Kim Min-A, Lee You Sun, Seo Kyung
Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
PLoS One. 2014 Oct 7;9(10):e107880. doi: 10.1371/journal.pone.0107880. eCollection 2014.
Placental inflammatory response (PIR) is associated with adverse neonatal outcomes such as sepsis, cerebral palsy, low birth weight, preterm birth, and neonatal mortality. However, there is an urgent need for noninvasive and sensitive biomarkers for prediction of PIR. In this study, we evaluated the clinical usefulness of maternal serum inflammatory markers for prediction of PIR in women with impending preterm birth. We conducted a retrospective cohort study of 483 patients who delivered preterm neonates. Serum levels of leukocyte differential counts, C-reactive protein (CRP), and neutrophil to lymphocyte ratio (NLR) were compared between women with no placental inflammation and women with PIR. The mean neutrophil counts, CRP levels, and NLR in both the patients with histologic chorioamnionitis (HCA) alone and those with HCA with funisitis were significantly higher than those in women with no placental inflammation. Compared to leukocyte subset or CRP, NLR in women with funisitis was significantly higher than in women with HCA alone and showed higher predictive accuracy, along with 71.4% sensitivity, 77.9% specificity, 80.7% positive predictive value, and 67.8% negative predictive value for prediction of PIR. On Kaplan-Meier survival analysis, women with both an elevated level of CRP and a high NLR had a shorter admission-to-delivery interval compared to women with either an elevated level of CRP or a high NLR alone. NLR may be a predictive marker of PIR and could be used as a cost-effective parameter for identifying women at risk of PIR.
胎盘炎症反应（PIR）与败血症、脑瘫、低出生体重、早产和新生儿死亡等不良新生儿结局相关。然而，迫切需要用于预测PIR的非侵入性且敏感的生物标志物。在本研究中，我们评估了母体血清炎症标志物对即将早产的女性预测PIR的临床实用性。我们对483例早产新生儿的产妇进行了一项回顾性队列研究。比较了无胎盘炎症的女性和有PIR的女性的白细胞分类计数、C反应蛋白（CRP）和中性粒细胞与淋巴细胞比值（NLR）的血清水平。单纯组织学绒毛膜羊膜炎（HCA）患者以及合并脐带炎的HCA患者的平均中性粒细胞计数、CRP水平和NLR均显著高于无胎盘炎症的女性。与白细胞亚群或CRP相比，合并脐带炎的女性的NLR显著高于单纯HCA的女性，并且显示出更高的预测准确性，预测PIR的灵敏度为71.4%、特异度为77.9%、阳性预测值为80.7%、阴性预测值为67.8%。在Kaplan-Meier生存分析中，与单纯CRP水平升高或NLR升高的女性相比，CRP水平升高且NLR高的女性从入院到分娩的间隔时间更短。NLR可能是PIR的预测标志物，可作为识别有PIR风险女性的经济有效参数。
