886 1005-2216 2011 12-0886 - 05 - - HELLP R714. 24 + 4 C APS HELLP HELLP HELLP HELLP APS APS catastrophic APS CAPS Asherson s syndrome 3 Abstract Coagulation disorders and thrombophilia related to pathogenesis and clinical manifestations of preeclampsia. Inspecting of coagulation-anticoagulation- fibrinolysis system function is an important part of monitoring and management of pre-eclampsia. Keywords preeclampsia HELLP syndrome thrombophilia anticoagulant therapy 3 HELLP 1 3. 1 FGR 130 ~ 139 /81 ~ 89mmHg 1mmHg = 0. 133kPa 1-2 S C Leiden V factorv Leiden A506G MTHFR C677T APS 3. 2 100191 zi_yang@ email. com 2 DIC DIC 2d
887 3. 3. 4 3. 3 3. 3. 1 DIC 4 4. 1 3. 3. 2 HELLP HELLP FGR HELLP - - 2008 AC- CP 8 FGR APL DIC 21% ~ 55% HELLP DIC APL APS APS HELLP SLE APL 2004 5 β2-gpⅠ 1 2006 11 APS LDH > 600U /L > β 2-GPⅠ APS 20. 5μmol /L 2 AST > 70U /L 3 < 100 10 9 /L 3 1 2 HELLP acute fatty liver of pregnancy AFLP thrombotic thrombocytopenic purpura TTP haemolytic uremic syndrome HUS 3. 3. 3 DIC DIC A ApoA B ApoB FGR 4. 2 DIC - - 2007 ISTH FGR DIC 4 PLT > 100 10 9 /L 0 < 100 10 9 /L 1 < 50 10 9 /L 2 0 2 3 PT < 3s 0 > 3s < 6s 1 > 6s 2 FIB > 1. 0g /L 0 < 1. 0g /L 1 5 DIC β 2-GPⅠ LA ANA dsd- NA ENA TC TG LDL-C HDL-C - - - -
888 PT TT APTT PT > 4. 3 3s DIC PLT FIB Ⅲ antithrombin Ⅲ AT-Ⅲ D- D-D 4. 3. 6 FDP TT PT APL APTT FGR APL 4. 3. 1 PLT APL APS SLE APL 3 β 2-GPⅠ 1999 HELLP β 2-GPⅠ PLT DIC PLT PLT 50% 6 4. 3. 7 4. 3. 2 FIB FIB 6 FIB 4. 3. 8 DIC FIB < 1. 5g /L FIB FIB PLT ALT AST 3 ~ 6g /L LDH HELLP FGR FIB < 1. 5g /L DIC FIB < 1g /L DIC FIB B < 5. 10cm 2. 92cm < 2. 48 < 10cm 4cm < 4. 3. 3 Ⅲ AT-Ⅲ 2. 0 / AT-Ⅲ AT-Ⅲ S /D MCA AT-Ⅲ 4. 4 4. 3. 4 D- D-D DIC DIC D-D - - D-D DIC D-D > 0. 5mg /L DIC D-D 5 5. 1 4. 3. 5 TT PT APTT TT FIB FIB PT Ⅰ Ⅴ Ⅶ Ⅹ APTT Ⅶ Ⅸ Ⅹ Ⅺ
889 5. 2. 2 2007 Duley 9 low dose aspirin LDA 5. 2 LDA 75mg /d LMWH 5. 2. 1 LMWH LDA 5. 2. 4 LMWH DIC 12 D-D 5. 3 AT-Ⅲ 5. 3. 1 HELLP LMWH 5. 2. 1. 2 LMWH HELLP CT D-D AT-Ⅲ PLT 21 10 9 /L LDH 1694U /L ALT 795U /L AST832U /L D-D 6. 28mg /L AT-Ⅲ 84% ACL-IgG 31RU / FGR ml ACL-IgM 22 RU /ml β 2-GP Ⅰ-IgG 25RU /ml β 2-GP LMWH ACCP 4000U 2 / LMWH dalteparin 5000U 1 tinzaparin 4500U 1 enoxaparin 40mg 1 LMWH 5000U 12h 1 40mg 5. 3. 2 DIC 12h1 LMWH D-D 0. 3 ~ 0. 5mg /L D-D 0. 3mg /L 2011 Trivedi 10 Duley 9 5. 2. 1. 1 LMWH Rossi 11 FGR LMWH Doppler LDA FGR 5. 2. 3 Kupferminc 7 LMWH LMWH Laskin 8 LM- WH HELLP Ⅰ-IgM55RU /ml APS d HELLP
