产后HELLP综合征合并后部可逆性脑病综合征

摘要(中文译文)

溶血、肝酶升高和低血小板（HELLP）综合征是一种与妊娠相关的、目前认识仍不充分的可危及生命的多系统疾病，起病迅速，通常见于重度子痫前期患者。多种机制可能导致与HELLP相关的弥漫性内皮损伤及可能的中枢神经系统受累。我们通过全面检索PubMed、Embase和Cochrane数据库，审查了产后HELLP综合征相关的临床、实验室和影像学特征，尤其是其与可逆性后部脑病综合征（PRES）的潜在关联。本综述的开展源于我们遇到的一例罕见病例。文献复习共识别出10篇记录妊娠期该关联的文章和7篇报告产后该关联的文章。我们的患者在产后出现多器官功能障碍（肾脏、肝脏、溶血和血小板减少），并伴有动脉高血压表现。患者出现癫痫发作，同时维持着对药物治疗抵抗的动脉高血压状态。脑磁共振成像得以诊断PRES和垂体腺瘤/垂体卒中。随访后患者完全康复。在诊断溶血、肝酶升高和低血小板（HELLP）综合征后，早期识别可逆性后部脑病综合征（PRES）至关重要。需要早期进行磁共振成像以识别PRES病灶并指导治疗。有必要提供讨论治疗方案的机会。

Abstract

Haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a poorly understood, life-threatening multisystemic condition related to pregnancy with a rapid onset, typically observed in patients with severe pre-eclampsia. Various mechanisms may lead to diffuse endothelial damage associated with HELLP and possible brain involvement. A comprehensive review of PubMed, Embase and Cochrane databases was conducted to examine the clinical, laboratory and radiological features associated with postpartum HELLP syndrome, particularly its potential association with posterior reversible encephalopathy syndrome (PRES). This review was prompted by a rare case we encountered. The literature review identified 10 articles documenting this association during pregnancy and 7 articles reporting it in the postpartum period. Our patient developed multiple organ dysfunction (renal, hepatic, haemolysis and thrombocytopenia) postpartum associated with an arterial hypertensive profile. The patient experienced seizures along with the maintenance of an arterial hypertensive profile resistant to pharmacological therapy. Brain magnetic resonance imaging allowed the diagnosis of PRES and pituitary adenoma/apoplexy. Follow-up led to complete recovery. Early identification of posterior reversible encephalopathy syndrome (PRES) is essential after diagnosis of haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome.Early magnetic resonance imaging is required to identify PRES lesions and guide therapy.There needs to be an opportunity to discuss therapeutic options.

如何引用