İNTRAUTERİN GELİŞME GERİLİĞİ İLE KOMPLİKE OLAN GEBELİKLERDE İNFLAMATUAR HEMATOLOJIK PARAMETRELERIN DEĞERLENDİRİLMESİ
Öz
AMAÇ: Intrauterine Gelişme Geriliği (IUGR) bulunan hastalarda inflamatuar hematolojik parametrelerin kullanılabilirliğini değerlendirmek.
GEREÇ VE YÖNTEM: Bu vaka-kontrol çalışmasına sırasıyla IUGR (n=100) ve kontrol (n=100) gruplarına ayrılan 200 gebe dahil edildi. Bu gebelerin, doğum için hastaneye başvuru sırasındaki nötrofil/lenfosit oranı (NLR) ve trombosit/lenfosit oranı (PLR) gibi laboratuvar parametreleri retrospektif olarak değerlendirildi. Intrauterine Gelişme Geriliği, gebelik haftasına göre fetüsün tahmini fetal ağırlığının 10.persantilin altında olması olarak tanımlandı.
BULGULAR: Ortalama PLR düzeyleri, Intrauterine Gelişme Geriliği gelişen kadınlarda istatistiksel olarak anlamlı şekilde daha yüksek bulundu (121, 32±44, 80’e karşı 117, 62±44, 64, p=0.014). PLR 107,48 cutt-of düzeyinde, IUGR oluşumunu %55 duyarlılık ve özgüllük oranlarıyla doğru bir şekilde tahmin etti (AUC = 0,53 (%95 güven aralığı 0.451–0.610).
SONUÇ: Son çalışmalar Intrauterine Gelişme Geriliği etiyolojisinde inflamasyonun da rol oynayabileceğini göstermiştir. Gebelerde IUGR gelişimini predikte etmek için, potansiyel bir belirteç olarak PLR düzeyinin faydası, nispeten düşük duyarlılık ve özgüllük nedeniyle sınırlıdır. IUGR hastalarında, inflamatuar hematolojik indekslerin önemini belirlemek için daha fazla araştırmaya ihtiyaç vardır.
Anahtar Kelimeler
Gebelik Intrauterine Gelişme Geriliği Nötrofil/lenfosit oranı (NLR) trombosit/lenfosit oranı (PLR) Hematolojik parametre.
Etik Beyan
Çalışma AFSÜ Klinik Araştırmalar Etik Kurulu Tıbbi Etik Kurul Başkanlığı tarafından onaylanmıştır.Onay numarası: 2023/13
Destekleyen Kurum
yok
Teşekkür
yok
Kaynakça
- 1. Gordijn SJ, Beune IM, Thilaganathan B, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48(3):333-39.
- 2. ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet. Gynecol. 2019;133(2):97-109.
- 3. Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine Consult Series #52:Diagnosis and management of fetal growth restriction. Am J Obstet Gynecol. 2020;223(4):2-17.
- 4. Nardozza, L MM, Caetano ACR, Zamarian ACP. et al. Fetal growth restriction: current knowledge. Arch Gynecol Obstet. 2017;295(5):1061-77.
- 5. Sharma D, Shastri S, Farahbakhsh N, Sharma P. Intrauterine growth restriction - part 1. J Matern Fetal Neonatal Med. 2016;29(24):3977-87.
- 6. Dessì A, Ottonello G, Fanos V. Physiopathology of intrauterine growth retardation: from classic data to metabolomics. J Matern Fetal Neonatal Med. 2012;25( 5):13-8.
- 7. Fung C, Zinkhan E. Short- and Long-Term Implications of Small for Gestational Age. Obstet Gynecol Clin North Am. 2021;48(2):311-23.
- 8. Pels A, Beune IM, van Wassenaer-Leemhuis AG, et al. Early-onset fetal growth restriction: A systematic review on mortality and morbidity. Acta obstetricia et gynecologica Scandinavica. 2020;99(2):153-66.
- 9. Crispi F, Miranda J, Gratacós E. Long-term cardiovascular consequences of fetal growth restriction: biology, clinical implications, and opportunities for prevention of adult disease. Am J Obstet Gynecol. 2018;218(2S):869- 79.
- 10. Çağlıyan E. İntrauterin büyüme kısıtlılığı olan gebeliklerin yönetimi. Turkiye Klinikleri Gynecology Obstetrics- Special Topics. 2015;(8):62–7.
- 11. Heyborne KD, Witkin SS, McGregor JA. Tumor necrosis factor-α in midtrimester amniotic fluid is associated with impaired intrauterine fetal growth. Am J Obstet Gynecol. 1992;167(4 Pt 1):920-5.
- 12. Street ME, Seghini P, Fieni S et al. Changes in interleukin-6 and IGF system and their relationships in placenta and cord blood in newborns with fetal growth restriction compared with controls. Eur J Endocrinol 2006;155(4): 567–74.
