妊娠期糖尿病孕妇中性粒细胞/淋巴细胞比值轨迹分析及与新生儿胎龄体重相关性研究OA
Dynamic trajectory of neutrophil/lymphocyte ratio in pregnant women with gestational diabetes mellitus and correlation with neonatal weight for gestational age
目的:探讨妊娠期糖尿病(GDM)孕妇中性粒细胞/淋巴细胞比值(NLR)的纵向变化轨迹及其与新生儿胎龄体重的相关性.方法:回顾分析 2024 年 1 月至 2024 年11 月于阜阳市人民医院产科产检并分娩的335 例GDM孕妇及其新生儿资料.收集所有GDM孕妇妊娠6～13+6周、妊娠14～19+6周、妊娠20～23+6周、妊娠24～28 周、妊娠 30～32 周、妊娠34～36 周和妊娠37～41 周孕检时NLR水平.采用增长混合模型(GMM)识别GDM孕妇NLR潜在类别轨迹.根据分娩孕周和出生体重,将新生儿分为小于胎龄儿(SGA)、适于胎龄体重儿(AGA)和大于胎龄儿(LGA),比较各组临床特征,通过多因素lo-gistic回归及ROC曲线分析NLR轨迹对新生儿胎龄体重的影响.结果:GDM孕妇妊娠期NLR水平整体呈上升趋势(F=338.70,P<0.001).基于 GMM 拟合出 GDM 孕妇 3 种NLR轨迹亚型:低NLR缓慢上升型89 例(26.6%)、低NLR快速上升型193 例(57.6%)和高NLR 缓慢上升型 53 例(15.8%).新生儿中 SGA 29 例(8.7%)、AGA 187 例(55.8%)、LGA 119 例(35.5%).3 种胎龄组GDM孕妇的年龄、BMI、教育水平、甲状腺功能减退比例、产妇类型、TG、TC和NLR轨迹比较差异有统计学意义(P<0.05).多因素logistic回归分析显示,年龄和教育水平是SGA和LGA的共同影响因素(P<0.05);TG和甲状腺功能减退是SGA的独立影响因素(P<0.05);BMI、产妇类型和NLR轨迹是LGA的独立影响因素(P<0.05).ROC曲线分析结果显示,NLR轨迹对LGA预测价值较高.结论:GDM孕妇妊娠期NLR表现出低NLR缓慢上升型、低NLR快速上升型和高NLR缓慢上升型三种轨迹,高NLR缓慢上升型与LGA风险增加相关,动态监测NLR水平可能为早期预测异常胎龄体重提供参考.
Objective:To investigate the longitudinal trajectory of neutrophil/lympho-cyte ratio(NLR)in pregnant women with gestational diabetes mellitus(GDM)and its correla-tion with neonatal weight for gestational age.Methods:The data of 335 pregnant women with GDM and their newborns who underwent labor and delivery in our hospital between January 2024 and November 2024 were retrospectively analyzed.NLR levels were collected from all GDM pregnant women at 6～13+6 weeks of gestation,14～19+6 weeks of gestation,20～23+6 weeks of gestation,24～28 weeks of gestation,30～32 weeks of gestation,34～36 weeks of ges-tation,and 37～41 weeks of gestation at the time of pregnancy checkup.Growth mixture model-ing(GMM)was used to identify potential category trajectories of NLR in pregnant women with GDM.According to the delivery gestational week and birth weight,neonates were classified into small for gestational age(SGA),appropriate for gestational age(AGA)and large for gestational age(LGA),and the clinical characteristics of each group were compared,and the effect of NLR trajectories on neonatal gestational age and weight was analyzed by multifactorial logistic regres-sion and ROC curves.Results:There was an overall increasing trend in NLR levels during preg-nancy in GDM pregnant women(F=338.70,P<0.001).Three NLR trajectory subtypes in GDM pregnant women were fitted based on GMM:low NLR slowly rising in 89 cases(26.6%),low NLR rapidly rising in 193 cases(57.6%)and high NLR slowly rising in 53 cases(15.8%).There were 29(8.7%)SGA,187(55.8%)AGA and 119(35.5%)LGA in the newborns.Differences in age,BMI,education level,percentage of hypothyroidism,maternal type,TG,TC and NLR trajectories were statistically significant when comparing pregnant women with GDM in the three gestational age groups(P<0.05).Multifactorial logistic regression analy-sis showed that age and education level were common influences on SGA and LGA(P<0.05).TG and hypothyroidism were independent influences on SGA(P<0.05).BMI,maternal type,and NLR trajectory were independent influences on LGA(P<0.05).The results of the ROC curve analysis showed that the predictive value of NLR trajectory for LGA was higher.Conclu-sion:NLR in GDM pregnant women showed three trajectories of low NLR slowly rising type,low NLR rapidly rising type and high NLR slowly rising type during gestation,and high NLR slowly rising type was associated with an increased risk of LGA.Dynamic monitoring of the NLR level may provide a reference for the early prediction of abnormal gestational age weight.
蒋秀敏;殷郑娜;穆梦露;梅莉;王常宏
阜阳市人民医院产科,阜阳 236000阜阳市人民医院产科,阜阳 236000阜阳市人民医院产科,阜阳 236000阜阳市人民医院产科,阜阳 236000阜阳市人民医院产科,阜阳 236000
医药卫生
妊娠期糖尿病中性粒细胞/淋巴细胞比值轨迹大于胎龄儿小于胎龄儿
Gestational diabetes mellitusNeutrophil/lymphocyte ratioTrajectoryLarge for gestational ageLess-than-gestational-age infant
《现代妇产科进展》 2026 (1)
35-41,7
安徽省卫生健康委科研项目(No:AHWJ2021b119)
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