孕晚期孕妇外周血中性粒细胞与淋巴细胞比值对早产的预测价值

Predictive value of neutrophil-lymphocyte ratio in the peripheral blood of pregnant women in the late pregnancy

目的探讨孕晚期孕妇外周血中性粒细胞与淋巴细胞比值(NLR)水平变化及其对早产的预测价值。方法选取2018年1月至2019年12月北京市大兴区人民医院妇产科收取的186例进行常规产前检查并分娩的孕晚期孕妇作为研究对象。根据孕妇的妊娠结局分为早产组(85例)和非早产组(101例)。检测血清C反应蛋白(CRP)、外周血白细胞计数(WBC)、中性粒细胞计数(NEUT)、淋巴细胞计数(LYMP),并计算NLR。通过受试者操作特征(ROC)曲线评价CRP、WBC和NLR在早产中的预测价值;应用多因素Logistic回归分析孕晚期孕妇早产的危险因素。结果早产组CRP、WBC、NEUT和NLR的水平高于非早产组,差异具有统计学意义(P<0.05);早产组和非早产组LYMP的水平比较,差异无统计学意义(P>0.05)。ROC曲线分析显示,CRP、WBC和NLR曲线下面积分别为0.759、0.705和0.833,当临界值为12.35mg/L、9.24×10^(9)/L和4.82时,具有较高的灵敏度和特异度;而且NLR预测早产的价值优于CRP和WBC。多因素Logistic回归分析结果显示,胎膜早破(OR=3.44,95%CI:1.34~8.83)、子痫前期(OR=2.95,95%CI:1.31~6.65)、高水平CRP(OR=2.36,95%CI:1.29~4.31)、高水平NLR(OR=3.51,95%CI:1.91~6.46)是孕晚期孕妇早产的危险因素。结论孕晚期孕妇NLR水平与早产密切相关,高水平NLR增加孕晚期孕妇早产的风险,监测NLR水平有助于尽早预测早产。

Objective To investigate the change of neutrophil-lymphocyte ratio(NLR) level in the peripheral blood of the late pregnant women and its clinical value in predicting preterm delivery. Methods 186 late pregnancy women who underwent routine prenatal examination and delivered in the Department of Gynecology and Obstetrics of Daxing District People′s Hospital of Beijing from January 2018 to December 2019 were selected as the research subjects. According to the outcome of pregnancy, the pregnant women were divided into preterm delivery group(85 cases) and non-preterm delivery group(101 cases). Serum C reactive protein(CRP), peripheral white blood cell count(WBC), neutrophils count(NEUT), lymphocyte count(LYMP) were measured, and NLR was calculated. The predictive value of CRP, WBC and NLR in preterm birth was evaluated by receiver operating characteristic curve(ROC). Multivariate Logistic regression was used to analyze the risk factors of preterm delivery in late pregnancy. Results The levels of CRP, WBC, NEUT and NLR in preterm delivery group were higher than those in non-preterm delivery group, and the difference was statistically significant(P<0.05). There was no significant difference in the level of LYMP between the preterm delivery group and the non-preterm delivery group(P>0.05). ROC curve analysis showed that the areas under CRP, WBC and NLR curves were 0.759, 0.705 and 0.833, respectively. When the critical values were 12.35 mg/L, 9.24×10^(9)/L and 4.82, the sensitivity and specificity were higher. Moreover, NLR is better than CRP and WBC in predicting preterm birth. Multivariate Logistic regression analysis showed that preterm rupture of membranes(OR=3.44, 95%CI:1.34~8.83), preeclampsia(OR=2.95, 95%CI:1.31~6.65), high level of CRP(OR=2.36, 95%CI:1.29~4.31), high level of NLR(OR=3.51, 95%CI:1.91~6.46) were risk factors for preterm delivery in late pregnancy. Conclusions NLR level is closely related to preterm delivery in late pregnancy. High NLR level increases the risk of preterm delivery. Monitoring NLR level is helpful to predict preterm delivery as early as possible.