预后营养指数与原发性干燥综合征患者疾病活动度的相关性研究

Study on the relationship between prognostic nutrition index and disease activity in patients with primary Sjögren syndrome

目的探讨预后营养指数(PNI)与原发性干燥综合征(pSS)患者疾病活动度的关系。方法回顾性收集2017年6月至2020年11月于青海大学附属医院风湿免疫科住院的94例pSS患者的临床资料,选取同期年龄性别相匹配的45名健康体检者作为对照组,比较pSS患者和健康对照组的PNI水平和其他指标。根据欧洲风湿病联盟干燥综合征疾病活动性指数(ESSDAI)评分,将患者分为稳定组(ESSDAI评分<5)60例和活动组(ESSDAI评分≥5)34例。采用Spearman相关性分析评价PNI、白蛋白(Alb)、淋巴细胞(LY)、C反应蛋白(CRP)及红细胞沉降率(ESR)等炎症指标与ESSDAI的关系。采用二元logistic回归分析pSS疾病活动度的影响因素。并采用受试者工作特征曲线及DeLong检验分析评价PNI及相关变量对pSS疾病活动度的诊断价值。结果pSS组PNI、Alb、LY、白细胞计数(WBC)、中性粒细胞计数(NEU)及血小板计数(PLT)水平均低于健康对照组(P<0.05),pSS组ESR水平高于健康对照组(P<0.05),而CRP在两组间差异无统计学意义(P>0.05);pSS疾病活动组PNI、Alb、LY、WBC、NEU、PLT及补体C4水平均低于疾病稳定组(P<0.05),pSS疾病活动组ESR、IgG水平均高于稳定组(P<0.05),而CRP在两组间差异无统计学意义(P>0.05);ESSDAI与PNI(rs=-0.587,P<0.001)呈负相关;PNI水平升高是pSS疾病活动的独立保护因素;PNI诊断pSS疾病活动的最佳界值为46.325,灵敏度为78.3%,特异度为88.2%。结论活动期pSS患者PNI水平显著降低,PNI可能是评估pSS患者疾病活动度可靠的生物学标志物。

Objective To explore the relationship between prognostic nutrition index(PNI)and disease activity in patients with primary Sjögren syndrome(pSS).Methods The clinical data of 94 patients with pSS hospitalized in the Qinghai University Affiliated Hospital from June 2017 to November 2020 were retrospectively collected,45 age-and gendermatched healthy subjects were included as control group.The PNI level and other indexes in patients with pSS and healthy controls were compared.According to the European League Against Rheumatism Sjogren′s syndrome disease activity index(ESSDAI)score,60 cases were in inactive group(ESSDAI<5)and 34 in active group(ESSDAI≥5).Spearman correlation analysis was used to evaluate the relationship between PNI,albumin(Alb),lymphocyte(L),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and ESSDAI in pSS patients.Binary logistic regression analysis was used to assess the influencing factors for pSS disease activity.Receiver operating characteristic(ROC)curve analysis and Delong testing analysis were used to evaluate the diagnostic value of PNI and related variables for disease activity of pSS.Results The PNI,Alb,LY,WBC,NEU,and PLT levels were lower in pSS patients than in healthy controls(P<0.05),the ESR level was higher in pSS patients than in healthy controls(P<0.05),and there was no statistically significant difference in CRP between the patients in pSS and control group(P>0.05);The PNI,Alb,LY,WBC,NEU,PLT and C4 levels were lower in the active group than in the inactive group(P<0.05),the ESR,and IgG levels were higher in the active group than in the inactive group(P<0.05),there was no statistically significant difference in CRP between the active and inactive group(P>0.05);PNI correlated negatively with ESSDAI in patients with pSS(r=-0.587,P<0.001);The increase of PNI is significantly an independent protective factor for disease activity of pSS.The sensitivity and specificity of PNI using a cut-off value of 46.325 was 78.3%and 88.2%,respectively,for the active group.Conclusion PNI is significantly decreased in active pSS group.PNI may be a reliable indicator to evaluate the disease activity of pSS patients.