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孕期中性粒细胞/淋巴细胞比值与血小板/淋巴细胞比值预测子痫前期的价值

Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Predicting Preeclampsia During Pregnancy

    摘要
  • 摘要:
      目的  探讨正常妊娠女性和子痫前期患者中性粒细胞/淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）与血小板/淋巴细胞比值（platelet-to-lymphocyte, PLR）的变化以及孕早期NLR 和PLR预测子痫前期的价值。
      方法  收集2016年1月1日–12月31日在四川大学华西第二医院住院分娩的485名孕妇（97例子痫前期、388例正常妊娠）及同期体检的30例正常非妊娠妇女的临床资料，计算并比较其NLR和PLR值。采用logistic回归分析子痫前期的危险因素，采用受试者工作特征曲线评估孕早期NLR和PLR对子痫前期的预测价值。
      结果  在孕早、中、晚期，子痫前期组与正常妊娠组的NLR、PLR差异均无统计学意义。与正常非妊娠组相比，子痫前期组和正常妊娠组NLR从孕早期开始升高，孕中期达到最大值，孕晚期下降；PLR从孕中期开始降低，孕晚期达到最低水平，差异均有统计学意义（P<0.05）。在各个孕期，NLR和PLR与子痫前期严重程度、孕妇年龄和孕前体质量指数均无关。孕前肥胖、高龄和初产因素的联合模型预测子痫前期的曲线下面积（AUC）为0.84。孕早期NLR、孕早期PLR分别加入上述模型后的AUC均为0.85。
      结论  NLR和PLR不是子痫前期的独立影响因素，不能提高对子痫前期的预测价值。

     

    Abstract:
      Objective  To investigate the changes of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in women with normal pregnancy women and pregnant women with preeclampsia (PE) and the value of using NLR and PLR in the first trimester to predict PE.
      Methods  We retrospectively collected the clinical data of 485 pregnant women (97 had PE and 388 were of normal pregnancy) who were admitted to West China Second University Hospital and had their babies delivered there between January 1 and December 31, 2016 and 30 healthy women who were not pregnant and who had physical examination at the hospital over the same period. The subjects' NLR and PLR were calculated and compared. Logistic regression analysis was done to study the risk factors of PE, and the receiver operating characteristic curves were used to assess the value of using NLR and PLR in the first trimester to predict PE.
      Results  There was no significant difference in NLR or PLR between the PE group and the normal pregnancy group in the first, second and third trimesters. Compared with that of the normal non-pregnant group, the NLR of the PE group and the normal pregnancy group started to rise in the first trimester, reached the maximum in the second trimester, and decreased in the third trimester; PLR started to decrease in the second trimester and reached the lowest level in the third trimester, exhibiting significant differences (P<0.05). In the three trimesters, NLR and PLR were not associated with the severity of PE, maternal age, or pre-pregnancy BMI. The predictive model combining factors including pre-pregnancy obesity, advanced maternal age, and nulliparity showed an area under the curve (AUC) of 0.84 for predicting PE. When NLR in the first trimester or PLR in the first trimester were added to the combined model of pre-pregnancy obesity, advanced maternal age, and nulliparity, the AUC subsequently derived were both 0.85.
      Conclusion  NLR and PLR are not independent influencing factors of PE and cannot improve the predictive value for PE.

     

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