Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study
Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study
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DOI：
10.1111/1471-0528.16339
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发表时间：
2020-06-21
影响因子：
5.8
通讯作者：
Suy, A.
中科院分区：
文献类型：
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作者：
Mendoza, M.;Garcia-Ruiz, I;Suy, A.
目的探讨COVID-19妊娠中与先兆子痫（PE）相关的临床、超声和生化表现的发生率，并评估其区分PE和COVID-19相关PE样特征的准确性。设计一项前瞻性、观察性研究。设置三级转诊医院。受试者COVID-19单胎妊娠>20（+0）周。方法收集42例连续妊娠的孕妇，根据是否发生重症肺炎分为重症组和非重症组。在疑似PE的女性中评估子宫动脉搏动指数（UtAPI）和血管生成因子（可溶性fms样酪氨酸激酶-1/胎盘生长因子[sFlt-1/PlGF]）。主要结果测量PE相关体征和症状的发生率，如高血压、蛋白尿、血小板减少、肝酶升高、UtAPI异常和sFlt-1/PlGF升高。结果34例被归类为非重症，8例被归类为重症。5名（11.9%）女性出现PE的体征和症状，所有5名均为严重COVID-19病例（62.5%）。而sFlt-1/PlGF和UtAPI异常仅见于1例。1例重度肺炎恢复后仍妊娠，PE样综合征自发消退。结论重度COVID-19孕妇可发生PE样综合征，通过sFlt-1/PlGF、LDH和UtAPI评估可将其与实际PE区分开来。医疗保健提供者应该意识到它的存在，并谨慎监测疑似先兆子痫的妊娠。这项研究表明，在一些患有严重COVID-19的孕妇中可能存在先兆子痫样综合征。
Objectives To investigate the incidence of clinical, ultrasonographic and biochemical findings related to pre-eclampsia (PE) in pregnancies with COVID-19, and to assess their accuracy to differentiate between PE and the PE-like features associated with COVID-19. Design A prospective, observational study. Setting Tertiary referral hospital. Participants Singleton pregnancies with COVID-19 at >20(+0) weeks. Methods Forty-two consecutive pregnancies were recruited and classified into two groups: severe and non-severe COVID-19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms-like tyrosine kinase-1/placental growth factor [sFlt-1/PlGF]) were assessed in women with suspected PE. Main outcome measures Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt-1/PlGF. Results Thirty-four cases were classified as non-severe and 8 as severe COVID-19. Five (11.9%) women presented signs and symptoms of PE, all five being among the severe COVID-19 cases (62.5%). However, abnormal sFlt-1/PlGF and UtAPI could only be demonstrated in one case. One case remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE-like syndrome. Conclusions Pregnant women with severe COVID-19 can develop a PE-like syndrome that might be distinguished from actual PE by sFlt-1/PlGF, LDH and UtAPI assessment. Healthcare providers should be aware of its existence and monitor pregnancies with suspected pre-eclampsia with caution. Tweetable abstract This study shows that a pre-eclampsia-like syndrome could be present in some pregnancies with severe COVID-19.