Kısa serviks öngörüsü: Nötrofil/lenfosit oranı servikal kısalmayı öngördürücü bir birinci basamak tarama yöntemi olabilir mi?

Year 2023, Volume: 15 Issue: 2, 56 - 59, 31.08.2023

Lutfiye Uygur

Abstract

Giriş
Preterm doğum, neonatal ve infant mortalitesinin en önde gelen nedenidir. Spontan preterm doğum açısından riskli hastaları yakalamak ve önleyici tedavi seçenekleri sunmak için transvajinal ultrason ile serviks uzunluğunun ölçülmesi önerilmektedir. Ancak düşük riskli hastalarda, özellikle serviakl uzunluk ölçümü 26-29 mm çıktığında takip algoritmalarının olmaması nedeniyle, bu yöntemle evrensel taramanın maliyet etkinliği konusunda kesin bir fikir birliği yoktur. Spontan preterm doğum ve servikal yetmezlikle intraamniyotik infeksiyon veya steril inflamasyon ilişkisi bilinmektedir. Bu çalışmada inflamasyon belirteci olarak klinik kullanımı olan nötrofil/lenfosit oranının servikal kısalıkla ilişkisi araştırılmıştır.
Materyal- metodlar
Bu çalışma, retrospektif bir gözlemsel çalışmadır. Kliniğimizde takip edilmekte olup 16-34 haftalar arasında transvajinal ultrason ile servikal kısalık tespit edilen 115 hasta çalışma grubu, servikal uzunluğu normal olan 94 hasta kontrol grubu olarak alındır. Ultrason tarihinden 1 hafta öncesine ve sonrasına kadar kan sayımı yaptırmamış olan, servikovajinal kültüründe üreme olan, aktif enfeksiyon kliniği olan ve çoğul gebelikler dışlandı. Çalışma ve kontrol gruplarının demografik verileri, hemogram parametreleri ve nötrofil/lenfosit oranları karşılaştırıldı.
Bulgular
Çalişma ve kontrol gruplarında maternal yaş ve parite açısından anlamlı fark yok idi. Kısa serviks (çalışma) grubunda vücut kitle indeksi, gebelik sayısı ve önceki preterm doğum sayısı kontrol grubundan yüksek saptandı. Çalışma grubunda servikal uzunluk, doğumda gebelik haftası ve doğum kilosu kontrol grubundan anlamlı düşüktü. Çalışma grubunda ortalama doğum haftası 33,7 ( 5.2) doğum ağırlığı 2374,1 ( 1027,5) iken kontrol grubunda 38,2 ( 3.1) ve 3410 ( 760) idi. Nötrofil ve lenfosit saysı gruplara arasında farksız iken, çalışma grubunda nötrofil/lenfosit oranının kontrol grubuna göre anlamlı olarak yüksek olduğu tespit edildi.
Sonuç
Gebelik ortası yüksek nötrofil/lenfosit oranı servikal kısalık ile ilişkilidir. Servikal yetmezliğin tanısında altın standart transvajinal ultrason ile servikal uzunluk ölçümüdür. Ancak bu muayene günlük pratikte herkese uygulanmamaktadır. Nötrofil/lenfosit oranı yüksek olan hastalarda bu muayeneden vazgeçilmemesi gerektiği hastalara vurgulanmalıdır. Düşük riskli grupta nötrofil/lenfosit oranı birinci basamak tarama yöntemi olarak kullanılabilir.

Keywords

Kısa serviks, nötrofil/lenfosit oranı, preterm doğum, servikal yetmezlik

Predicting short cervix: Could NLR be used as a first-line screening method for short cervix?

Abstract

Introduction
Preterm birth is the leading cause of neonatal and infant mortality. It is recommended to measure the length of the cervix with transvaginal ultrasound in order to detect the patients at risk for spontaneous preterm delivery and to offer preventive treatment options. However, there is no definite consensus on cost-effectiveness of universal screening with this method in low- risk patients particularly in the absence of follow-up algorithms for those cases with 26-29 mm cervical length. The relationship between spontaneous preterm delivery, cervical insufficiency and intraamniotic infection/inflammation is well-known. In this study, the relationship of neutrophyl/lymphocyte ratio, which is clinically used as an inflammation marker, with short cervix was investigated.
Material- methods
This study is a retrospective observational study. 114 patients with short cervix detected by transvaginal ultrasound between 16-34 weeks were recruited as study group, and 94 patients with normal cervical length were taken as the control group. Multiple pregnancies, the patients who did not have a blood count performed one week before or after the ultrasound date, the patients with a positive cervicovaginal culture, the ones who had an active infection clinic according to the examination notes were excluded. Demographic data, hemogram parameters and neutrophyl/lymphocyte ratios of the study and control groups were compared.
Results
There was no significant difference in terms of maternal age and parity in the study and control groups. Body mass index, number of pregnancies and number of previous preterm deliveries were higher in the short cervix (study) group than in the control group. Cervical length, gestational week at birth and birth weight were significantly lower in the study group than in the control group. Mean week of birth was 33.7 ( 5.2) and birth weight was 2374.1 ( 1027.5) in the study group, while it was 38.2 ( 3.1) and 3410 ( 760) in the control group. While the neutrophyl and lymphocyte counts were not different between the groups, the neutrophyl/lymphocyte ratio was found to be significantly higher in the study group than in the control group.
Conclusion: Elevated neutrophyl/lymphocyte ratio in mid-trimester is associated with short cervix. The gold standard in the diagnosis of cervical insufficiency is cervical length measurement with transvaginal ultrasound. However, this examination is not applied to everyone in daily practice. It should be emphasized to patients that this examination should not be abandoned in patients with a high neutrophyl/lymphocyte ratio. In the low-risk group, the neutrophyl/lymphocyte ratio can be used as a first-line screening method.

Keywords

: neutrophyl/lymphocyte ratio, short cervix, cervical insufficiency, preterm delivery

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