Translational Research Unit, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Universidad Nacional Autónoma de México, Mexico City, Mexico.
Lupus. 2023 Oct;32(12):1409-1417. doi: 10.1177/09612033231206446. Epub 2023 Oct 16.
Pregnancy in SLE continues to be a challenge. The neutrophil-to-lymphocyte ratio (NLR) and chemerin are predictors of preeclampsia in the general population; however, their role as predictors of maternal-fetal complications in pregnant SLE patients has not been analyzed.
To investigate the prognostic value of NLR and serum chemerin, to predict maternal-fetal complications in pregnant SLE patients, and compare both biomarkers among three study groups.
Design: Analytical cross-sectional study of cases and controls with the following study groups: systemic lupus erythematosus (SLE), preeclampsia, and healthy. NLR and chemerin serum were determined between 20 and 25 weeks of gestation. Patients were evaluated every 4-6 weeks until pregnancy resolution. Maternal and fetal outcomes were registered. We employed Receiver Operating Characteristic (ROC) curves to validate prognostic values.
Seventy pregnant patients were included: 20 with SLE, 20 with preeclampsia, and 30 healthy pregnant women; NLR values were 4 (2.3-5.6) in SLE, 6 (4.6-9.2) in preeclampsia, and 2.8 (2.1-2.9) in the group of healthy women ( = .0001). Chemerin levels were: 26 (15.3-56.2) in SLE, 96 (37.3-146.2) in preeclampsia, and 24.6 ng/mL (15.3-47.4) in the healthy group ( = .007) Maternal complications were observed in 11 (55%), 20 (100%), and 8 (26%) per group, respectively. Thrombocytopenia was the most frequent complication in all pregnant women, followed by hypertensive disorders. Fetal complications were registered in 12 (60%), 16 (80%), and 2 (6.7%), respectively. Congenital malformations and prematurity were the most frequent fetal complications. NLR had good diagnostic accuracy in predicting maternal-fetal complications (AUROC 0.715) = .015, CI 95% 0.56-0.86, cut-off point level: 2.9, sensitivity 61%, specificity 78%, positive predictive value (PPV) 65%, negative predictive value (NPV) 75%. Regarding chemerin, a cut-off point level >43 ng/mL had a sensitivity of 75%, specificity of 72% AUROC 0.75, = .001, CI 95% 0.61-0.89, PPV 51.7% NPV 87.8%, meaning that 51.7% of patients with chemerin levels >43 ng/mL have or will have preeclampsia.
The NLR may help predict maternal-fetal complications in SLE pregnancy, constituting a marker of subclinical inflammation. Chemerin levels may be associated with preeclampsia. These biomarkers could improve the care of SLE patients with timely intervention of potential complications during pregnancy.
妊娠合并系统性红斑狼疮（SLE）仍然是一个挑战。中性粒细胞与淋巴细胞比值（NLR）和趋化素是一般人群子痫前期的预测因子；然而，它们作为预测妊娠合并 SLE 患者母胎并发症的作用尚未被分析。
探讨 NLR 和血清趋化素在预测妊娠合并 SLE 患者母胎并发症中的预后价值，并比较三组研究中的两种生物标志物。
设计：病例对照的分析性横断面研究，研究组包括系统性红斑狼疮（SLE）、子痫前期和健康孕妇。在妊娠 20-25 周时测定 NLR 和趋化素血清。每 4-6 周对患者进行评估，直到妊娠结束。登记产妇和胎儿结局。我们采用Receiver Operating Characteristic（ROC）曲线来验证预测价值。
共纳入 70 例孕妇：20 例 SLE 患者，20 例子痫前期患者，30 例健康孕妇；SLE 组 NLR 值为 4（2.3-5.6），子痫前期组为 6（4.6-9.2），健康组为 2.8（2.1-2.9）（ =.0001）。趋化素水平：SLE 组为 26（15.3-56.2），子痫前期组为 96（37.3-146.2），健康组为 24.6ng/ml（15.3-47.4）（ =.007）。各组分别有 11 例（55%）、20 例（100%）和 8 例（26%）出现母婴并发症。所有孕妇中最常见的并发症是血小板减少症，其次是高血压疾病。12 例（60%）、16 例（80%）和 2 例（6.7%）分别出现胎儿并发症。先天性畸形和早产是最常见的胎儿并发症。NLR 在预测母胎并发症方面具有良好的诊断准确性（AUROC 0.715）（ =.015，95%CI 0.56-0.86，临界值水平：2.9，灵敏度 61%，特异性 78%，阳性预测值（PPV）65%，阴性预测值（NPV）75%）。关于趋化素，临界值水平>43ng/ml 的灵敏度为 75%，特异性为 72%（AUROC 0.75）（ =.001，95%CI 0.61-0.89，PPV 51.7%，NPV 87.8%），这意味着 51.7%的趋化素水平>43ng/ml 的患者将患有子痫前期。
NLR 有助于预测妊娠合并 SLE 患者的母胎并发症，是亚临床炎症的标志物。趋化素水平可能与子痫前期有关。这些生物标志物可以改善 SLE 患者的护理，以便在怀孕期间及时干预潜在的并发症。
