HELLP综合征并肝损害1例并文献复习

doi:10.3969/j.issn.1004-583X.2024.07.011

摘要/Abstract

摘要：

目的研究HELLP综合征并肝损害的病情变化及处理。方法回顾性分析HELLP综合征并肝损害1例,并复习相关文献。结果患者35岁女性,既往有妊娠期高血压、子痫病史,此次在妊娠30⁺⁴周时发生HELLP综合征并肝损害,经解痉、降血压、护肝、激素、血浆置换、终止妊娠等治疗后,患者病情逐渐好转出院。结论对于HELLP综合征,早期识别和及时的多学科管理对于预防灾难性出血、肝功能衰竭和死亡至关重要。考虑到年轻女性可能发生的演变的严重性,必须正确诊断和治疗HELLP综合征引起的肝脏并发症。

关键词: HELLP综合征, 肝功能不全, 糖皮质激素类, 血浆置换, 终止妊娠, 病例报告

Abstract:

Objective To study the changes and management of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome with liver damage. Methods A retrospective analysis of one case of HELLP syndrome with liver damage and a review of relevant literature were conducted. Results A 35-year-old woman with a history of gestational hypertension and eclampsia developed HELLP syndrome with liver damage at 30⁺⁴ weeks of gestation. After treatment with spasm-relieving, blood pressure lowering, liver protection, hormones, plasma exchange and termination of pregnancy, the patient was discharged from hospital after her condition gradually improved. Conclusion Early identification and timely multidisciplinary management are crucial for preventing catastrophic bleeding, liver failure, and death in HELLP syndrome. Considering the severity of the evolution that may occur in young women, it is necessary to correctly diagnose and treat liver complications caused by HELLP syndrome.

Key words: HELLP syndrome, hepatic insufficiency, glucocorticoids, plasma exchange, termination of pregnancy, case report

中图分类号:

R714.245

刘云. HELLP综合征并肝损害1例并文献复习[J]. 临床荟萃, 2024, 39(7): 644-649.

Liu Yun. HELLP syndrome with liver damage: A case report and literature review[J]. Clinical Focus, 2024, 39(7): 644-649.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.07.011

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I7/644

图/表 3

图1 患者血液指标变化 a. WBC、RBC和PLT; b. HGB; c. ALT、AST和LDH; d. 总胆红素、间接胆红素和直接胆红素; e. PT和APTT; f. D-二聚体

Fig.1 Changes in blood indicators of patients a. WBC, RBC and PLT; b.HGB; c.ALT, AST and LDH; d. total bilirubin, indirect bilirubin and direct bilirubin; e.PT and APTT; f. D-Dimer

