akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLCakusherstvo-66Research ArticleREVIEW ARTICLEНАУЧНЫЙ ОБЗОРHELLP-SYNDROMEHELLP-СИНДРОММакацарияА. Д.MakatsariyaA. D.gemostasis@mail.ruБицадзеВ. О.BitsadzeV. O.ХизроеваД. В.KhizroevaD. Kh.ГБОУ ВПО «Первый МГМУ имени И.М. Сеченова» Минздрава РФ, МоскваРоссияFirst Moscow State Medical Sechenov University of the Ministry of Health Russian FederationRussian Federation201407062016826168Copyright © Makatsariya A.D., Bitsadze V.O., Khizroeva D.K., 20162016Макацария А.Д., Бицадзе В.О., Хизроева Д.В.Makatsariya A.D., Bitsadze V.O., Khizroeva D.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/66

The pathophysiology of HELLP syndrome is not well defined. Nowadays endothelial dysfunction if considered the key moment of the development of HELLP-syndrome. Endothelial cell dysfunction results in hypertension, proteinuria, and increased platelet activation and aggregation. Furthermore, activation of the coagulation cascade causes consumption of platelets due to adhesion onto a damaged and activated endothelium, in addition to microangiopathic hemolysis caused by shearing of erythrocytes as they traverse through capillaries laden with platelet-fibrin deposits. Multiorgan microvascular injury and hepatic necrosis causing liver dysfunction contribute to the development of HELLP.

HELLP-синдром среди беременных с гестозами встречается, по обобщенным данным мировой литературы, в 20-20% случаев и характеризуется высокой материнской и перинатальной смертностью. HELLPсиндром обычно развивается в III триместре беременности, как правило, при сроке 35 нед., также может возникнуть после родов на фоне нормального течения беременности. Патофизиология синдрома остается до конца неизученной. На сегодняшний день считается, что ключевым этапом формирования HELLP-синдрома является эндотелиальная дисфункция. В результате повреждения эндотелия и активации воспалительного ответа происходит активация процессов свертывания крови, что приводит к развитию коагулопатии, усилению потребления тромбоцитов, формированию тромбоцитарнофибриновых микротромбов. Возможно, углубление знаний о патогенезе HELLP-синдрома, развитие представлений об осложнении беременности, как о крайнем проявлении системного ответа на воспаления, приводящем к развитию мультиорганной дисфункции, позволит разработать эффективные способы профилактики и интенсивной терапии этого угрожающего состояния.

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The authors declare that there are no conflicts of interest present.