救援性宫颈环扎术前中性粒细胞/淋巴细胞比值对潜在组织绒毛膜羊膜炎的预测价值

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目的探讨救援性宫颈环扎术前中性粒细胞/淋巴细胞比值（NLR）对潜在组织绒毛膜羊膜炎（HCA）的预测价值。方法回顾性分析2016年1月至2020年12月福建省妇幼保健院98 例行救援性宫颈环扎术早产孕妇的临床资料，根据分娩后胎盘的病理结果分为早产伴HCA 组（63 例）和早产不伴HCA 组（35 例）。比较两组术前外周血相关炎症标志物及宫颈分泌物培养阳性率。对NLR 进行ROC 曲线分析，分析其对HCA 的预测价值。结果早产伴HCA 组的胎膜早破孕龄、分娩孕龄低于早产不伴HCA 组，妊娠延长天数短于早产不伴HCA 组，剖宫产率、新生儿体重低于早产不伴HCA 组，差异有统计学意义（P＜0.05）。早产伴HCA 组的外周血NLR、宫颈微生物培养阳性率高于早产不伴HCA 组，差异有统计学意义（P＜0.05）。ROC 曲线分析显示，NLR 的AUC 为0.726（P＜0.05），最佳截断值为5.61，预测HCA 的灵敏度、特异度、阳性预测值、阴性预测值分别为69.84%，57.78%，83.02%和42.22%。按照NLR 的截断值分组，Kaplan-Meier 生存分析显示，NLR≥5.61 组宫颈环扎术后妊娠延长天数中位数为53 d，NLR＜5.61 组的宫颈环扎术后妊娠延长天数中位数为63 d，差异有统计学意义（P＜0.05）。结论外周血NLR 可成为预测急性宫颈机能不全孕妇合并HCA 的炎症标志物，并与救援性宫颈环扎术后孕周的延长有关。

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	李莉
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关键词 ：组织绒毛膜羊膜炎, 中性粒细胞与淋巴细胞比值, 宫颈机能不全, 救援性宫颈环扎术

Abstract：

Objective To investigate whether the preoperative peripheral blood neutrophil/lymphocyte ratio (NLR) of pregnant women with acute cervical insufficiency can predict potential histologic chorioamnionitis (HCA). Methods A retrospective analysis was performed on the clinical data of 98 preterm pregnant women who underwent salvage cervical cyclization in Maternal and Child Health Hospital of Fujian Province from January 2016 to December 2020.According to the pathological results of placenta after delivery, they were divided into preterm with HCA group (63 cases) and preterm without HCA group (35 cases).Preoperative peripheral blood inflammation markers and positive rate of cervical secretion culture were compared between the two groups.ROC curve analysis of NLR was conducted to analyze its predictive value to HCA. Results The gestational age of premature rupture of membranes and the gestational age of delivery in preterm with HCA group were lower than those in preterm labor without HCA group, the pregnancy extension days were shorter than those in preterm without HCA group, and the cesarean section rate and neonatal weight were lower than those in preterm without HCA group, the differences were statistically significant (P＜0.05).The positive rate of NLR and cervix microbial culture in preterm with HCA group were higher than those in preterm labor without HCA group, the differences were statistically significant (P＜0.05).ROC curve analysis showed that THE AUC of NLR was 0.726 (P＜0.05), and the optimal cutoff value was 5.61.The sensitivity, specificity, positive predictive value and negative predictive value of NLR were 69.84%, 57.78%, 83.02% and 42.22%, respectively.Kaplan-Meier survival analysis showed that the median length of pregnancy prolonged after cervical cyclization was 53 days in the NLR≥5.61 group, and 63 days in the NLR ＜5.61 group, the difference was statistically significant (P＜0.05). Conclusion Maternal peripheral blood NLR is expected to be an inflammatory marker for predicting potential placental chorioamnionitis in pregnant women with acute cervical insufficiency, and is related to the prolongation of gestational week after rescue cervical cerclage.

Key words： Histologic chorioamnionitis Neutrophil to lymphocyte ratio Cervical insufficiency Rescue cervical cerclage

基金资助:福建省妇幼保健院院内科室重点研究项目（妇幼YCXZ18-21）

通讯作者: 潘勉（1973-），男，主任医师，硕士研究生导师，研究方向：围生医学。

作者简介: 李莉（1977-），女，硕士，副主任医师，研究方向：围生医学。

引用本文:

李莉；潘勉；黄欣欣；张钧；杨丹林. 救援性宫颈环扎术前中性粒细胞/淋巴细胞比值对潜在组织绒毛膜羊膜炎的预测价值[J]. 中国当代医药, 2022, 29(23): 10-14转29.
LI Li； PAN Mian； HUANG Xinxin； ZHANG Jun；YANG Danlin. Predictive value of neutrophil/lymphocyte ratio for potential histologic chorioamnionitis before rescue cervical cerclage. 中国当代医药, 2022, 29(23): 10-14转29.

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