HELLP综合征二例诊治报告及文献复习

发布时间：2018-06-15 18:19

本文选题：HELLP综合征 + 血栓性微血管病变　；参考：《临床肾脏病杂志》2016年07期

【摘要】：目的报道2例HELLP(hemolysis,elevated liver enzymes and low platelets)综合征患者诊治情况,并结合文献系统复习HELLP综合征的临床表现、早期预警标志、鉴别诊断、治疗及随访管理,以期提高对该病的认识和重视,避免误漏诊,早期获得正确合理的治疗。方法回顾分析2例HELLP综合征患者的临床表现、诊治经过,并总结复习相关文献。结果 2例妊娠早中期各项指标均未见异常。例1患者妊娠晚期出现血小板计数低下,肝酶升高,总胆红素异常,为本病诊断提供了线索;例2患者妊娠晚期出现高血压、蛋白尿,是HELLP综合征患者高危人群。2例均为终止妊娠后并发急性肾损伤,患者经过药物及肾脏替代(renal replacement therapy,RRT)治疗,例1患者至今未脱离腹膜透析治疗,例2患者病情完全缓解。结论 HELLP综合征患者,及时进行连续性血液净化(continuous blood purification,CBP)治疗对缓解HELLP综合征、降低病死率非常关键,HELLP综合征是一种罕见的以血栓性微血管病变为特征的临床综合征,其发病机制尚不清楚,早期预警措施非常有限,临床表现缺乏特异性,而且病情恶化迅速。
[Abstract]:Objective to report the diagnosis and treatment of HELLP syndrome in 2 patients with hemolysis elevated liver enzymes and low platelets) syndrome, and to review the clinical manifestations, early warning signs, differential diagnosis, treatment and follow-up management of HELLP syndrome in order to improve the understanding and attention of HELLP syndrome. Avoid misdiagnosis and get correct and reasonable treatment at the early stage. Methods the clinical manifestations, diagnosis and treatment of 2 cases of HELLP syndrome were analyzed retrospectively. Results there were no abnormal indexes in 2 cases of early and middle pregnancy. In case 1, low platelet count, elevated liver enzyme and abnormal total bilirubin were found in the third trimester of pregnancy, which provided clues for the diagnosis of this disease. There were 2 cases of acute renal injury after termination of pregnancy in the high risk population of HELLP syndrome. The patients were treated with drugs and renal replacement renal therapy. Case 1 had not been treated with peritoneal dialysis, and case 2 was completely relieved. Conclusion in patients with HELLP syndrome, the treatment of continuous blood purificationin time is very important to alleviate HELLP syndrome and reduce mortality. HELLP syndrome is a rare clinical syndrome characterized by thrombotic microangiopathy. Its pathogenesis is not clear, early warning measures are very limited, clinical manifestations are not specific, and the disease is deteriorating rapidly.
【作者单位】：兰州大学第二医院肾病科;兰州大学第二医院泌尿外科研究所;甘肃省人民医院妇产科;
【基金】：国家自然科学基金(NO.8140100336)
【分类号】：R714.246

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