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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 266 -271. doi: 10.3877/cma.j.issn.1674-0785.2023.03.006

临床研究

脐动脉超声检查联合NLR、sFlt-1/PLGF对妊娠高血压综合征患者不良妊娠结局的预测价值
吴晓翔†(), 杨波, 李景漩, 张凤玲, 郭桂辉, 郑少培   
  1. 510700　广东广州，广州医科大学附属第五医院超声科
  • 收稿日期:2022-03-03 出版日期:2023-03-15
  • 通信作者: 吴晓翔

Predictive value of umbilical artery ultrasonography parameters, neutrophil to lymphocyte ratio, and sFlt-1/PLGF ratio for adverse pregnancy outcomes in patients with pregnancy induced hypertension syndrome

Xiaoxiang Wu†(), Bo Yang, Jingxuan Li, Fengling Zhang, Guihui Guo, Shaopei Zheng   

  1. Department of Ultrasound, the Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510700, China
  • Received:2022-03-03 Published:2023-03-15
  • Corresponding author: Xiaoxiang Wu
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吴晓翔, 杨波, 李景漩, 张凤玲, 郭桂辉, 郑少培. 脐动脉超声检查联合NLR、sFlt-1/PLGF对妊娠高血压综合征患者不良妊娠结局的预测价值[J]. 中华临床医师杂志(电子版), 2023, 17(03): 266-271.

Xiaoxiang Wu, Bo Yang, Jingxuan Li, Fengling Zhang, Guihui Guo, Shaopei Zheng. Predictive value of umbilical artery ultrasonography parameters, neutrophil to lymphocyte ratio, and sFlt-1/PLGF ratio for adverse pregnancy outcomes in patients with pregnancy induced hypertension syndrome[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(03): 266-271.

目的

探讨脐动脉超声检查联合中性粒细胞淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）、可溶性血管内皮生长因子受体1（soluble fms-like tyrosine kinase-1，sFlt-1）与胎盘生长因子（placental growth factor，PLGF）的比值对妊娠高血压综合征（pregnancy-induced hypertension syndrome，PIH）不良妊娠结局的预测价值。

方法

选取2020年4月至2021年4月在广州医科大学附属第五医院分娩的100例PIH患者为观察组，选择同期100例健康孕妇为对照组。比较2组孕晚期脐动脉超声与NLR、sFlt-1/PLGF水平，并记录其不良妊娠结局的情况。

结果

观察组的搏动指数（pulse index，PI）、阻力指数（resistance index，RI）、收缩期与舒张期流速比（systolic and diastolic velocity ratio，S/D）均高于对照组，S/D异常比例高于对照组（33.00% vs 9.00%），差异有统计学意义（P均＜0.05）；观察组NLR、sFlt-1/PLGF均明显高于对照组，2组比较差异均有统计学意义（P＜0.05）。观察组早产、胎儿窘迫、低出生体重儿、1 min Apgar＜7分的比例均高于对照组，差异有统计学意义（P均＜0.05）。Pearson相关分析显示，脐动脉超声PI、RI、S/D异常及NLR、sFlt-1/PLGF比值异常均与PIH不良妊娠结局呈正相关性（r分别为0.511、0.495、0.524、0.533、0.606，P均＜0.01）。脐动脉PI、RI、S/D及NLR、sFlt-1/PLGF比值预测PIH不良妊娠结局的ROC曲线下面积（AUC）分别为0.833（95%CI：0.786~0.904）、0.814（95%CI：0.754~0.877）、0.864（95%CI：0.773~0.924）和0.820（95%CI：0.754~0.854）、0.870（95%CI：0.763~0.892）；敏感度分别为74.11%、72.19%、76.32%和70.25%、78.52%；特异度分别为72.18%、84.37%、87.65%和80.33%、82.51%。脐动脉超声联合NLR、sFlt-1/PLGF比值预测PIH不良妊娠结局的ROC曲线下面积（AUC）为0.940（95%CI：0.825~0.984）；敏感度为88.56%，特异度为97.41%。

结论

PIH孕妇脐动脉超声PI、RI、S/D和胎心基线指标异常比例均明显高于健康孕妇。脐动脉超声联合NLR、sFlt-1/PLGF比值对PIH不良妊娠结局具有一定预测价值。

关键词: 妊娠高血压综合征, 脐动脉, 中性粒细胞淋巴细胞比值, 可溶性血管内皮生长因子受体1妊娠结局, 胎盘生长因子, 妊娠结局
Objective

To investigate the relationship of umbilical artery ultrasonography parameters, neutrophil to lymphocyte ratio (NLR), and soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PLGF) ratio with adverse pregnancy outcomes in patients with pregnancy induced hypertension syndrome (PIH).