- 13. Kirbas A, Ersoy AO, Daglar K et al. Prediction of preeclampsia by first trimester combined test and simple complete blood count parameters. J Clin Diagn Res. 2015; 9(11): QC20-3.
- 14. Kan E, Emektar E, Corbacioglu K et al. Evaluation of relationship between inflammatory markers and hyperemesis gravidarum in patients admitted to emergency department. Am J Emerg Med. 2020;38(2):292-5.
- 15. Madendag Y, Sahin E, Aydin E, et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can be useful markers for distinguishing uterine adenomyosis and leiomyoma. Gynecol Obstet Reprod Med. 2017;24(3):147-50.
- 16. Crovetto F, Triunfo S, Crispi F et al. Differential performance of first-trimester screening in predicting small- for-gestational-age neonate or fetal growth restriction. Ultrasound Obstet Gynecol 2017;49(3): 349–56.
- 17. Sotiriadis A, Figueras F, Eleftheriades M, et al. First-trimester and combined first- and second-trimester prediction of small-for-gestational age and late fetal growth restriction. Ultrasound Obstet Gynecol. 2019;53(1):55-61.
- 18. He B, Hu C, Zhou Y. First-trimester screening for fetal growth restriction using Doppler color flow analysis of the uterine artery and serum PAPP-A levels in unselected pregnancies. J Matern Fetal Neonatal Med. 2021;34(23):3857-61.
- 19. Tolunay HE, Eroğlu H, Varlı EN, et al. Evaluation of first-trimester neutrophil-lymphocyte ratio and platelet- lymphocyte ratio values in pregnancies complicated by intrauterine growth retardation. Turk J Obstet Gynecol. 2020;17(2):98-101.
- 20. Kırmızı DA, Baser E, Onat T, et al. Can Inflammatory Hematological Parameters be a Guide to Late-onset Fetal Growth Restriction? Z Geburtshilfe Neonatol. 2020;224(5):262-68.
- 21. Wang D, Yang JX, Cao DY, et al. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther. 2013;6:211–16.
- 22. Mathur K, Kurbanova N, Qayyum R. Platelet-lymphocyte ratio (PLR) and all-cause mortality in general population: insights from national health and nutrition education survey. Platelets. 2019;30(8):1036–41.
- 23. Sargın MA, Yassa M, Taymur BD, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: are they useful for predicting gestational diabetes mellitus during pregnancy? Ther Clin Risk Manag. 2016;12:657–65.
- 24. Gogoi P, Sinha P, Gupta B, et al. Neutrophil-to-lymphocyte ratio and platelet indices in pre-eclampsia. Int J Gynaecol Obstet. 2019;144(1):16–20.
- 25. Rogers LK, Velten M. Maternal inflammation, growth retardation, and preterm birth: insights into adult cardiovascular disease. Life Sci. 2011;89(13-14):417–21.
EVALUATION OF INFLAMMATORY HEMATOLOGICAL PARAMETERS IN PREGNANCIES COMPLICATED WITH INTRAUTERINE GROWTH RESTRICTION
Öz
OBJECTIVE: To evaluate the usability of inflammatory hematological parameters in Intrauterine Growth Retardation (IUGR) patients.
MATERIAL AND METHODS: This case-control study included 200 pregnant women divided into IUGR (n=100) and control (n=100) groups. Laboratory parameters such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) of these pregnant women at the time of admission to the hospital for delivery were evaluated retrospectively. Intrauterine Growth Retardation was defined as the estimated fetal weight of the fetus below the 10th percentile for gestational age.
RESULTS: Mean PLR levels were found to be statistically significantly higher in women who developed Intrauterine Growth Retardation (121.32±44.80 vs 117.62±44.64, p = 0.014). PLR accurately predicted the occurrence of IUGR with 55% sensitivity and specificity rates at a cut-off level of 107.48 (AUC = 0.53 (95% confidence interval 0.451–0.610).
CONCLUSIONS: PLR level can be used as a potential marker to predict the development of Intrauterine Growth Retardation in pregnant women. The usefulness of PLR level as a potential marker to predict the development of IUGR in pregnant women is limited due to relatively low sensitivity and specificity. Further research is needed to determine the importance of inflammatory hematological indices in IUGR patients.
Anahtar Kelimeler
Pregnancy Intrauterine Growth Retardation neutrophil/lymphocyte ratio (NLR) Platelet/lymphocyte ratio (PLR) Hematological parameter.
Kaynakça
- 1. Gordijn SJ, Beune IM, Thilaganathan B, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48(3):333-39.
- 2. ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet. Gynecol. 2019;133(2):97-109.
- 3. Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine Consult Series #52:Diagnosis and management of fetal growth restriction. Am J Obstet Gynecol. 2020;223(4):2-17.
- 4. Nardozza, L MM, Caetano ACR, Zamarian ACP. et al. Fetal growth restriction: current knowledge. Arch Gynecol Obstet. 2017;295(5):1061-77.
