晚发型子痫前期患者血清炎症因子水平和妊娠结局分析

Analysis of association between serum inflammatory factor levels and pregnancy outcomes in patients with late-onset preeclampsia

摘要

目的 分析晚发型子痫前期患者血清炎症因子水平的变化及其与妊娠结局的相关性。方法 选择2018年1月至2023年8月收治于我院的晚发型子痫前期患者作为病例组(n=133),另选取同期入院行产检的孕晚期孕妇作为对照组(n=159);将病例组中最终发生不良妊娠结局者纳入不良妊娠结局组(n=36),未发生不良妊娠结局者纳入正常妊娠组(n=97).比较病例组与对照组间炎症因子水平包括中性粒细胞计数、淋巴细胞计数、中性粒细胞/淋巴细胞比值(NLR)、C反应蛋白(CRP)的差异.采用单因素分析和多因素Logistic分析探究影响晚发型子痫前期患者妊娠结局的相关因素,通过受试者工作特征(ROC)曲线分析炎症因子与晚发型子痫前期患者妊娠结局的关系。结果 病例组与对照组间淋巴细胞计数水平差异无统计学意义(P>0.05).相较于对照组,病例组孕妇中性粒细胞、NLR、CRP水平明显更高(t值分别为6.569、14.483、25.980,均P<0.05).相较于正常妊娠组,不良妊娠结局组的分娩孕周更小(t=5.245,P<0.001)、重度子痫前期占比更高(χ²=10.569,P<0.001),且中性粒细胞计数、NLR以及CRP水平更高(t值分别为5.048、5.724、4.920,均P<0.05).经Logistic分析显示,分娩时孕周、子痫前期程度、中性粒细胞计数、NLR水平、CRP水平是影响晚发型子痫前期患者妊娠结局的危险因素,OR值及其95%置信区间分别为2.252(1.288~3.217)、2.284(1.295~3.273)、2.102(1.246~2.958)、2.237(1.283~3.190)、1.978(1.215~2.741)(均P<0.05).NLR、CRP水平评估晚发型子痫前期患者发生不良妊娠结局的曲线下面积(AUC)分别为0.807(95%CI:0.699~0.915)、0.730(95%CI:0.629~0.832),NLR、CRP两者联合检测评估晚发型子痫前期患者发生不良妊娠结局的AUC为0.916(95%CI:0.860~0.971),优于两者单独检测(P<0.05)。结论 晚发型子痫前期患者NLR、CRP水平升高是晚发型子痫前期患者发生妊娠不良结局的危险因素,NLR、CRP联合对评估晚发型子痫前期患者的不良妊娠结局发生风险具有一定价值.

Abstract

Objective To analyze association between serum levels of inflammatory factors and pregnancy outcomes in patients with late-onset preeclampsia. Methods A total of 133 patients with late-onset preeclampsia who admitted to our hospital from January 2018 to August 2023 were selected in case group, and 159 women in late pregnancy who admitted to the same hospital for health examination in same period were as the control group. The patients in the case group were divided into normal pregnancy outcome group and poor pregnancy outcome group according to their pregnancy outcomes. The serum levels of inflammatory factors [(neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP)] of the late pregnant women were detected and compared between the case group and the control group. Univariate and multivariate Logistic regression analysis were used to explore the related factors affecting pregnancy outcomes of the patients with late-onset preeclampsia, and receiver operating characteristic (ROC) curve was applied to analyze relationship between changes in inflammatory factors and pregnancy outcomes of the patients with late-onset preeclampsia. Results There was no significant difference in lymphocyte count between the two groups (P>0.05). Compared with the control group, neutrophil count, NLR and serum level of CRP of the patients in the case group were significantly higher (t=6.569, 14.483 and 25.980 respectively, all P<0.05). Among 133 patients with late-onset preeclampsia, 36 (27.07%) patients had poor pregnancy outcomes. Compared with the normal pregnancy outcome group, gestational weeks at delivery of the patients in the poor pregnancy outcome group was smaller (t=5.245, P<0.001), proportion of severe preeclampsia was higher (χ²=10.569, P<0.001), and their neutrophil count, NLR and serum level of CRP were higher (t=5.048, 5.724, 4.920 respectively, all P<0.05). Logistic regression analysis showed that gestational week at delivery, severity of preeclampsia, neutrophil count, NLR and serum CRP level were all risk factors affecting the pregnancy outcomes of the patients with late-onset preeclampsia [ORs (95%CI)=2.252 (1.288-3.217), 2.284 (1.295-3.273), 2.102 (1.246-2.958), 2.237 (1.283-3.190), and 1.978 (1.215-2.741) respectively, all P<0.05]. The area under the curve (AUC) of combination of NLR and CRP for predicting poor pregnancy outcomes in the patients with late-onset preeclampsia was 0.916 (95%CI: 0.860-0.971), which was superior to the AUCs of single NLR and single CRP alone (both P<0.05). Conclusion Significantly elevated neutrophil count, NLR and serum level of CRP are independent risk factors for poor pregnancy outcomes of those patients with late-onset preeclampsia, and the combined detection of NLR and CRP can predict the risk to some extent.

关键词

晚发型子痫前期 / 炎症因子 / 妊娠结局

Key words

late-onset preeclampsia / inflammatory factor / pregnancy outcome

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基金资助

池州市科技计划项目(CZSF21r009)