HELLP syndrome: hemolysis, elevated liver enzymes, and low platelets.
HELLP syndrome: hemolysis, elevated liver enzymes, and low platelets.
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HELLP综合征：溶血、肝酶升高和血小板低。
DOI：
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发表时间：
1998
期刊：
影响因子：
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通讯作者：
J. Stone
中科院分区：
文献类型：
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作者：
J. Stone
斯通博士：N女士是一位32岁的加州女商人。两年前，当我在加州大学旧金山分校做博士后时，我成为了她的21⁄病例的主要患者，她向当地的医生报告右上腹疼痛。她很客气地同意今天和我们一起在霍普金斯大学参加盛大的比赛。N夫人，右上腹疼痛是您疾病的首发症状吗？病人：没有。在那之前的两三个星期里，我注意到我的眼睛周围有一些肿胀，我的眼睛看起来很肿。星期五，也就是疼痛开始的前一天，我和丈夫去度周末了。在两个小时的车程中，我意识到我的脚踝肿了。为了减轻肿胀，我把脚放在汽车的仪表盘上。大约30分钟后，我的脚踝恢复了轮廓，但我的膝盖和大腿变得非常肿胀。在周末的最后一段时间里，它们一直在肿胀。斯通医生：你有没有注意到那段时间你的尿液有什么变化？尿液是多了还是少了，颜色有了变化，还是有其他不同？病人：据我所知没有。斯通医生：请告诉我们有关腹痛的情况。病人：星期六，我的右侧肋骨附近有些疼痛。我以为我的胸腔拉伤了一块肌肉。我躺在床上很不舒服，尽管坐了好几个姿势。凌晨3点左右，我洗了个澡，试着放松一下。躺在浴缸里也没什么帮助，所以我在地板上做了一些伸展运动。这也帮不上忙。斯通医生：疼痛有没有让你想起烧心？病人：没有。斯通医生：疼痛持续了多久？病人：好几个小时。然后，它自己消退了。到了早上它就不见了。斯通医生：在出现右上腹疼痛之前，你有没有过胆囊病的病史？病人：没有。斯通医生：你有没有患过黄斑症或肝脏有问题？病人：没有。斯通博士：除了腿部肿胀和右上腹疼痛，你还有另外一个症状。病人：星期六晚上，我和我的丈夫在玩五子棋。我的眼睛似乎在捉弄我：我看到他的骰子上有额外的圆点，我以为他在作弊。当我再看一眼时，我意识到我错了，他实际上是在公平地比赛。我把我的视力问题归因于房间里昏暗的灯光。斯通博士：N女士有偏头痛病史，用布洛芬和舒马曲坦治疗。在患病时，她已经几个月没有服用这两种药物了。她患有儿时常见的疾病，并在5岁时接受了扁桃体切除术。12岁时，她因肾脏问题住进了当地的医院，她和她的母亲都记不清了。她住了一夜，接受了可能是静脉脊髓造影的程序，第二天就出院了。从那以后，她再也没有出现过任何已知的肾脏问题。她在陈述时没有服用任何药物，也没有药物过敏。她有希腊血统，但在美国出生和长大。她的家族史不同凡响，只是因为她的父亲在68岁时死于黑色素瘤。她没有结缔组织病的家族史。她不吸烟，只在社交场合喝酒，也没有使用过非法药物。N太太，你是什么时候决定去看医生的？病人：星期天晚上我回家的时候，我太累了，所以我预约了周一的看病时间。斯通博士：到目前为止，有两条重要的信息被故意从历史上遗漏了。首先，N太太在患病时已经怀孕32周，她的真名是“M”，这是因为她是我的妻子。第二天下午，我带M去看产科医生。她感觉好多了。右上腹疼痛消失。护士助手测量的她的血压是正常的。她有一点脚踏板浮肿，但医生的助手和我认为这与怀孕32周的情况一致。她的深肌腱反射在正常范围内。在感到完全放心后，当医生的助手到来时，我们准备离开医生的办公室，这一彻底的行为让我们永远感激，再次测量M的血压。实际上是160/110毫米汞柱。我们还了解到尿试纸条显示为蛋白尿(4+)。M似乎患有先兆子痫。她有三个基本特征：高血压、蛋白尿和浮肿。诊断为先兆子痫，至少意味着M将在怀孕剩下的6周里卧床休息。我们被送到当地医院进行常规化验和进一步观察M的血压。检查结果出来后，产科医生告诉我们M需要
DR STONE: Mrs N is a 32-year-old businesswoman from California. I becamefamiliarwithhercase21⁄2 yearsago when I was a postdoctoral fellow at the University of California, San Francisco, and she presented to her local physician with right-upper–quadrant pain. She has graciously agreed to join us at Hopkins today for Grand Rounds. Mrs N, was the right-upper–quadrant pain the first symptom of your illness? PATIENT: No. For 2 or 3 weeks before that, I had noticed some swelling around myeyesandovermybrowbone.Myeyes looked puffy. On Friday, the day before the pain started, my husband and I went away for the weekend. During the 2hour drive, I realized that my ankles were swollen. To relieve the swelling, I put my feet up on the dashboard of the car. After about 30 minutes, the definition of my ankles had returned but my knees and upper legs had become very swollen.Theystayedswollenfortherest of the weekend. DR STONE: Did you notice any changes in your urine around that time? Was there more or less urine, a change in color, or any other difference? PATIENT: None that I recall. DR STONE: Please tell us about the abdominal pain. PATIENT: On Saturday, I developed some pain near my ribs on the right side. I thought I had pulled a muscle in my rib cage. I couldn’t get comfortable in bed, despitetryingseveralpositions.Atabout 3:00 in the morning, I took a bath to try to relax. Lying in the bathtub didn’t help, so I did some stretching exercises on the