中性粒细胞/淋巴细胞比值与妊娠早期妊娠剧吐程度的相关性分析

Correlations of different neutrophil/lymphocyte ratios with degrees of hyperemesis gravidarum in early pregnancy

摘要

目的 探究中性粒细胞/淋巴细胞比值(NLR)与妊娠早期妊娠剧吐(HG)程度的相关性。方法 选取2021年1月至2023年12月期间上海市浦东新区人民医院收治的HG患者158例为研究对象,根据恶心呕吐妊娠专用量化指数(PUQE)评分结果分为轻度组、中度组和重度组,比较三组临床资料.根据NLR水平从低到高等分为四分位数组(Q₁~Q₄),进行NLR水平与重度HG风险相关性的亚组分析.构建广义线性混合模型分析NLR水平与重度HG风险相关性.使用NLR作为连续变量,应用限制性三次样条分析NLR与重度HG的关系。结果 不同HG程度的患者在白细胞介素6(IL-6)、乳酸脱氢酶(LDH)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、C反应蛋白(CRP)、NLR、血小板-淋巴细胞比值(PLR)水平方面的差异显著(F=2.140、2.311、2.234、2.369、3.264、2.167、2.248,P<0.05),重度组HG患者β-人绒毛膜促性腺激素(β-hCG)水平明显高于轻度组和中度组患者,孕酮(P)水平明显低于轻度组和中度组患者(F=2.485和2.072,P<0.05).广义线性混合模型结果显示,调整IL-6、LDH、CRP、β-hCG、P指标之后,与NLR<2.88比较,2.88~3.15、3.15~3.42、≥3.42 NLR发生重度HG的OR分别为2.368(95%CI:1.269~3.558)、2.480(95%CI:1.933~2.847)、2.751(95%CI:2.163~3.425).限制性三次样条回归结果表明,NLR水平与重度HG呈明显的相关性(P<0.001)。结论 中性粒细胞/淋巴细胞比值水平越高,妊娠早期妊娠剧吐程度越高.调整混杂因素后,中性粒细胞/淋巴细胞比值水平与重度妊娠剧吐风险仍显著相关.

Abstract

Objective To explore correlation between neutrophil/lymphocyte ratio (NLR) and degree of hyperemesis gravidarum (HG) in the first trimester of pregnancy. Methods A total of 158 early pregnant women with HG who admitted to our hospital from January 2021 to December 2023 were selected as study subjects. According to score in pregnancy-unique quantification of emesis and nausea (PUQE), the pregnant women were divided into mild HG group (n=62), moderate HG group (n=42) and severe HG group (n=54). The clinical data of the pregnant women were compared among the three groups. Subgroup analysis of association between NLR level and risk of severe HG was performed by dividing NLR levels into quartile arrays (Q1-Q4) from low to high in order. A generalized linear mixed model was constructed to analyze correlation between NLR and severe HG. Using NLR as a continuous variable, the correlation between NLR and HG severity was analyzed by restricted cubic spline regression. Results There were significant differences in serum levels of interleukin-6 (IL-6), lactate dehydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), NLR and platelet/lymphocyte ratio (PLR) among the early pregnant women with different HG levels (F=2.140, 2.311, 2.234, 2.369, 3.264, 2.167 and 2.248 respectively, P<0.05). β-human chorionic gonadotropin (β-hCG) of the pregnant women in the severe HG group was significantly higher than those in the mild HG group and the moderate HG group, while the serum level of progesterone (P) was significantly lower than those in the mild HG group and the moderate HG group (F=2.485 and 2.072 respectively, both P<0.05). Subgroup analysis of association between NLR level and risk of severe HG showed that NLR level was more significantly associated with severe HG in these pregnant women with IL-6≥4.95 pg/mL compared with HG patients with IL-6<4.95 pg/mL (P interaction=0.031). The generalized linear mixed model showed that after adjusting such indexes as IL-6, LDH, CRP, β-hCG and P, compared with NLR<2.88, the ORs of NLR in ranges of 2.88-3.15, 3.15-3.42 and ≥3.42 for severe HG were 2.368 (95%CI: 1.269-3.558), 2.480 (95%CI: 1.933-2.847) and 2.751 (95%CI: 2.163-3.425) respectively. The restricted cubic spline regression analysis showed that the level of NLR was significantly correlated with the severity of HG (P<0.001). Conclusions The higher the level of NLR, the higher the degree of HG in early pregnancy. After adjusting for confounding factors, NLR levels are still significantly correlated with risk of severe HG.

关键词

中性粒细胞/淋巴细胞比值 / 妊娠早期 / 妊娠剧吐 / 相关性

Key words

neutrophil-to-lymphocyte ratio / early pregnancy / hyperemesis gravidarum / correlation

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基金资助

江苏省中医药科技发展计划项目(YB202055)

常州市应用基础研究计划(CJ20200110)

上海市浦东新区卫生健康委员重点学科(PWZxk2022G28)