HELLP 综合征患者作为病例组，将年龄匹配的健康孕妇作为对照组纳入研究。从医院的计算机系统中记录数据，包括性别、年龄、实验室值、预后等。p 值<0.05 被认为具有统计学意义。
本研究共纳入 40 例 HELLP 综合征患者和 124 例年龄匹配的健康孕妇。对照组和 HELLP 患者在平均尿蛋白、血小板计数、ALT、AST、肌酐、D 二聚体水平以及平均 APRI 评分方面存在统计学差异。在多变量回归分析中，APRI 评分比 AST 更能预测 HELLP，两者均能很好地预测 HELLP。在 ROC 曲线中，为了将 HELLP 患者与对照组区分开来，AST 和 APRI 评分的敏感性分别为 71.7%和 82.6%，特异性分别为 91.2%和 87.6%。HELLP 综合征的孕产妇死亡率为 10%。
我们的研究结果表明，在本研究中，APRI 评分比单独的 AST 更能准确预测 HELLP 综合征。需要进一步的研究来支持我们的数据，这些研究需要采用前瞻性、多中心、更大的患者群体。
