C反应蛋白、中性粒细胞与淋巴细胞比值与胎盘植入球囊阻断术后穿刺相关下肢动脉血栓形成的相关性

doi:10.3877/cma.j.issn.2095-5782.2026.03.006

目的

研究C反应蛋白（C-reactive protein，CRP）、中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）与胎盘植入性疾病（placenta accreta spectrum，PAS）患者腹主动脉球囊阻断并剖宫产术后穿刺相关下肢动脉血栓形成的相关性。

方法

回顾性分析2023年1月至2025年12月就诊于郑州大学第一附属医院的PAS患者的基线、血清学及围手术期指标。根据术后48 h内超声结果是否有穿刺相关下肢动脉血栓分为血栓组（52例）及非血栓组（138例）。采用单因素及多因素Logistic回归分析筛选有关因素，并绘制受试者工作特征曲线评价预测价值。

结果

血栓组的CRP、NLR、D-二聚体、术中输红细胞量与非血栓组比较，差异有统计学意义（P<0.05）。Logistic回归分析结果显示，CRP、NLR、D-二聚体与PAS患者球囊阻断并剖宫产术后穿刺相关下肢动脉血栓形成有关，曲线下面积分别为0.752、0.710、0.703。

结论

CRP、NLR与PAS患者腹主动脉球囊阻断并剖宫产术后早期穿刺相关下肢动脉局部血栓形成有关。

关键词: 炎症, 胎盘植入性疾病, 球囊闭塞, 血栓形成, 穿刺术

Objective

To investigate the relationship between C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and puncture-related lower extremity arterial thrombosis following abdominal aortic balloon occlusion combined with caesarean section in patients with placenta accreta spectrum (PAS).

Methods

A retrospective analysis was conducted on baseline data, serological indicators, and perioperative indicators of PAS patients treated at our hospital. Univariate and multivariate logistic regression analyses were performed to identify relevant factors. Receiver operating characteristic (ROC) curves were plotted to evaluate predictive value.

Results

The levels of CRP, NLR, D-dimer, and the amount of red blood cells transfused intraoperatively in the thrombus group differed significantly from those in the non-thrombus group (P < 0.05). Logistic regression analysis indicated that CRP, NLR, and D-dimer were associated with puncture-related lower extremity arterial thrombosis following balloon occlusion and cesarean section in PAS patients, with AUC values of 0.752, 0.710, and 0.703, respectively.

Conclusion

CRP and NLR were associated with early puncture-related lower extremity arterial thrombosis following abdominal aortic balloon occlusion and cesarean section in PAS patients.

Key words: Inflammatory, Placenta accreta spectrum, Balloon occlusion, Thrombosis, Punctures

图1 PAS患者的超声及磁共振图像图1A：子宫前壁下段胎盘后间隙消失，可见丰富血流信号（黑色箭头）；图1B：胎盘下缘完全覆盖宫颈口，胎盘厚薄、信号不均，与子宫前壁下段肌层分界欠清，可见条片状短T2信号（白色箭头）。PAS：胎盘植入性疾病。

图2 充盈的腹主动脉球囊图像球囊置于髂动脉分叉上方约1个椎体处，充盈的腹主动脉球囊（箭头）阻断盆腔供血。

图3 下肢动脉血栓的彩色多普勒超声图像右侧股动脉管腔增宽，可见附壁低回声（箭头），血流信号充盈缺损。

表1 血栓组与非血栓组患者基线资料比较

组别	血栓组(n=52)	非血栓组(n=138)	P值
年龄[岁，M(Q₁，Q₃)]	34.00(32.00,37.00)	33.50(31.00,34.00)	0.083
孕周[周，M(Q₁，Q₃)]	35.00(33.00,35.00)	35.00(33.00,36.00)	0.445
BMI[kg/m²，M(Q₁，Q₃)]	28.04(25.78,30.47)	27.87(25.33,32.52)	0.868
怀孕次数[次，M(Q₁，Q₃)]	4.00(3.00,5.00)	4.00(3.00,5.00)	0.598
剖宫次数[次，M(Q₁，Q₃)]	2.00(1.00,2.00)	2.00(1.00,2.00)	0.327
胎盘评分[分，M(Q₁，Q₃)]	12.00(10.00,13.00)	12.00(11.00,13.00)	0.947
糖尿病[例(%)]	12.00(23.08)	32.00(23.19)	0.987

