​​重症COVID-19可诱发子痫前期样症状：一项前瞻性观察性研究

【目的】

研究子痫前期（preeclampsia，PE）合并COVID-19患者在临床、超声和生物医学指标的发生率，并评价这些指标区分子痫前期和COVID-19相关类子痫前期的准确性。

【设计】

前瞻性观察性研究

【处所】

三级转诊医院

【人群】

孕＞20周罹患COVID-19单胎孕妇

【方法】

42名孕妇纳入研究，根据发生重症肺炎分为重症COVID-19组和非重症COVID-19组。对疑诊PE的孕妇测量子宫动脉搏动指数（UtAPI）和血管生成因子（可溶性fms样酪氨酸激酶/胎盘生长因子sFlt-1/PlGF）。

【主要测量结局】

子痫前期相关症状和体征的发生率如高血压，蛋白尿，血小板减少，肝酶升高，异常UtAPI和Sfl-1/PlGF升高。

【结果】

34例属于非重症COVID-19，8例属于重症COVID-19。6（14.3%）名孕妇出现PE的体征和症状，这6例均属于重症COVID-19（75%）。然而仅有1例发现异常sFlt-1/PlGF和UtAPI值。2例从重症肺炎恢复后继续妊娠，PE样症状也随之自行缓解。

【结论】

重症COVID-19孕妇会出现子痫前期样症状，但可通过sFlt-1/PlGF，LDH和UtAPI检测区分真实PE。医务工作者应意识到该现象的存在，并对疑诊子痫前期都孕妇引起重视。

Preeclampsia‐like syndromeinduced by severe COVID‐19: a prospective observational study

Manel Mendoza, Itziar Garcia‐Ruiz , Nerea Maiz, Carlota Rodo , Pablo Garcia‐Manau , Berta Serrano , Rosa Maria Lopez‐Martinez, Joan Balcells , Nuria Fernandez‐Hidalgo , Elena Carreras ,Anna Suy

First published: 01 June 2020

https://doi.org/10.1111/1471-0528.16339

This article has been accepted forpublication and undergone full peer review but has not been through thecopyediting, typesetting, pagination and proofreading process, which may leadto differences between this version and the Version of Record. Please cite thisarticle as doi:10.1111/1471‐0528.16339

【Objectives】

To investigate the incidence of clinical,ultrasonographic and biochemical findings related to preeclampsia (PE) inpregnancies with COVID‐19, and to assess their accuracy to differentiatebetween 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】

42 consecutive pregnancies were recruitedand classified into two groups: severe and nonsevere COVID‐19, according to theoccurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) andangiogenic 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 toPE, such as hypertension, proteinuria, thrombocytopenia, elevated liverenzymes, abnormal UtAPI and increased sFlt‐1/PlGF.

【Results】

34 cases were classified as nonsevere and 8as severe COVID‐19. Six (14.3%) women presented signs and symptoms of PE, allsix being among the severe COVID‐19 cases (75.0%). However, abnormalsFlt‐1/PlGF and UtAPI could only be demonstrated in one case. Two casesremained pregnant after recovery from severe pneumonia and had a spontaneousresolution of the PE‐like syndrome.

【Conclusions】

Pregnant women with severe COVID‐19 candevelop a PE‐like syndrome that might be distinguished from actual PE by sFlt‐1/PlGF,LDH and UtAPI assessment. Health care providers should be aware of itsexistence and monitor pregnancies with suspected preeclampsia with caution.

   （编译 王伟琳）​​​​​