全身免疫炎症指数评估溃疡性结肠炎严重程度的价值

CLINICAL VALUE OF SYSTEMIC IMMUNE INFLAMMATION INDEX IN ASSESSING THE SEVERITY OF ULCERATIVE COLITIS

目的探讨全身免疫炎症指数(SII)评估溃疡性结肠炎(UC)严重程度的临床价值。方法收集224例UC病人和224例健康对照者,比较两组的性别、年龄、体质量指数(BMI)、血红蛋白(Hb)、血小板(PLT)、中性粒细胞(NEU)、淋巴细胞(LYM)、单核细胞(MONO)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)、SII的差异。根据改良Truelove和Witts评分(TWC)、Mayo内镜评分(MES)、溃疡性结肠炎肠道炎症负担程度(DUBLIN)、溃疡性结肠炎内镜下严重程度指数(UCEIS)评价UC活动性及严重程度,根据蒙特利尔分型评估肠道受累范围。分析SII、NLR、PLR、LMR与UC严重程度、病变范围的相关性,通过接受者操作特征曲线(ROC曲线)和多因素回归分析评估SII、NLR、PLR、LMR预测活动性UC的诊断效率。结果与对照组相比,UC组SII、NLR、PLR明显升高,LMR明显降低,差异均有统计学意义(Z=-12.47~-9.75,P<0.01)。UC组SII与TWC、MES、DUBLIN、UCEIS评分呈正相关(r=0.494~0.633,P<0.001),且不同严重程度分组间差异有统计学意义(Z=-7.12~-2.81,P<0.01),与蒙特利尔分型无相关性(r=0.007,P>0.05)。ROC曲线分析显示,SII的ROC曲线下面积(AUC=0.84)、NLR(AUC=0.78)、PLR(AUC=0.79)、LMR(AUC=0.74)对UC严重程度有预测价值(P<0.01)。多因素Logistic分析显示,SII是中重度UC的显著独立预测危险因素(OR=1.002,95%CI=1.001~1.003,P<0.05)。低体质量、正常体质量、体质量超标组间SII差异有统计学意义(Z=-9.10~-3.01,P<0.05)。结论SII是UC严重程度的独立危险因素,其升高提示机体存在营养不良,可为评估UC严重程度提供临床依据。

Objective To explore the clinical value of systemic immune inflammation index(SII)in assessing the severity of ulcerative colitis(UC).Methods A total of 224 patients with UC and 224 healthy controls were included respectively.Diffe-rences in gender,age,body mass index(BMI),hemoglobin,platelets,neutrophils,lymphocytes,monocytes,neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),lymphocyte-monocyte ratio(LMR),and SII were compared between the two groups.Modified Truelove and Witts score(TWC),Mayo endoscopic score(MES),the Degree of Ulcerative Colitis Burden of Luminal Inflammation(DUBLIN),and the Ulcerative Colitis Endoscopic Index of Severity(UCEIS)were used to evaluate the activity and severity of UC.Montreal classification was used to evaluate the disease extension.The correlation of SII,NLR,PLR,and LMR with UC severity and disease extension was analyzed.The receiver operator characteristic(ROC)curve and the multivariate regression analysis were performed to assess the diagnostic efficiency of SII,NLR,PLR,and LMR in predicting active UC.Results Compared with the control group,SII,NLR,and PLR in the UC group were significantly increased,and LMR was significantly decreased(Z=-12.47 to-9.75,P<0.01).In the UC group,SII was positively associated with TWC,MES,DUBLIN,and UCEIS scores(r=0.494-0.633,P<0.001),was significantly different between different severity groups(Z=-7.12 to-2.81,P<0.01),and had no correlation with Montreal classification(r=0.007,P>0.05).The ROC curve analysis found that the area under the ROC curve(AUC)of SII(AUC=0.84),NLR(AUC=0.78),PLR(AUC=0.79),and LMR(AUC=0.74)had a predictive value for UC severity(P<0.01).Multivariate Logistic regression analysis showed that SII was a significant independent risk factor for moderate and severe UC(OR=1.002,95%CI=1.001-1.003,P<0.05).The difference in SII in patients with UC was statistically significant between the low,normal,and excessive BMI groups(Z=-9.10 to-3.01,P<0.05).Conclusion SII is an independent risk factor for UC severity,and its elevation suggests malnutrition in the body,which provides a clinical basis for the assessment of UC severity.