表1 血栓组与非血栓组患者基线资料比较

组别	血栓组(n=52)	非血栓组(n=138)	P值
年龄[岁，M(Q₁，Q₃)]	34.00(32.00,37.00)	33.50(31.00,34.00)	0.083
孕周[周，M(Q₁，Q₃)]	35.00(33.00,35.00)	35.00(33.00,36.00)	0.445
BMI[kg/m²，M(Q₁，Q₃)]	28.04(25.78,30.47)	27.87(25.33,32.52)	0.868
怀孕次数[次，M(Q₁，Q₃)]	4.00(3.00,5.00)	4.00(3.00,5.00)	0.598
剖宫次数[次，M(Q₁，Q₃)]	2.00(1.00,2.00)	2.00(1.00,2.00)	0.327
胎盘评分[分，M(Q₁，Q₃)]	12.00(10.00,13.00)	12.00(11.00,13.00)	0.947
糖尿病[例(%)]	12.00(23.08)	32.00(23.19)	0.987

表2 血栓组与非血栓组患者血清学指标比较

指标	血栓组[n=52，M(Q₁，Q₃)]	非血栓组[n=138，M(Q₁，Q₃)]	P值
白细胞(×10⁹/L)	8.44(7.10, 9.81)	8.12(6.99, 9.61)	0.636
血小板(×10⁹/L)	197.00(181.50, 225.50)	194.50(152.00, 221.00)	0.155
单核细胞(×10⁹/L)	0.51(0.41, 0.62)	0.45(0.36, 0.57)	0.154
CRP(mg/L)	4.41(3.05, 5.38)	2.72(1.84, 3.56)	<0.001
NLR	5.10(4.53, 6.22)	4.08(3.45, 5.08)	<0.001
D-二聚体(mg/L)	0.92(0.63, 1.28)	0.63(0.45, 0.92)	<0.001
PT(s)	10.25(10.00, 10.70)	10.30(10.00, 10.50)	0.508
FIB(g/L)	3.61(3.40, 4.00)	3.49(3.25, 3.91)	0.324

表2 血栓组与非血栓组患者血清学指标比较

指标	血栓组[n=52，M(Q₁，Q₃)]	非血栓组[n=138，M(Q₁，Q₃)]	P值
白细胞(×10⁹/L)	8.44(7.10, 9.81)	8.12(6.99, 9.61)	0.636
血小板(×10⁹/L)	197.00(181.50, 225.50)	194.50(152.00, 221.00)	0.155
单核细胞(×10⁹/L)	0.51(0.41, 0.62)	0.45(0.36, 0.57)	0.154
CRP(mg/L)	4.41(3.05, 5.38)	2.72(1.84, 3.56)	<0.001
NLR	5.10(4.53, 6.22)	4.08(3.45, 5.08)	<0.001
D-二聚体(mg/L)	0.92(0.63, 1.28)	0.63(0.45, 0.92)	<0.001
PT(s)	10.25(10.00, 10.70)	10.30(10.00, 10.50)	0.508
FIB(g/L)	3.61(3.40, 4.00)	3.49(3.25, 3.91)	0.324

表3 血栓组与非血栓组患者围手术期指标比较

组别	血栓组[n=52，M(Q₁，Q₃)]	非血栓组[n=138，M(Q₁，Q₃)]	P值
术中出血量（mL）	1 500.00(800.00, 2 500.00)	1 200.00(700.00, 2 000.00)	0.145
术中输红细胞量（U）	4.00(0.00, 4.00)	2.00(0.00, 4.00)	0.046
术中输血浆量（mL）	400.00(0.00, 400.00)	300.00(0.00, 400.00)	0.104
球囊放置时长（min）	259.50(206.00, 324.00)	267.00(213.00, 327.00)	0.985