- 5. Sharma D, Shastri S, Farahbakhsh N, Sharma P. Intrauterine growth restriction - part 1. J Matern Fetal Neonatal Med. 2016;29(24):3977-87.
- 6. Dessì A, Ottonello G, Fanos V. Physiopathology of intrauterine growth retardation: from classic data to metabolomics. J Matern Fetal Neonatal Med. 2012;25( 5):13-8.
- 7. Fung C, Zinkhan E. Short- and Long-Term Implications of Small for Gestational Age. Obstet Gynecol Clin North Am. 2021;48(2):311-23.
- 8. Pels A, Beune IM, van Wassenaer-Leemhuis AG, et al. Early-onset fetal growth restriction: A systematic review on mortality and morbidity. Acta obstetricia et gynecologica Scandinavica. 2020;99(2):153-66.
- 9. Crispi F, Miranda J, Gratacós E. Long-term cardiovascular consequences of fetal growth restriction: biology, clinical implications, and opportunities for prevention of adult disease. Am J Obstet Gynecol. 2018;218(2S):869- 79.
- 10. Çağlıyan E. İntrauterin büyüme kısıtlılığı olan gebeliklerin yönetimi. Turkiye Klinikleri Gynecology Obstetrics- Special Topics. 2015;(8):62–7.
- 11. Heyborne KD, Witkin SS, McGregor JA. Tumor necrosis factor-α in midtrimester amniotic fluid is associated with impaired intrauterine fetal growth. Am J Obstet Gynecol. 1992;167(4 Pt 1):920-5.
- 12. Street ME, Seghini P, Fieni S et al. Changes in interleukin-6 and IGF system and their relationships in placenta and cord blood in newborns with fetal growth restriction compared with controls. Eur J Endocrinol 2006;155(4): 567–74.
- 13. Kirbas A, Ersoy AO, Daglar K et al. Prediction of preeclampsia by first trimester combined test and simple complete blood count parameters. J Clin Diagn Res. 2015; 9(11): QC20-3.
- 14. Kan E, Emektar E, Corbacioglu K et al. Evaluation of relationship between inflammatory markers and hyperemesis gravidarum in patients admitted to emergency department. Am J Emerg Med. 2020;38(2):292-5.
- 15. Madendag Y, Sahin E, Aydin E, et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can be useful markers for distinguishing uterine adenomyosis and leiomyoma. Gynecol Obstet Reprod Med. 2017;24(3):147-50.
- 16. Crovetto F, Triunfo S, Crispi F et al. Differential performance of first-trimester screening in predicting small- for-gestational-age neonate or fetal growth restriction. Ultrasound Obstet Gynecol 2017;49(3): 349–56.
- 17. Sotiriadis A, Figueras F, Eleftheriades M, et al. First-trimester and combined first- and second-trimester prediction of small-for-gestational age and late fetal growth restriction. Ultrasound Obstet Gynecol. 2019;53(1):55-61.
- 18. He B, Hu C, Zhou Y. First-trimester screening for fetal growth restriction using Doppler color flow analysis of the uterine artery and serum PAPP-A levels in unselected pregnancies. J Matern Fetal Neonatal Med. 2021;34(23):3857-61.
- 19. Tolunay HE, Eroğlu H, Varlı EN, et al. Evaluation of first-trimester neutrophil-lymphocyte ratio and platelet- lymphocyte ratio values in pregnancies complicated by intrauterine growth retardation. Turk J Obstet Gynecol. 2020;17(2):98-101.
- 20. Kırmızı DA, Baser E, Onat T, et al. Can Inflammatory Hematological Parameters be a Guide to Late-onset Fetal Growth Restriction? Z Geburtshilfe Neonatol. 2020;224(5):262-68.
- 21. Wang D, Yang JX, Cao DY, et al. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther. 2013;6:211–16.
- 22. Mathur K, Kurbanova N, Qayyum R. Platelet-lymphocyte ratio (PLR) and all-cause mortality in general population: insights from national health and nutrition education survey. Platelets. 2019;30(8):1036–41.
- 23. Sargın MA, Yassa M, Taymur BD, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: are they useful for predicting gestational diabetes mellitus during pregnancy? Ther Clin Risk Manag. 2016;12:657–65.
- 24. Gogoi P, Sinha P, Gupta B, et al. Neutrophil-to-lymphocyte ratio and platelet indices in pre-eclampsia. Int J Gynaecol Obstet. 2019;144(1):16–20.
- 25. Rogers LK, Velten M. Maternal inflammation, growth retardation, and preterm birth: insights into adult cardiovascular disease. Life Sci. 2011;89(13-14):417–21.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri (Diğer) |
| Bölüm | Makaleler-Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Nisan 2025 |
| Gönderilme Tarihi | 25 Mart 2024 |
| Kabul Tarihi | 2 Kasım 2024 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 26 Sayı: 2 |
Kaynak Göster
