全身免疫炎症指数在糖尿病足感染评估中的价值

The value of systemic immune inflammation index in the evaluation of diabetic foot infection

目的探讨全身免疫炎症指数(systemic immune inflammation index,SII指数)在糖尿病足感染评估中的价值。方法回顾性分析2018年4月至2022年3月于广东祈福医院住院的糖尿病足患者216例,根据PEDIS感染分级将患者分为无/轻度感染组(n=137)和中/重度感染组(n=79),比较两组患者的临床资料,并分析SII指数与白细胞计数(white blood cell count,WBC)、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)的相关性。采用多因素Logistic回归分析糖尿病足患者中/重度感染的独立危险因素,采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析SII指数对糖尿病足患者中/重度感染的预测价值。结果两组患者的体质量指数、糖尿病病程、WBC、中性粒细胞、SII指数、CRP、PCT、糖化血红蛋白、踝肱指数(ankle brachial index,ABI)、震动感觉阈值、日均住院费用比较,差异均有统计学意义(P<0.05)。SII指数与WBC、CRP、PCT均呈正相关(r=0.642、0.501、0.161,P<0.05)。多因素Logistic回归分析显示SII指数升高、ABI降低均是糖尿病足患者中/重度感染的独立危险因素(P<0.01)。ROC曲线显示,SII指数预测中/重度感染的曲线下面积为0.724,最佳截断值为2057.06,敏感度55.7%,特异性89.1%。结论SII指数特异性高,对糖尿病足患者中/重度感染有较高的预测价值,且易于推广,可成为评估糖尿病足感染程度的新型标志物。

Objective To explore the value of systemic immune inflammatory(SII)index in the evaluation of diabetic foot infection.Methods A total of 216 diabetic foot patients admitted to Guangdong Clifford Hospital from April 2018 to March 2022 were retrospectively analyzed.According to the PEDIS infection grade,the patients were divided into no/mild infection group(n=137)and moderate/severe infection group(n=79).The clinical data of two groups were compared,and the correlation between SII index and white blood cell count(WBC),C-reactive protein(CRP)and procalcitonin(PCT)was analyzed.Multivariate Logistic regression was used to analyze the independent risk factors for moderate/severe infection of diabetic foot.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of SII index for moderate/severe infection in diabetic foot patients.Results There were statistically significant differences in body mass index,diabetes duration,WBC,neutrophils,SII index,CRP,PCT,glycosylated hemoglobin,ankle brachial index(ABI),vibrating perception threshold,and average daily hospitalization cost between the two groups(P<0.05).SII index was positively correlated with WBC,CRP and PCT(r=0.642,0.501,0.161,P<0.05).Multivariate Logistic regression analysis showed that increased SII index and decreased ABI were independent risk factors for moderate/severe infection in diabetic foot patients(P<0.01).The ROC curve showed that the area under the curve of SII index for predicting moderate/severe infection was 0.724,the optimal cut-off value was 2057.06,the sensitivity was 55.7%,and the specificity was 89.1%.Conclusion SII index is highly specific,has high predictive value for moderate/severe infection in diabetic foot patients,and is easy to popularize,and may become a new marker to evaluate the degree of diabetic foot infection.