外周血系统性免疫炎症指数在组织学绒毛膜羊膜炎中的诊断及不良妊娠结局的预测价值  

Diagnostic Value of Peripheral Blood Systemic Immune Inflammatory Index in Histological Chorioamnionitis and Prediction of Adverse Pregnancy Outcomes

作　　者：张蕾[1] 李智伟 王福珍 杜曲晓[1] ZHAGN Lei;LI Zhiwei;WANG Fuzhen(Department of Obstetrical,People′s Hospital of Zhengzhou,Zhengzhou Henan 450000,China)

机构地区：[1]郑州人民医院产科,河南郑州450000

出　　处：《实用妇产科杂志》2023年第11期865-869,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨外周血系统性免疫炎症指数(SII)在组织学绒毛膜羊膜炎(HCA)中的诊断及不良妊娠结局的预测价值。方法:选择2021年1月至2022年6月于郑州人民医院产前诊断疑似HCA孕妇138例为研究对象,根据胎盘病理学检查结果分为非HCA组(66例)和HCA组(72例)。对两组的一般临床资料、实验室指标及预后不良结局进行比较,采用多因素Logistic回归分析以上指标与HCA之间的关系,并采用ROC曲线分析SII对HCA及不良妊娠结局的预测价值。结果:①Logistic回归分析示,中性粒细胞百分比(Neut%)、SII升高可一定程度地增加HCA发生的风险(OR>1,P<0.05),淋巴细胞百分比(Lym%)升高有利于降低HCA风险(OR<1,P<0.05)。②ROC曲线分析示:Neut%、Lym%诊断HCA的曲线下面积(AUC)分别为0.628、0.638,而SII的AUC较高为0.722,SII的诊断界值为974.49×10^(9)/L。③高SII组(SII>974.49×10^(9)/L)的产后出血、新生儿感染以及早产比例高于低SII组(SII≤974.49×10^(9)/L),差异有统计学意义(P<0.05);SII对产后出血(AUC 0.708)、新生儿感染(AUC 0.848)的预测价值高于早产(AUC 0.637)。结论:Neut%、Lym%水平异常一定程度地增加了HCA的发生风险,但对HCA的诊断价值一般;外周血SII在HCA中的诊断价值较高,且对产后出血和新生儿感染也具有较好的预测价值,有望成为HCA产前诊断和不良妊娠结局预测的新指标。Objective:To investigate the diagnostic value of peripheral blood systemic immune inflammatory index(SII)in histological chorioamnionitis(HCA)and the predictive value of adverse pregnancy outcomes.Methods:A total of 138 pregnant women with suspected HCA were included from January 2021 to June 2022 in People′s Hospital of Zhengzhou as the research objects.According to the results of placental pathology examination,they were divided into non-HCA group(66 cases)and HCA group(72 cases).The general clinical data,laboratory indicators and adverse outcome indicators of the two groups were compared,and the relationship between the above indicators and HCA was analyzed by multivariate Logistic regression.ROC curve was used to analyze the predictive value of SII for HCA and adverse pregnancy outcomes.Results:①Logistic regression analysis showed that increased neutrophil percentage(Neut%)and SII could increase the risk of HCA(OR>1,P<0.05),and increased lymphocyte percentage(Lym%)was beneficial for reducing the risk of HCA(OR<1,P<0.05).②ROC curve analysis showed that the area under the curve(AUC)of Neut%and Lym%for diagnosing HCA were 0.628 and 0.638,respectively,while the AUC of SII was higher(0.722),and the diagnostic threshold of SII was 974.49×10^(9)/L.③The rates of postpartum hemorrhage,neonatal infection and premature delivery in high SII group(SII>974.49×10^(9)/L)were higher than those in low SII group(SII≤974.49×10^(9)/L),and the difference was statistically significant(P<0.05).The value of SII in predicting postpartum hemorrhage(AUC 0.708)and neonatal infection(AUC 0.848)were higher than that in preterm birth(AUC 0.637).Conclusions:Abnormal Neut%and Lym%levels increase the risk of HCA to some extent,but the diagnostic value of HCA is average.Peripheral blood SII has high diagnostic value in HCA,and has good predictive value for postpartum hemorrhage and neonatal infection,which is expected to be a new indicator for prenatal diagnosis and prognosis prediction of adverse pregnancy outcomes in HCA.

关 键 词：系统性免疫炎症指数 组织学绒毛膜羊膜炎 诊断价值 预后 ROC曲线 

分 类 号：R714[医药卫生—妇产科学]