floor. That didn’t help, either. DR STONE: Did the pain remind you of heartburn? PATIENT: No. DR STONE: How long did the pain last? PATIENT: For several hours. Then it subsided on its own. It was gone by morning. DR STONE: Did you have any history of gallbladder problems before you got this right-upper–quadrant pain? PATIENT: No. DR STONE: Had you ever been jaundiced or had problems with your liver? PATIENT: No. DR STONE: In addition to your leg swelling and right-upper–quadrant pain, you had one other symptom. PATIENT: On Saturday evening, my husbandandIwereplayingbackgammon. My eyes seemed to be playing tricks on me: I saw extra dots on his dice and thought he was cheating. When I looked again, I realized I was wrong and he was actually playing fairly. I attributed my vision problems to dim lighting in the room. DR STONE: Mrs N had a history of migraine headaches, treated with ibuprofen and sumatriptan. At the time of this illness, she had not taken either medication in months. She had had the usual childhood illnesses and had undergone a tonsillectomy when she was 5 years old. At 12 years of age, she had been admitted to her local hospital with a kidney problem that neither she nor her mother could recall well. She had stayed overnight, undergone a procedure that was probablyan intravenouspyelogram,and been discharged the next day. Since then, she has not had any known kidney problems. She was taking no medications at the time of her presentation and had no drug allergies. She is of Greek ancestry but was born and grew up in the United States. Her family history is remarkable only for her father’s death from melanoma when he was 68 years old. She had no family history of connective tissue disease. She did not smoke, she drank only socially, and she had not used illicit drugs. Mrs. N, when did you decide to see a doctor about your symptoms? PATIENT: When I returned home on Sunday night, I was so exhausted that I made an appointment to be seen on Monday. DR STONE: Two important pieces of informationhavebeenintentionallyomitted from the history so far. The first is thatMrsNwas32 weeks’ pregnantat the onsetofthis illness.Thesecondisthatshe is my wife, and her real name is “M.” The next afternoon I took M to the obstetrician. She was feeling much better. The right-upper–quadrant pain was gone. Her blood pressure, taken by the nurse’s aide, was normal. She had a little pedal edema, but the physician’s assistantandIconsideredthatconsistentwith a 32-week pregnancy. Her deep tendon reflexes were within normal limits. Feelingcompletelyreassured,wewere aboutto leavethedoctor’sofficewhenthe physician’s assistant, in an act of thoroughness for which we will forever be grateful, tookM’sbloodpressureagain.It was actually 160/110 mm Hg. We also learned that the urine dipstick had shown proteinuria (4+). M appeared to have preeclampsia. She had all 3 cardinal features: hypertension, proteinuria, and edema. A diagnosis of preeclampsia would mean, at least, that M would be on bed rest for the 6 remaining weeks of her pregnancy. We were sent to the local hospital for routine laboratory tests and further observation of M’s blood pressure.Whenthetestresultsreturned, the obstetrician informed us that M needed
影响因子：
158.5
作者：
BELL, WR;BRAINE, HG;KICKLER, TS
通讯作者：
KICKLER, TS