妊娠期高血压疾病患者孕早期外周血中性粒细胞、单核细胞与淋巴细胞比值的观察

Neutrophil to lymphocyte ratio and monocyte to lymphocyte ratio in early pregnant women with hypertensive disorders

目的了解妊娠期高血压疾病孕妇孕早期外周血中性粒细胞/淋巴细胞值(NLR)、单核细胞/淋巴细胞值(MLR)的变化。方法采用倾向性评分匹配法进行1∶1匹配,回顾性分析2014年1月至2019年1月在北京潞河医院常规产检并诊断为妊娠期高血压疾病患者(病例组)、正常分娩的健康孕妇(对照组)各212例的临床资料。比较各组孕10~14周外周血白细胞数计数、中性粒细胞数、淋巴细胞数、单核细胞数、NLR、MLR水平。结果病例组白细胞计数、中性粒细胞数、单核细胞数、NLR和MLR的中位数(M)分别为9.1×10^9/L、6.6×10^9/L、0.5×10^9/L、3.7和0.3,均显著高于对照组的8.5×10^9/L、5.9×10^9/L、0.4×10^9/L、3.3和0.2,差异有统计学意义(Z=4.89,P<0.01;Z=4.33,P<0.01;Z=3.83,P=0.01;Z=1.97,P=0.04;Z=3.83,P=0.01)。妊娠高血压疾病孕妇中,48例为妊娠期高血压、77例为子痫前期+重度子痫前期,55例为慢性高血压并发子痫前期、32例为慢性高血压,四者的白细胞计数、中性粒细胞数、淋巴细胞数、单核细胞数、NLR、MLR比较差异均无统计学意义(均P>0.05),但随着疾病的加重,NLR呈升高趋势。logistic回归分析显示,NLR(以M=3.38分组)是妊娠期高血压疾病的相关因素[OR=1.68,95%CI:1.07~2.62,P<0.05]。结论孕早期外周血NLR水平增高与妊娠期高血压疾病的发生相关。

Objective To investigate the correlation of systemic inflammation parameters including neutrophil to lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) with the pregnancy outcome of hypertension disorders of pregnancy. Methods Two hundred and twelve pregnant women in first-trimester with hypertensive disorders and 212 matched healthy subjects (control group) were enrolled in the study. The differences in white blood cell count (WBC), neutrophil (N), lymphocyte (L), monocyte (M), NLR and MLR were compared between groups. Results The WBC, N, M, NLR and MLR values were significantly higher in pregnant women with hypertensive disorders than those in healthy controls (9.1×10^9/L vs.8.5×10^9/L,Z=4.89, P<0.01;6.6×10^9/L vs. 5.9×10^9/L,Z=4.33, P<0.01;0.5×10^9/L vs. 0.4×10^9/L,Z=3.83, P=0.01;3.7 vs. 3.3, Z=1.97, P=0.04;0.3 vs. 0.2, Z=3.83, P=0.01). The pregnant women were divided into gestational hypertension group (n=48), mild and severe preeclampsia group (n=77), chronic hypertension with superimposed preeclampsia group (n=55) and chronic hypertension complicating pregnancy group (n=32). There were no significant differences in the WBC, N, L, M,NLR and MLR values among all groups (P>0.05). Multivariate logistic regression analysis showed that NLR was a predictive factor of hypertensive disorders of pregnancy (OR=1.68, 95%CI: 1.07-2.62, P<0.05). Conclusions NLR might be a useful systemic inflammation marker for the prediction of hypertensive disorders in women with early pregnancy.