图2 产后第4天肝实质情况

Fig.2 Liver parenchyma on the fourth day after delivery

图3 产后第18天肝实质情况

Fig.3 Liver parenchyma on the 18th day after delivery

参考文献 37

[1]	Messina V, Dondossola D, Paleari MC, et al. Liver bleeding due to HELLP syndrome treated with embolization and liver transplantation: A case report and review of the literature[J]. Front Surg, 2021, 8:774702.
[2]	Koek GH, Spaanderman MA, et al. Placenta derived factors involved in the pathogenesis of the liver in the syndrome of haemolysis, elevated liver enzymes and low platelets (HELLP): A review[J]. Pregnancy Hypertens, 2019, 18:42-48. doi: S2210-7789(18)30731-1 pmid: 31494464
[3]	Vigil-De Gracia P. Síndrome HELLP[HELLP syndrome][J]. Ginecol Obstet Mex, 2015, 83(1):48-57. pmid: 26016316
[4]	许丽丽, 王芳. 妊娠期高血压并发HELLP综合征16例治疗分析框架[J]. 中国社区医师, 2021, 37(11):59-60.
[5]	Kirkpatrick CA. The HELLP syndrome[J]. Acta Clin Belg, 2010, 65(2):91-97. pmid: 20491358
[6]	Khalid F, Tonismae T. HELLP syndrome[M]. In: StatPearlsInternet.Treasure Island (FL):2021.
[7]	姜明波, 张瑶, 曹玉, 等. HELLP综合征合并肝梗死引起产妇死亡一例及文献复习[J]. 国际妇产科学杂志, 2021, 48(3):268-271.
[8]	Jiang R, Wang T, Li B, et al. Clinical characteristics and pregnancy outcomes of atypical hemolysis, elevated liver enzymes, and low platelets syndrome: A case series[J]. Medicine (Baltimore), 2020, 99(18):e19798.
[9]	Medhioub KF, Chaari A, Turki O, et al. Actualité sur le syndrome HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) [Up-to-date on the HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelets)][J]. Rev Med Interne, 2016, 37(6):406-411. doi: 10.1016/j.revmed.2015.12.009 pmid: 26774917
[10]	贺秀芳. 子痫前期患者的妊娠结局及其发病危险因素分析[J]. 中国药物与临床, 2017, 17(3):407-410.
[11]	Augustin G, Hadzic M, Juras J, et al. Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: A systematic review of 391 reported cases[J]. World J Emerg Surg, 2022, 17(1):40. doi: 10.1186/s13017-022-00444-w pmid: 35804368
[12]	Allani EL, Benlamkaddem S, Berdai MA, et al. A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome[J]. Pan Afr Med J, 2020, 36:78. doi: 10.11604/pamj.2020.36.78.23302 pmid: 32774637
[13]	Mikolajczyk AE, Renz J, Diaz G, et al. Massive hepatic infarction caused by HELLP syndrome[J]. ACG Case Rep J, 2017, 4:e81.
[14]	Guo Q, Yang Z, Guo J, et al. Hepatic infarction induced by HELLP syndrome: A case report and review of the literature[J]. BMC Pregnancy Childbirth, 2018, 18(1):191.
[15]	Maged AM, Elsherief A, Hassan H, et al. Maternal, fetal, and neonatal outcomes among different types of hypertensive disorders associating pregnancy needing intensive care management[J]. J Matern Fetal Neonatal Med, 2020, 33(2):314-321. doi: 10.1080/14767058.2018.1491030 pmid: 29914278
[16]	Arigita LM, Martínez FGS. Síndrome HELLP: Controversias y pronóstico [HELLP syndrome: Controversies and prognosis][J]. Hipertens Riesgo Vasc, 2020, 37(4):147-151. doi: S1889-1837(20)30068-4 pmid: 32811776
[17]	Jiang R, Wang T, Li B, et al. Clinical characteristics and pregnancy outcomes of atypical hemolysis, elevated liver enzymes, and low platelets syndrome: A case series[J]. Medicine (Baltimore), 2020, 99(18):e19798.
[18]	Al-Khify HA, Murad MA, Albeladi FI, et al. “Hellp syndrome and heart disease: A cross sectional study in Jeddah- KSA”[J]. J Pharm Res Int, 2021, 33(30A), pp. 84-90.
[19]	Lisonkova S, Bone JN, Muraca GM, et al. Incidence and risk factors for severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia at preterm and term gestation: A population-based study[J]. Am J Obstet Gynecol, 2021, 225(5):538.e1-538.e19.
[20]	Haddad B, Barton JR, Livingston JC, et al. Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome[J]. Am J Obstet Gynecol, 2000, 183(2):444-448. doi: 10.1067/mob.2000.105915 pmid: 10942484
[21]	杨柳, 邹丽. HELLP 综合征诊治的最新认识[J]. 中华产科急救电子杂志, 2021, 10(3):142-146.
[22]	Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): A review[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 166(2):117-123. doi: 10.1016/j.ejogrb.2012.09.026 pmid: 23107053
[23]	Khalid F, Mahendraker N, Tonismae T. HELLP syndrome[M]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2024. [3]
[24]	McCormick PA, Higgins M, McCormick CA, et al. Hepatic infarction, hematoma, and rupture in HELLP syndrome: support for a vasospastic hypothesis[J]. J Matern Fetal Neonatal Med, 2022, 35(25):7942-7947.
[25]	Cam T, Cimilli SGN, Ozturk N, et al. May human epididymis 4 protein play a role in the etiopathogenesis of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome?[J]. J Obstet Gynaecol Res, 2021, 47(7):2324-2328.
[26]	薛洁, 郝绍英, 马海英, 等. 血清维生素B₁₂及维生素E含量与HELLP 综合征发生的关系[J]. 重庆医学, 2021, 50(16):2731-2734.
[27]	Morgan J, Della TM, Whelan AR, et al. A case of massive hepatic infarction in a patient with HELLP syndrome[J]. AJP Rep, 2019, 9(1):e84-e87.
[28]	Beucher G, Simonet T, Dreyfus M. Prise en charge du HELLP syndrome [Management of the HELLP syndrome][J]. Gynecol Obstet Fertil, 2008, 36(12):1175-1190.
[29]	Mao M, Chen C. Corticosteroid therapy for management of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome: A meta-analysis[J]. Med Sci Monit, 2015, 21:3777-83.
[30]	高霞. HELLP综合征的诊治进展[J]. 中国城乡企业卫生, 2021, 36(7):42-44.
[31]	杨柳, 邹丽. HELLP 综合征诊治的最新认识[J]. 中华产科急救电子杂志, 2021, 10(3):142-146.
[32]	Mousseaux C, Joly BS, Mohamadou I, et al. Severe HELLP syndrome masquerading as thrombocytopenic thrombotic purpura: A case report[J]. BMC Nephrol, 2020, 21(1):204. doi: 10.1186/s12882-020-01865-y pmid: 32471388
[33]	Lam MTC, Dierking E. Intensive care unit issues in eclampsia and HELLP syndrome[J]. Int J Crit Illn Inj Sci, 2017, 7(3):136-141. doi: 10.4103/IJCIIS.IJCIIS_33_17 pmid: 28971026
[34]	刘晓夏, 邹丽. 强化对子痫前期及HELLP综合征在产时产后的认知和管理[J]. 中国实用妇科与产科杂志, 2021, 37(5):542-546. doi: 10.19538/j.fk2021050110
[35]	Uckan K, Sahin HG. Serum amyloid A, procalcitonin, highly sensitive C reactive protein and tumor necrosis factor alpha levels and acute inflammatory response in patients with hemolysis, elevated liver enzymes, low platelet count (HELLP) and eclampsia[J]. J Obstet Gynaecol Res, 2018, 44(3):440-447.
[36]	Barton JR, Sibai BM. Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count)[J]. Am J Obstet Gynecol, 1996, 174(6):1820-1825. pmid: 8678146
[37]	Barton JR, Riely CA, Adamec TA, et al. Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count)[J]. Am J Obstet Gynecol, 1992, 167(6):1538-1543. pmid: 1471661