NLR、AT-Ⅲ和SUA/Cr水平与妊娠期急性脂肪肝患者病情程度和妊娠结局的相关性

摘要/Abstract

摘要： 目的探讨中性粒细胞/淋巴细胞比率(NLR)、抗凝血酶-Ⅲ(AT-Ⅲ)和血尿酸/肌酐比值(SUA/Cr)水平检测对妊娠期急性脂肪肝(AFLP)的临床价值。方法选择2021年1月至2024年12月南京江北医院诊治的AFLP孕妇29例列入观察组,根据是否出现急性肝衰竭(ALF)和不良妊娠结局(APO)进行分组;选择同期健康产妇50名列入对照组。比较观察组和对照组及观察组各亚组之间的NLR、AT-Ⅲ和SUA/Cr水平,Pearson分析评估各指标与APRI、肝功能Child-Pugh和Nesbitt评分的相关性,ROC分析各指标单独和联合检测的评估效能。结果观察组的NLR和SUA/Cr水平为3.85±0.79和5.37±0.86,高于对照组的2.27±0.43和3.62±0.47;观察组的AT-Ⅲ为(57.49±4.81)%,低于对照组的(74.68±3.56)%,差异有统计学意义(t=9.165、10.536、12.724,均P<0.05)。7例发生ALF亚组的NLR和SUA/Cr水平为4.73±0.91和5.74±0.97,高于22例无ALF亚组的3.47±0.62和4.39±0.58;ALF亚组的AT-Ⅲ为(52.36±5.28)%,低于无ALF亚组的(62.84±4.35)%,差异有统计学意义(t=7.462、8.763、8.017,均P<0.05)。23例APO亚组的NLR和SUA/Cr水平为4.58±0.86和5.36±0.85,高于6例无APO亚组的3.36±0.58和4.18±0.54,APO亚组的AT-Ⅲ为(53.27±5.14)%,低于无APO亚组的(61.49±4.26)%,差异有统计学意义(t=7.429、7.254、8.395,均P<0.05)。Pearson分析显示,AFLP孕妇的NLR和SUA/Cr与APRI、Child-Pugh评分呈正相关,与Nesbitt评分呈负相关;AT-Ⅲ与Nesbitt评分呈正相关,与APRI、Child-Pugh评分呈负相关(P<0.001);ROC曲线显示,NLR、AT-Ⅲ、SUA/Cr和3项联合检测评价AFLP孕妇发生ALF和APO的AUC为0.679、0.786、0.713、0.936,灵敏度和特异度均高于任一单项评价效能(P<0.001)。结论血清NLR、AT-Ⅲ和SUA/Cr水平联合检测对AFLP孕妇发生急性肝衰竭和不良妊娠结局的临床评估价值较高。

关键词: 妊娠期急性脂肪肝, 中性粒细胞/淋巴细胞比率, 抗凝血酶-Ⅲ, 血尿酸/肌酐比值, 妊娠结局

Abstract: Objective To investigate the clinical value of neutrophil/lymphocyte ratio (NLR), antithrombin Ⅲ (AT-Ⅲ) and serum uric acid/creatinine ratio (SUA/Cr) in patients with acute fatty liver of pregnancy (AFLP). Methods Twenty-nine pregnant women with AFLP diagnosed and treated from January 2021 to December 2024 were included in the observation group, and were grouped according to whether they developed acute liver failure (ALF) and adverse pregnancy outcome (APO). Fifty healthy parturients during the same period were selected and included in the control group. NLR, AT-Ⅲ, and SUA/Cr levels were detected and analyzed retrospectively. The levels of NLR, AT-Ⅲ, and SUA/Cr were compared between the observation group and the control group, as well as among subgroups in the observation group. The correlation between each index and APRI, Child-Pugh and Nesbitt scores of liver function was analyzed by Pearson, and the evaluation efficiency of each index was analyzed by ROC. Results The levels of NLR and SUA/Cr in the observation group were 3.85±0.79 and 5.37±0.86, which were higher than those in the control group (2.27±0.43 and 3.62±0.47). The AT-Ⅲ in the observation group was 57.49±4.81%, which was lower than that in the control group (74.68±3.56%). The difference was statistically significant (t=9.165, 10.536, 12.724, all P<0.05). The levels of NLR and SUA/Cr of 7 cases in the ALF subgroup were 4.73±0.91 and 5.74±0.97, higher than those in the non-ALF subgroup of 22 cases, (3.47 ± 0.62 and 4.39 ± 0.58), and the AT-Ⅲ level in the ALF subgroup was 52.36±5.28%, which was lower than that in the non-ALF subgroup (62.84±4.35%). The difference was statistically significant (t=7.462, 8.763, 8.017, all P<0.05). The levels of NLR and SUA/Cr in the APO subgroup of 23 cases were 4.58±0.86 and 5.36±0.85, which were higher than those in the non-APO subgroup of 6 cases (3.36±0.58 and 4.18±0.54). The AT-Ⅲ level in the APO subgroup was 53.27%±5.14%, which was lower than that in the non-APO subgroup (61.49%±4.26%). The difference was statistically significant (t=7.429, 7.254, 8.395, all P<0.05). Pearson analysis showed that NLR and SUA/Cr in AFLP pregnant women were positively correlated with APRI and Child-Pugh score, but negatively correlated with Nesbitt. AT-Ⅲ was positively correlated with Nesbitt and negatively correlated with APRI and Child-Pugh score (P<0.001). ROC curve showed that the AUC of NLR, AT-Ⅲ and SUA/Cr in the evaluation of ALF and APO in AFLP pregnant women were 0.679, 0.786, 0.713 and 0.936, and the sensitivity and specificity of the combined model were higher than those of any individual indicator (P<0.001). Conclusion The combined assessment of NLR, AT-Ⅲ, and SUA/Cr levels has high clinical value in the assessment of acute liver failure and adverse pregnancy outcomes in AFLP pregnant women.

Key words: AFLP, NLR, AT-Ⅲ, SUA/Cr, Pregnancy outcome

邱聿媛, 王丽娟, 高艳杰, 杨元晨, 杨金燕. NLR、AT-Ⅲ和SUA/Cr水平与妊娠期急性脂肪肝患者病情程度和妊娠结局的相关性[J]. 肝脏, 2026, 31(8): 1183-1187.

Qiu Yuyuan, Wang Lijuan, Gao Yanjie, Yang Yuanchen, Yang Jinyan. Correlations of NLR, AT-Ⅲ, and SUA/Cr levels with disease severity and pregnancy outcomes in patients with acute fatty liver of pregnancy[J]. Chinese Hepatolgy, 2026, 31(8): 1183-1187.

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