Kang Su-Ya, Wang Yun, Zhou Li-Ping, Zhang Hong
Department of Obstetrics, Suzhou Affiliated Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215002, Jiangsu Province, China.
Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China.
World J Clin Cases. 2021 Feb 26;9(6):1259-1270. doi: 10.12998/wjcc.v9.i6.1259.
Indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are considered new markers of the systemic inflammatory response (SIR), and have been widely implemented for the diagnosis of patients with inflammatory diseases. These new indicators have also been widely investigated in preeclampsia (PE) but less analyzed in hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome.
To compare SIR markers among HELLP patients, PE only patients, and healthy gravidae.
This retrospective case-control study enrolled 630 cases, including 210 patients with HELLP syndrome (HELLP group), 210 patients with only PE (PE group) and 210 healthy gravidae (control group). The three groups were matched by age, parity, status of assisted reproduction, and multiple pregnancies. Birthweight, gestational age at complete blood count collection, gestational age at delivery, mode of delivery, were recorded. The main indices as NLR, PLR, MPV, PDW, and RDW among the groups were compared, as well as some secondary outcomes including neutrophil, platelets, and hemoglobin
The NLR (6.4 4.3 3.5), MPV (11.9 s 11.2 10.7), PDW (16.4 13.3 14.2), leukocyte (12.4 × 10/L 9.7 × 10/L 8.7 × 10/L) and neutrophil count (9.9 × 10/L 7.3 × 10/L 6.1 × 10/L) were highest in the HELLP group, lower in the PE group, and lowest in the control group. Both the overall comparisons between the three groups (all < 0.01) and pairwise comparisons between every two groups elicited statistically significant differences (all < 0.01, except control PE: < 0.05 in PDW). The average lymphocyte counts were 1.4 (1.1, 2.0) × 10/L in the HELLP group, 1.6 (1.3, 2.0) × 10/L in the PE group and 1.7 (1.4, 2.0) × 10/L in the control group. The overall comparison of lymphocyte count within the three groups had statistically significant differences ( = 0.000). The pairwise comparisons between every two groups demonstrated that the HELLP group had a lower lymphocyte count than both the PE ( = 0.019) and control groups ( = 0.000), but the difference between the PE and control groups was not statistically significant ( = 0.432). The overall comparisons on platelet counts and the PLR among these three groups also showed statistically significant differences (both = 0.000), from low to high being those in the HELLP group (43.4 × 10/L, 64.0), control group (180.5 × 10/L, 103.6) and PE group (181.5 × 10/L, 112.8). Pairwise comparisons of neither index displayed statistically significant differences between the PE and control groups (both > 0.05), while the differences in the two indices between the HELLP group and the two other groups were still statistically significant (all = 0.000). RDW values were highest in the HELLP group (14.5% [13.6, 15.3]), lower in the control group (14.1% [13.5, 14.8]) and lowest in the PE group (13.9% [13.4, 14.9]). The difference between the PE and control group did not show statistical significance ( = 1.000), while RDW values in the HELLP group were higher than those in the other two groups ( < 0.05 control, < 0.01 PE).
SIR markers such as NLR, RDW, MPV, and PDW were increased and PLR was decreased in HELLP. These SIR markers may become new indicators in the evaluation of HELLP syndrome.
中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、平均血小板体积（MPV）、血小板分布宽度（PDW）和红细胞分布宽度（RDW）等指标被认为是全身炎症反应（SIR）的新标志物，并已广泛应用于炎症性疾病患者的诊断。这些新指标在子痫前期（PE）中也得到了广泛研究，但在溶血、肝酶升高和血小板减少（HELLP）综合征中的分析较少。
比较HELLP患者、单纯PE患者和健康孕妇的SIR标志物。
这项回顾性病例对照研究纳入了630例病例，包括210例HELLP综合征患者（HELLP组）、210例单纯PE患者（PE组）和210例健康孕妇（对照组）。三组在年龄、产次、辅助生殖状况和多胎妊娠方面进行匹配。记录出生体重、全血细胞计数时的孕周、分娩时的孕周、分娩方式。比较各组间的主要指标NLR、PLR、MPV、PDW和RDW，以及一些次要指标，包括中性粒细胞、血小板和血红蛋白。
HELLP组的NLR（6.4 4.3 3.5）、MPV（11.9 s 11.2 10.7）、PDW（16.4 13.3 14.2）、白细胞（12.4×10/L 9.7×10/L 8.7×10/L）和中性粒细胞计数（9.9×10/L 7.3×10/L 6.1×10/L）最高，PE组次之，对照组最低。三组间的总体比较（均P<0.01）以及每两组间的两两比较均有统计学差异（均P<0.01，对照组与PE组比较：PDW中P<0.05）。HELLP组的平均淋巴细胞计数为1.4（1.1，2.0）×10/L，PE组为1.6（1.3，2.0）×10/L，对照组为1.7（1.4，2.0）×10/L。三组间淋巴细胞计数的总体比较有统计学差异（P = 0.000）。两两比较显示，HELLP组的淋巴细胞计数低于PE组（P = 0.019）和对照组（P = 0.000），但PE组与对照组之间的差异无统计学意义（P = 0.432）。这三组血小板计数和PLR的总体比较也有统计学差异（均P = 0.000），从低到高依次为HELLP组（43.4×10/L，64.0）、对照组（180.5×10/L，103.6）和PE组（181.5×10/L，112.8）。PE组与对照组之间这两个指标的两两比较均无统计学差异（均P>0.05），而HELLP组与其他两组之间这两个指标的差异仍有统计学意义（均P = 0.000）。RDW值在HELLP组最高（14.5%[13.6，15.3]），对照组较低（14.1%[13.5，14.8]），PE组最低（13.9%[13.4，14.9]）。PE组与对照组之间的差异无统计学意义（P = 1.000），而HELLP组的RDW值高于其他两组（与对照组比较P<0.05，与PE组比较P<0.
