妊娠晚期母体血清中性粒/淋巴细胞比值可作为预测与胎盘炎症的指标

Maternal neutrophil-to-lymphocyte ratio as a prognostic biomarker for placental inflammatory response in late pregnancy

目的探讨妊娠晚期母体血清中性粒/淋巴细胞比值(NLR)水平与胎盘炎症反应程度相关性。方法回顾性分析2016年1月~2016年12月在南方医科大学南方医院妇产科进行常规产前检查并在我院分娩的478例孕妇的临床资料,根据分娩后胎盘病理结果分为PIR组(238例)和非PIR组(240例)。分别比较两组孕妇晚孕期的几种血清炎症指标(外周血白细胞、中性粒细胞数、淋巴细胞数、CRP、NLR)水平与胎盘炎症相关性进行比较,并利用多因素logistic回归分析确定胎盘炎症反应发生独立危险因素,建立logistic回归模型,绘制模型受试者工作特征曲线(ROC),并记录曲线下面积以分析晚孕期不同血清炎症指标预测PIR发生的临床价值。结果外周血白细胞、中性粒细胞数、淋巴细胞数、CRP、NLR预测PIR的曲线下面积分别为0.698(95%CI:0.485~0.766)、0.716(95%CI:0.453~0.783)、0.329(95%CI:0.228~0.431)、0.725(95%CI:0.677~0.765)和0.801(95%CI:0.742~0.856)。校正混杂因素后,多因素logistic回归分析显示,孕妇早产(OR=2.446,95%CI:1.003~4.590)、胎膜早破(OR=2.304,95%CI:1.049~4.161)、NLR>7(OR=3.268,95%CI:2.071~6.920)、CRP>15 mg/L(OR=2.137,95%CI:1.412~8.236)均为PIR发生的独立危险因素。结论晚孕期NLR增高可作为预测胎盘炎症发生风险的一项有效指标。

Objective To investigate the association between maternal serum neutrophil-lymphocyte ratio（NLR） and placental inflammatory response（PIR） in late pregnancy. Methods We retrospectively analyzed the clinical and follow-up data of 478 pregnant women undergoing routine prenatal examination and delivery in our hospital in the year 2016. According to the placental pathological results, the women were divided into PIR group（238 cases） and control group（240 cases）. The levels of serum inflammatory makers including leukocytes, neutrophils, lymphocytes, C-reactive protein（CRP） and NLR were compared between the two groups to analyze the association of these markers with PIR. Multivariate analysis was performed to identify the independent risk factors of PIR. Logistic regression model was established and the area under the receiver operating characteristic curve（ROC） was used for analyzing the prognostic value of these makers in late pregnancy. Results The areas under the curve（AUC） of leukocytes, neutrophils, lymphocytes, CRP and NLR were 0.698（95%CI： 0.485-0.766）, 0.716（95% CI： 0.453-0.783）, 0.329（95% CI： 0.228-0.431）, 0.725（95% CI： 0.677-0.765） and 0.801（95% CI： 0.742-0.856）, respectively. After adjusting the confounders, multivariate logistic regression analysis showed that preterm labor（OR=2.446, 95%CI： 1.003-4.590）,premature rupture of membranes（OR=2.304, 95% CI： 1.049-4.161）, NLR7（OR=3.268, 95% CI： 2.071-6.920）, and CRP15 mg/L（OR=2.137, 95% CI： 1.412-8.236） were independent risk factors for PIR. Conclusion An increased NLR in late pregnancy can serve as an effective indicator for predicting the risk of PIR.