Methods

A total of 100 PIH patients who gave birth in the Fifth Affiliated Hospital of Guangzhou Medical University from April 2020 to April 2021 were selected as an observation group, and 100 healthy pregnant women in the same period were selected as a control group. Umbilical artery ultrasound and NLR and sFlt-1/PLGF ratio in the late pregnancy were compared between the two groups, and adverse pregnancy outcomes were recorded.

Results

The pulse index (PI), resistance index (RI), and systolic/diastolic velocity ratio (S/D) in the observation group were significantly higher than those in the control group (P＜0.05). The percentage of subjects with an abnormal S/D was higher in the observation group than in the control group (33.00% vs 9.00%, P＜0.05). NLR and sFlt-1/PLGF ratio in the observation group were significantly higher than those in the control group (P＜0.05). The percentages of subjects with premature delivery, fetal distress, low birth weight infants, and Apgar <7 points at 1 min in the observation group were significantly higher than those in the control group (P＜0.05). Pearson correlation analysis showed that abnormal PI, RI, S/D, NLR, and sFlt-1/PLGF ratio were positively correlated with adverse pregnancy outcome in PIH patients (r=0.511, 0.495, 0.524, 0.533, and 0.606, respectively, P＜0.01). The a rea under the ROC curve (AUC) values of PI, RI, S/D, NLR, and sFlt-1/PLGF ratio for predicting adverse pregnancy outcomes in PIH patients were 0.833 [95% confidence interval (CI): 0.786~0.904], 0.814 (95%CI: 0.754~0.877), 0.864 (95%CI: 0.773~0.924), 0.820 (95%CI: 0.754~0.854), and 0.870 (95%CI: 0.763~0.892), respectively; the sensitivities were 74.11%, 72.19%, 76.32%, 70.25%, and 78.52%, and the specificities were 72.18%, 84.37%, 87.65%, 80.33%, and 82.51%, respectively. The AUC of umbilical artery ultrasound parameters combined with NLR and sFlt-1/PLGF ratio in predicting adverse pregnancy outcomes in PIH patients was 0.940 (95%CI: 0.825~0.984), with a sensitivity of 88.56% and specificity of 97.41%.

Conclusion

The proportion of patients with abnormal PI, RI, S/D, and umbilical artery ultrasound parameters in PIH pregnant women is significantly higher than that of healthy pregnant women. Umbilical artery ultrasound combined with NLR and sFlt-1/PLGF ratio has appreciated predictive value for adverse pregnancy outcomes of PIH.

Key words: Pregnancy-induced hypertension syndrome, Arteria umbilicalis, Neutrophil to lymphocyte ratio, Soluble fms-like tyrosine kinase-1, Placental growth factor, Pregnancy outcomes
表1 孕妇一般资料比较（
x¯
±s）
组别 例数 年龄（岁） 孕周（周） 孕次
观察组 100 28.64±3.75 35.21±1.85 0.85±0.23
对照组 100 28.81±3.67 35.34±1.79 0.87±0.25
t值 0.324 0.505 0.589
P值 0.373 0.307 0.278
表2 观察组与对照组孕妇脐动脉超声及NLR、sFlt-1/PLGF比值标比较
组别 例数 脐动脉超声指标 血清检测指标
PI RI S/D S/D异常 NLR sFlt-1/PLGF
观察组 100 1.03±0.23 0.95±0.34 2.57±0.45 33（33.00） 6.56±1.02 34.52±6.81
对照组 100 0.77±0.16 0.62±0.20 2.04±0.28 9（9.00） 3.45±0.69 13.05±3.04
t/χ2值 9.280 8.366 10.000 17.360 25.255 28.684
P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
图1 健康与PIH孕妇脐动脉超声多普勒图像。图a示健康孕妇脐动脉超声多普勒血流动力学图，PI=1.03，RI=0.64，S/D=2.81；图b示PIH孕妇脐动脉血流频谱PI=1.17，RI=0.70，S/D=3.28
表3 观察组与对照组孕妇不良妊娠结局比较［n（%）］
组别 例数 早产 胎儿窘迫 低出生体重儿 1min Apgar＜7分
观察组 100 35（35.00） 22（22.00） 19（19.00） 23（23.00）
对照组 100 11（11.00） 6（6.00） 7（7.00） 10（10.00）
χ2值 16.262 10.631 6.366 6.133
P值 ＜0.001 0.001 0.012 0.013
表4 脐动脉超声和NLR、sFlt-1/PLGF比值与PIH不良妊娠结局相关性分析
相关指标 PIH不良妊娠结局
r值 P值
脐动脉超声
PI 0.511 ＜0.01
RI 0.495 ＜0.01
S/D异常 0.524 ＜0.01
血清学指标
NLR 0.533 ＜0.01
sFlt-1/PLGF 0.606 ＜0.01
图2 脐动脉超声联合NLR、sFlt-1/PLGF比值预测PIH不良妊娠结局的ROC曲线
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