背景:本研究旨在探讨急性组织绒毛膜羊膜炎(HCA)病理分期对实验室指标的影响,并进行进一步的研究以重新评估临床医生用于确定硬膜外镇痛的高热产妇急性HCA的阈值。
方法:回顾性研究南京市妇幼保健院2018年1月1日至2018年12月31日接受硬膜外镇痛的发热母亲。参与者按急性HCA的进展进行分组,并比较各组的实验室指标。C反应蛋白(CRP)的能力,中性粒细胞-淋巴细胞比率(NLR),单核细胞-淋巴细胞比率(MLR),和单核细胞-白细胞比率(M%),单独或组合,使用logistic回归和ROC曲线评估在接受硬膜外镇痛的高热产妇中确定急性HCA。
结果:预测HCA的最佳逻辑回归模型的曲线下面积(AUC)攀升至0.706(CRP+MLR)。孕产妇CRP,NLR,随着急性HCA的进展,MLR显着逐渐增加(p<0.0001)。根据ROC曲线,选择以下阈值来定义用于识别急性HCA的增加的实验室指标:CRP≥6.90mg/L,NLR≥11.93,MLR≥0.57。此外,预测HCA≥2期的最佳logistic回归模型的AUC为0.710,因此这些炎症标志物在预测HCA≥2期方面更为精确.
结论:CRP升高(≥6.90mg/L),NLR(≥11.93),和MLR(≥0.57)可能有助于临床医师发现接受硬膜外镇痛的发热产妇的早期潜在急性HCA,并监测病情进展以优化临床治疗方案.
背景:该研究于2021年11月24日在中国临床试验注册中心注册(http://www.chictr.org.cn,ChiCTR2100053554)。
BACKGROUND: This study aimed to investigate the effect of the pathological staging of acute histological chorioamnionitis (HCA) on laboratory indicators and to conduct further studies to reassess the threshold values used by clinicians to identify acute HCA in febrile parturients undergoing epidural analgesia.
METHODS: A retrospective study of febrile mothers receiving epidural analgesia at Nanjing Maternal and Child Health Care Hospital from January 1, 2018 to December 31, 2018. The participants were grouped by the progression of acute HCA, and the laboratory parameters were compared between groups. The ability of C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and monocyte-leukocyte ratio (M%), alone or in combination, to identify acute HCA in febrile parturients undergoing epidural analgesia was assessed using logistic regression and ROC curves.
RESULTS: The area under the curve (AUC) of the best logistic regression model predicting HCA climbed to 0.706 (CRP + MLR). Maternal CRP, NLR, and MLR significantly and progressively increased with the progression of acute HCA (p < 0.0001). Based on the ROC curves, the following thresholds were selected to define increased laboratory indicators for identifying acute HCA: CRP ≥ 6.90 mg/L, NLR ≥ 11.93, and MLR ≥ 0.57. In addition, the AUC of the best logistic regression model predicting HCA ≥ stage 2 was 0.710, so these inflammatory markers were more precise in predicting HCA ≥ stage 2.
CONCLUSIONS: Increased CRP (≥ 6.90 mg/L), NLR (≥ 11.93), and MLR (≥ 0.57) may help clinicians to identify early potential acute HCA in febrile parturients receiving epidural analgesia and to monitor progression to optimize clinical treatment options.
BACKGROUND: The study was registered in the Chinese Clinical Trial Registry on November 24, 2021 ( http://www.chictr.org.cn , ChiCTR2100053554).