孕早期NLR、PLR联合孕中期超声脐动脉阻力指数预测早发型子痫前期价值

Prediction values of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio during the first trimester of pregnancy combined with ultrasound umbilical artery resistance indexes during the second trimester of pregnancy of pregnant women for their early-onset preeclampsia

目的:探讨孕早期检测中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)联合孕中期检查超声脐动脉阻力指数(UA-RI)对早发型子痫前期(EOPE)的预测价值。方法:选取2019年6月-2022年12月在本院建册产前检查的2000例孕妇,孕10~13周采血检测NLR、PLR水平,孕20~24周超声检查UA-RI值,随访至妊娠结束,观察EOPE发生情况,出现EOPE的孕妇为EOPE组,未出现EOPE的孕妇按1:3比例随机选择孕妇为对照组。比较两组临床资料、NLR、PLR水平、超声UA-RI值;观察重度、非重度EOPE患者NLR、PLR水平、超声UA-RI值;分析NLR、PLR水平、超声UA-RI值与EOPE患者病情程度关系;logistic回归分析EOPE发病影响因素;绘制受试者工作特征(ROC)曲线分析NLR、PLR、UA-RI对EOPE发病的预测效能。结果:2000例随访至分娩,357例失访,获得随访的1643例孕妇中64例发生EOPE,发生率为3.9%,为EOPE组;1579例非随机选择192例为对照组。EOPE组NLR水平、超声UA-RI值均高于对照组,PLR水平低于对照组,重度患者超声UA-RI值高于非重度患者(均P<0.05),NLR、PLR水平不同程度患者无差异(P>0.05);Pearson相关分析显示,UA-RI与EOPE患者病情程度呈正相关(P<0.05);logistic回归分析显示,年龄、NLR、UA-RIs异常升高均为EOPE发病独立危险因素,PLR升高为独立保护因素(均P<0.05);ROC曲线显示,NLR、PLR、UA-RI曲线下面积(AUC)分别为=0.729、0.599、0.892,均对EOPE发病有一定预测意义,3项指标联合预测效能最高(AUC=0.920)。结论:孕早期NLR、PLR及孕中期超声UA-RI与EOPE发病密切相关,3者联合检查可提升EOPE预测效能。

Objective:To observe the prediction values of neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)during the first trimester of pregnancy combined with ultrasound umbilical artery resistance indexes(UA?RI)during the second trimester of pregnancy of pregnant women for their early-onset preeclampsia(EOPE).Methods:2000pregnant women who had been registered in hospital for prenatal examination from June 2019to June 2022 were selected in this study.The blood samples were collected to detect the values of NLR and PLR during 10-13gestational weeks of pregnancy,and the UA-RI value of the women was examined by ultrasound during 20-24gestational weeks.These women were followed up to the end of pregnancy,and the occurrence of EOPE of the women was observed.The pregnant women with EOPE were included in study group,and the pregnant women without EOPE were selected in control group based on the ratio of 1:3.The clinical data,the values of NLR,PLR,and UA-RI of the women were compared between the two groups.The values of NLR,PLR,and UA-RI of the women with different severity of EOPE were observed.The correlation between the values of NLR,PLR,and UA-RI of the women and their severity of EOPE was analyzed.Logistic regression analysis was used to analyze the influencing factors of EOPE.Receiver operating characteristic(ROC)curve was drawn to explore the predictive efficacy of the values of NLR,PLR,and UA-RI of the women for their EOPE.Results:A total of 2000pregnant women were followed up until delivery,and 357women were lost to follow-up.Among the 1643pregnant women who had completed the followed up,there were 64(3.9%)women in the study group and 192women were randomly selected from the other 1579women without EOPE in the control group.The values of NLR and UA-RI of the women in the study group were significantly higher than those of the women in the control group,and the PLR value of the women in the study group was significantly lower.The UA-RI of the women with severe EOPE was significantly higher than that of the women with nonsevere EOPE(all P<0.05).There were no significantly difference in the values of NLR and PLR between the women with severe EOPE and the women with non-severe EOPE(P>0.05).Pearson correlation analysis showed that the UA?RI value of the women was positively correlated with their severity of EOPE(P<0.05).Logistic regression analysis showed that the age,and the abnormal increased NLR and UA-RI values of the women were the independent risk factors of their EOPE,and the increased PLR value of the women was the independent protective factor of their EOPE(all P<0.05).ROC curve showed that the area under the curvecy(AUC)of the NLR value,the PLR value,and the UA-RI value of the women for predicting their EOPE occurrence were 0.729,0.599,and 0.892,respectively,which had certain predictive significance for EOPE,and the combined of the values of NLR,PLR,and UA-RI for EOPE had the highest prediction efficiency(AUC=0.920).Conclusion:The values of NLR and PLR of the pregnant women during the first trimester of pregnancy combined with the ultrasound umbilical artery resistance indexes UA-RI of the pregnant women during the second trimester of pregnancy are closely related to the occurrence of their EOPE.The combined of the values of NLR,PLR,and UA-RI of the women can improve the predictive efficiency of their EOPE.