表3 血栓组与非血栓组患者围手术期指标比较

组别	血栓组[n=52，M(Q₁，Q₃)]	非血栓组[n=138，M(Q₁，Q₃)]	P值
术中出血量（mL）	1 500.00(800.00, 2 500.00)	1 200.00(700.00, 2 000.00)	0.145
术中输红细胞量（U）	4.00(0.00, 4.00)	2.00(0.00, 4.00)	0.046
术中输血浆量（mL）	400.00(0.00, 400.00)	300.00(0.00, 400.00)	0.104
球囊放置时长（min）	259.50(206.00, 324.00)	267.00(213.00, 327.00)	0.985

表4 PAS术后血栓形成多因素分析结果

项目	β	SE	Walds	OR值（95% CI）	P值
年龄	0.095	0.051	3.518	1.091(0.995~1.214)	0.061
CRP	0.474	0.117	16.551	1.607(1.278~2.019)	<0.001
NLR	0.313	0.096	10.669	1.368(1.134~1.651)	0.001
D-二聚体	1.472	0.467	9.95	4.360(1.746~10.883)	0.002
术中输红细胞量	0.039	0.09	0.189	1.040(0.872~1.239)	0.664

表4 PAS术后血栓形成多因素分析结果

项目	β	SE	Walds	OR值（95% CI）	P值
年龄	0.095	0.051	3.518	1.091(0.995~1.214)	0.061
CRP	0.474	0.117	16.551	1.607(1.278~2.019)	<0.001
NLR	0.313	0.096	10.669	1.368(1.134~1.651)	0.001
D-二聚体	1.472	0.467	9.95	4.360(1.746~10.883)	0.002
术中输红细胞量	0.039	0.09	0.189	1.040(0.872~1.239)	0.664

图4 CRP、NLR、D-二聚体预测提示PAS患者腹主动脉球囊阻断术后早期穿刺相关下肢动脉血栓形成的ROC曲线 CRP：C反应蛋白；NLR：中性粒细胞与淋巴细胞比值；PAS：胎盘植入性疾病；ROC曲线：受试者工作特征曲线。

表5 血栓组患者血栓情况及临床表现

项目	血栓组 [n=52，例(%)]
右侧股动脉	45(86.54)
右侧髂外动脉	7(13.46)
临床表现
足背动脉搏动减弱	50(96.15)
皮温低	2(3.85)
麻木	7(13.46)
静息痛	12(23.08)
运动迟缓	7(13.46)
闭塞程度
Rutherford Ⅰ	33(63.46)
Rutherford Ⅱa	7(13.46)
Rutherford Ⅱb	12(23.08)
治疗方法
药物保守治疗	7(13.46)
置管溶栓	22(42.31)
球囊扩张+置管溶栓	5(9.62)
AngioJet血栓抽吸+置管溶栓	12(23.08)
AngioJet血栓抽吸+球囊扩张	2(3.85)
AngioJet血栓抽吸+球囊扩张+置管溶栓	4(7.69)
术后1个月Cooley标准
痊愈	50(96.15)
良好	2(3.85)

表5 血栓组患者血栓情况及临床表现

项目	血栓组 [n=52，例(%)]
右侧股动脉	45(86.54)
右侧髂外动脉	7(13.46)
临床表现
足背动脉搏动减弱	50(96.15)
皮温低	2(3.85)
麻木	7(13.46)
静息痛	12(23.08)
运动迟缓	7(13.46)
闭塞程度
Rutherford Ⅰ	33(63.46)
Rutherford Ⅱa	7(13.46)
Rutherford Ⅱb	12(23.08)
治疗方法
药物保守治疗	7(13.46)
置管溶栓	22(42.31)
球囊扩张+置管溶栓	5(9.62)
AngioJet血栓抽吸+置管溶栓	12(23.08)
AngioJet血栓抽吸+球囊扩张	2(3.85)
AngioJet血栓抽吸+球囊扩张+置管溶栓	4(7.69)
术后1个月Cooley标准
痊愈	50(96.15)
良好	2(3.85)

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Study on the Relationship Between CRP, NLR and Puncture-related Lower Extremity Arterial Thrombosis Following Placental Accreta Spectrum Balloon Occlusion

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Study on the Relationship Between CRP, NLR and Puncture-related Lower Extremity Arterial Thrombosis Following Placental Accreta Spectrum Balloon Occlusion