890 5. 3. 3 1005-2216 2011 12-0890 - 03 1 Rath W. Pre-eclampsia and inherited thrombophilia a reappraisal J. Semin Thromb Hemost 2011 37 2 118-124. 2 Robertson L Wu O Langhorne P et al. Thrombophilia in pregnancy a systematic review J. Br J Haematol 2006 132 171-196. 3 Appenzeller S Souza FH Wagner Silva de Souza A et al. HELLP syndrome and its relationship with antiphospholipid syndrome and antiphospholipid antibodies J. Semin Arthritis Rheum 2011 Epub ahead of print 4 Toh CH Hoots WK. The scoring system of the scientific and standardization committee on disseminated intravascular coagulation of the Internal Society of Thrombosis and Haemostasis. A 5- year review J. J Thromb Haemost 2007 5 604-606. 5 Bates SM Greer IA Pabinger I et al. Venous thromboembolism thrombophilia antithrombotic therapy and pregnancy american college of chest physicians evidence-based clinical pract ice guidelines 8th edit ion J. Chest 2008 133 844-886. Abstract Hypertensive disorders complicating pregnancy remains a leading cause of maternal and perinatal mortality and morbidity and affects 5% to 7% of all pregnancies. The pathophysiologic changes associated with HDCP such as small artery spasm a reduction in colloid osmotic pressure while an increase in intravascular hydrostatic pressure an increase in capillary permeability can have a serious 6. J. impact on the maternal respiratory function and lead 2009 25 140-142. 7 Kupferminc M Rimon E Many A et al. Low molecular weight heparin versus no treatment in women with previous severe pregnancy complications and placental findings without thrombophilia J. Blood Coagul Fibrinolysis 2011 22 123-126. 8 Laskin CA Spitzer KA Clark CA et al. Low molecular weight heparin and aspirin for recurrent pregnancy loss results from the randomized controlled HepASA trial J. J Rheumatol 2009 36 279-287. 9 Duley L Henderson Smart DJ Meher S et al. Antiplatelet agents for preventing preeclampsia and its complications J. Cochrane Database Syst Rev 2007 2 CD004659. 10 Trivedi NA. A meta-analysis of low-dose aspirin for prevention of preeclampsia J. J Postgrad Med 2011 57 91-95. 11 Rossi AC Mullin PM. Prevention of pre-eclampsia with low-dose aspirin or vitamins C and E in women at high or low risk a systematic review with meta-analysis J. Eur J Obstet Gynecol Reprod Biol 2011 158 9-16. 12 Maki M Kobayashi T Terao T et al. Antithrombin therapy for severe preeclampsia results of a double-blind randomized placebo-controlled trial. BI51. 017 Study Group J. Thromb Haemost 2000 84 583-590. 2011-08 - 31 5% ~ 7% R714. 24 + 6 210008 yali_hu@ hotmail. com C to pulmonary edema even if without left heart failure in the mother. Correct hypoxemia and remove the primary disease is the key to treatment. Keywords hypertensive disorders complicating pregnancy pulmonary edema hypoproteinemia HDCP 5% ~ 7% 1-2 HDCP 3% 3-4 0. 08% 5 HDCP 1