HELLP综合征患者实验室参数变化的临床研究  

Clinical study on the changes of experimental parameters in patients with HELLP Syndrome

作　　者：曹卫平 甘梦雯 陈廷美 谢冰 倪霞 朱华英 王琴 陈娟 CAO Weiping;GAN Mengwen;CHEN Tingmei;XIE Bing;NI Xia;ZHU Huaying;WANG Qin;CHEN Juan(Departments of Obstetrics,Zhenjiang Maternity and Child Health Hospital,Zhenjiang,Jiangsu 212001,China;Department of Nursing,School of Medicine,Jiangsu University,Zhenjiang,Jiangsu 212013,China)

机构地区：[1]镇江市妇幼保健院产科,江苏镇江212001 [2]江苏大学医学院护理系,江苏镇江212013

出　　处：《现代医药卫生》2022年第13期2172-2177,共6页Journal of Modern Medicine & Health

基　　金：江苏省卫生健康委员会妇幼保健科研项目(F201933)。

摘　　要：目的探究HELLP综合征实验室参数变化的临床研究。方法采用回顾性队列研究,回顾比较2005年1月1日至2020年12月30日镇江市妇幼保健院收治的12例完全性HELLP综合征患者(HELLP综合征组)和42例重度子痫前期(SPE)患者(SPE组)的实验室参数与母婴并发症的临床资料。采用logistic回归模型分析HELLP综合征发生与实验室参数之间的内在联系,运用受试者工作特征曲线(ROC曲线)评估实验室参数在评价HELLP综合征病程进展中的临床价值。结果在溶血参数方面,与SPE组比较,HELLP综合征组患者血红蛋白水平显著降低,而乳酸脱氢酶(LDH)和总胆红素(TBIL)水平均明显升高,差异均有统计学意义(P<0.05)。在凝血参数方面,与SPE组比较,HELLP综合征组患者凝血酶原时间(PT)延长,纤维蛋白原(FG)和血小板计数(PLT)水平显著下降,D-二聚体(D-D)水平升高,差异均有统计学意义(P<0.05)。在肝肾功能方面,与SPE组比较,HELLP综合征组谷草转氨酶(AST)、尿酸(UA)、肌酐(Cr)、24 h尿蛋白水平显著升高,而血清中的清蛋白(ALB)水平显著降低,差异均有统计学意义(P<0.05)。HELLP综合征组患者发生低蛋白血症、输血和新生儿肺炎等不良母体结局与SPE组比较,差异均有统计学意义(P<0.05)。logistic回归分析显示,较低的PLT、ALB和较高的LDH、AST、ALT、UA、TBIL、D-D、24 h尿蛋白是HELLP综合征发生的危险因素(P<0.05)。ROC曲线下面积最大的为LDH、PLT、ALT和UA,分别为0.98、0.96、0.93和0.79。结论实验室参数PLT、ALB、LDH、AST、ALT、UC、TBIL、D-D、24 h尿蛋白在评估HELLP综合征中有一定的诊断价值,特别要关注PLT、LDH、ALT和UA这些实验室参数的动态变化,为早期识别和评估HELLP综合征病情进展提供临床参考。Objective To investigate the changes of experimental parameters in patients with HELLP Syndrome.Methods By using the retrospective cohort study,the experimental parameters and clinical data of maternal and fetal complications between 12 patients with complete HELLP Syndrome(the HELLP Syndrome group)and 42 patients of severe preeclampsia(the SPE group)treated in Zhenjiang Women and Child Health Care Hospital from January 1,2005 to December 30,2020 were compared.The logistic model were used to analyze the internal relationship between the occurrence of HELLP Syndrome and laboratory parameters,and receiver operating characteristic curve(ROC)was used to evaluate the clinical value of laboratory parameters in evaluating the course of HELLP Syndrome.Results In hemolysis,compared with the SPE group,the level of hemoglobin in HELLP Syndrome group was significantly lower,while the levels of lactate dehydrogenase(LDH)and total bilirubin(TBIL)were significantly higher,and the differences were statistically significant(P<0.05).In terms of coagulation parameters,compared with the SPE group,the prothrombin time(PT)of HELLP syndrome group was prolonged,fibrinogen(FG)and platelet count(PLT)levels were significantly decreased,and D-dimer(D-D)levels were increased,the differences were all statistically significant(P<0.05).In terms of liver and kidney function,compared with SPE group,the levels of aspartate aminotransferase(AST),uric acid(UA),creatinine(Cr)and 24-hour urine protein in the HELLP Syndrome group were significantly higher,while the level of serum albumin(ALB)was significantly lower,with statistical significances(P<0.05).The adverse maternal outcomes such as hypoalbuminemia,blood transfusion and neonatal pneumonia in the HELLP Syndrome group were significantly different from those in the SPE group(P<0.05).The logistic regression analysis showed that lower PLT,ALB and higher LDH,AST,ALT,UA,TBIL,D-D,24 h urine protein were risk factors of HELLP Syndrome(P<0.05).The largest areas under the ROC curve were LDH,PLT,ALT and UA

关 键 词：HELLP综合征 实验室参数 临床价值 

分 类 号：R71[医药卫生—妇产科学]