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一例临床表现复杂的重度子痫前期及 HELLP(溶血、肝酶升高、血小板减少)综合征罕见病例。

A Rare Case of Severe Preeclampsia and HELLP (Hemolysis, Increased Liver Enzymes, Low Platelets) Syndrome With Complex Clinical Presentation.

作者信息

Gaikwad Vidya, Patel Jay, Gaikwad Suhas, Aramandla Sneha, Phutane Rushikesh

机构信息

Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.

出版信息

Cureus. 2024 Aug 18;16(8):e67127. doi: 10.7759/cureus.67127. eCollection 2024 Aug.

DOI:10.7759/cureus.67127
PMID:39290922
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11407787/
Abstract

Severe preeclampsia is a disorder of pregnancy, characterized by increased blood pressure (>140/90 mmHg) and proteinuria (≥ 300 mg/24 hours) at later than 20 weeks of gestation. Particularly in underdeveloped nations, severe preeclampsia and eclampsia have a significant negative impact on the health of expectant mothers, fetuses, and newborns. The HELLP (hemolysis, increased liver enzymes, low platelets) syndrome is thought to be a subset of preeclampsia, a group of hypertensive disorders of pregnancy that also includes eclampsia. Compared to preeclampsia alone, maternal and fetal problems are more severe in HELLP. There can be a diagnostic dilemma that arises when attempting to differentiate HELLP from its numerous imitators to determine the appropriate course of treatment. Here, we present a rare case of a pregnant woman presenting with preeclampsia complicated by manifestations and investigations suggestive of HELLP syndrome with acute kidney injury (AKI), retinal detachment, and symptoms of DIC (disseminated intravascular coagulation), which can be grievous to the mother as well as the fetus.

摘要

重度子痫前期是一种妊娠期疾病,其特征为妊娠20周后血压升高(>140/90 mmHg)和蛋白尿(≥300 mg/24小时)。特别是在欠发达国家,重度子痫前期和子痫对孕妇、胎儿和新生儿的健康有重大负面影响。HELLP(溶血、肝酶升高、血小板减少)综合征被认为是子痫前期的一个亚型,子痫前期是一组妊娠期高血压疾病,其中还包括子痫。与单纯子痫前期相比,HELLP患者的母婴问题更为严重。在试图将HELLP与其众多类似疾病区分开来以确定合适的治疗方案时,可能会出现诊断难题。在此,我们报告一例罕见病例,一名孕妇患有子痫前期,并伴有提示HELLP综合征的表现及检查结果,同时并发急性肾损伤、视网膜脱离和弥散性血管内凝血症状,这对母亲和胎儿都可能是严重的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/06d5/11407787/be4b9f803cca/cureus-0016-00000067127-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/06d5/11407787/be4b9f803cca/cureus-0016-00000067127-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/06d5/11407787/be4b9f803cca/cureus-0016-00000067127-i01.jpg

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本文引用的文献

1
Acute kidney injury during pregnancy and puerperium: a retrospective study in a single center.妊娠和产褥期急性肾损伤:单中心回顾性研究
BMC Nephrol. 2017 May 1;18(1):146. doi: 10.1186/s12882-017-0551-4.
2
Liver dysfunction in women with pregnancy-induced antithrombin deficiency.妊娠诱导的抗凝血酶缺乏女性的肝功能障碍
J Obstet Gynaecol Res. 2017 Feb;43(2):257-264. doi: 10.1111/jog.13210. Epub 2016 Dec 19.
3
Eclampsia: Feto-Maternal Outcomes in A Tertiary Care Centre in Eastern Nepal.子痫:尼泊尔东部一家三级护理中心的母婴结局
JNMA J Nepal Med Assoc. 2016 Jan-Mar;54(201):24-28.
4
Pre-eclampsia: its pathogenesis and pathophysiolgy.子痫前期:其发病机制与病理生理学
Cardiovasc J Afr. 2016 Mar-Apr;27(2):71-8. doi: 10.5830/CVJA-2016-009.
5
Long-term renal and cardiovascular risk after preeclampsia: towards screening and prevention.子痫前期后的长期肾脏和心血管风险:迈向筛查与预防
Clin Sci (Lond). 2016 Feb;130(4):239-46. doi: 10.1042/CS20150567.
6
Revisiting HELLP syndrome.再探HELLP综合征。
Clin Chim Acta. 2015 Dec 7;451(Pt B):117-20. doi: 10.1016/j.cca.2015.10.024. Epub 2015 Oct 23.
7
Pre-eclampsia and preterm birth in Reunion Island: a 13 years cohort-based study. Comparison with international data.留尼汪岛的子痫前期与早产:一项基于队列的13年研究。与国际数据的比较。
J Matern Fetal Neonatal Med. 2016 Sep;29(18):3035-40. doi: 10.3109/14767058.2015.1114081. Epub 2015 Nov 23.
8
Potential targets for the treatment of preeclampsia.子痫前期的潜在治疗靶点。
Expert Opin Ther Targets. 2015;19(11):1517-30. doi: 10.1517/14728222.2015.1088004. Epub 2015 Sep 21.
9
An essay of reflection: Why does preeclampsia exist in humans, and why are there such huge geographical differences in epidemiology?一篇反思性文章:子痫前期为何存在于人类中,以及为何在流行病学上存在如此巨大的地理差异?
J Reprod Immunol. 2016 Apr;114:44-7. doi: 10.1016/j.jri.2015.07.001. Epub 2015 Jul 11.
10
Milestones in the quest for best management of patients with HELLP syndrome (microangiopathic hemolytic anemia, hepatic dysfunction, thrombocytopenia).HELLP 综合征(微血管性溶血性贫血、肝肾功能障碍、血小板减少症)患者最佳治疗方法探索的里程碑。
Int J Gynaecol Obstet. 2013 Jun;121(3):202-7. doi: 10.1016/j.ijgo.2013.02.001. Epub 2013 Mar 23.