基于ROC曲线评价血常规指标中系统性炎症参数识别硬膜外镇痛相关产时发热与组织型绒毛膜羊膜炎的临床价值

Evaluating the clinical value of systemic inflammatry indexes in identifying epidural analgesia-related maternal fever and histological chorioamnionitis based on ROC curve

目的探讨运用血常规指标中系统性炎症参数识别硬膜外镇痛相关产时发热(epidural-related maternal fever,ERMF)与孕妇发生组织学绒毛膜羊膜炎(histological chorioamnionitis,HCA)的临床价值。方法筛选2018年6月1日至2018年12月31日于厦门大学附属妇女儿童医院住院分娩期间接受硬膜外分娩镇痛出现EEMF的单胎足月产妇119例,分为对照组52例(未合并HCA)、观察组67例(合并HCA)。比较两组孕妇出现ERMF 2h内的血常规参数,通过二元logistic回归分析与受试者工作特征(receiver operating characteristic,ROC)曲线方法研究各指标单独或联合识别HCA的能力。结果系统性炎症参数淋巴细胞比例(LYM%)、中性粒细胞计数(NEUT)、中性粒细胞比例(NEUT%)、血小板淋巴细胞比值比(PLR)、中性粒细胞淋巴细胞比值比(NLR)在观察组与对照组间存在显著差异(P<0.05)。上述参数单独或2项、3项、4项及5项联合诊断HCA的最佳敏感度分别为:65.7%、58.2%、64.2%、67.2%、76.1%;最佳特异度分别为:76.9%、88.5%、80.8%、90.4%、76.9%;其中以LYM%、NEUT、PLR、NLR 4项联合预测曲线下面积效果最佳,其预测HCA概率公式:Logit(P)=-0.011-0.205×LYM%-0.586×NLR+0.024×PLR+0.367×NEUT。结论HCA症状隐匿,可导致新生儿不良结局。希望利用系统性炎症参数LYM%、NEUT、PLR、NLR等联合检测对ERMF与HCA早期识别,以期在临床中有较好的应用价值。

Objective To investigate the clinical value of applying blood routine parameters(systemic inflammatory indexes)to identify epidural-related maternal fever(ERMF)and histological chorioamnionitis(HCA).Methods One hundred and nineteen singleton birth,full-term pregnancy patients with intrapartum fever using epidural labor analgesia,who were hospitalized for delivery at our hospital from 1 June 2018 to 31 December 2018,were divided into control group(52 cases,without HCA)and case group(67 cases,with HCA).Compare the laboratory indexes within 2 hours of fever;binary Logistic regression analysis and Receiver Operating Characteristic(ROC)curve method were used to study the ability of each indicator to identify HCA,separately or jointly.Results(1)There were significant difference in LYM%,NE%,NE,PLR and NLR between the case group and the control group(P<0.05).(2)The best sensitivity and specificity of combining any two of the above-mentioned indexes were 65.7%,76.9%.The best sensitivity and specificity of combining any three of the above-mentioned indexes were 58.2%、88.5%.The best sensitivity and specificity of combining any four of the above-mentioned indexes were 67.2%,90.4%.The best sensitivity and specificity of combining all of the above-mentioned indexes were 76.1%、76.9%.The prediction effect under-curve area of combining LYM%,PLR,NLR and NEUT was the best,and the probability formula of predicting HCA was as follows:Logit(P)=-0.011-0.205×LYM%-0.586×NLR+0.024×PLR+0.367×NEUT.Conclusion The symptoms of HCA are obscure and can lead to poor outcome of the neonates.The symptoms of HCA are obscure and lead to pooroutcome of the neonates.The combined detection of blood routine parameters LYM%,NEUT,PLR and NLR has good clinical application value for early identification of ERMF and HCA.