系统免疫炎症指数对腹腔镜胰十二指肠切除术后胰瘘发生的诊断价值

Diagnostic value of systemic immune-inflammation index in postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy

目的分析系统免疫炎症指数(SII)对腹腔镜胰十二指肠切除术(LPD)后胰瘘发生的诊断价值。方法选取2018年1月至2023年6月首都医科大学附属北京友谊医院普通外科接受LPD的患者306例。统计患者的基本资料、根据公式(血小板计数×中性粒细胞计数/淋巴细胞计数)计算患者术前3 d的SII;按照2016年国际胰腺外科研究组胰瘘诊断标准和分级依据分为临床相关胰瘘(CRPF)组31例与非CRPF组275例。通过单因素及多因素回归分析筛选出影响患者发生术后胰瘘的危险因素,并通过甘油三酯(TG)、血清白蛋白(Alb)及SII的指标对术后胰瘘进行受试者操作特征(ROC)曲线绘制并评估其诊断价值。结果本研究中31例(10.2%)发生CRPF,其中24例为B级胰瘘,7例为C级胰瘘。单因素分析发现,CRPF组中性粒细胞率(NEU-R)和TG水平高于非CRPF组,血清Alb水平低于非CRPF组(P<0.05)。CRPF组SII高于非CRPF组(P<0.05)。多因素回归分析发现,Alb、TG和SII是LPD术后胰瘘发生的危险因素,Alb是LPD术后胰瘘的发生的独立保护因素(P<0.05)。SII的AUC值为0.945。TG的AUC值为0.911,95%CI(0.918~0.971),约登指数为0.733,截断值为5.62 mmol/L,(Z=4.78,P<0.001)。Alb的AUC值为0.771,95%CI(0.674~0.867),约登指数为0.515,截断值为35.1 g/L,Z=4.34,P<0.001,相比较于TG与Alb,SII曲线下面积最大,且具有更高的预测效能。ROC曲线来确定SII最佳临界值为984.6×10^(9)/L,灵敏度为0.782,特异度为0.736。结论SII是LPD术后的胰瘘的独立危险因素,并且相比于TG及血清Alb,SII具有更高的诊断价值。

Objective To evaluate the diagnostic value of systemic immuno inflammatory index(SII)in pancreatic fistula after laparoscopic pancreaticoduodenectomy(LPD).Methods A total of 306 patients receiving LPD in the Department of General Surgery,Beijing Friendship Hospital,Capital Medical University from January 2018 to June 2023 were selected.Basic data of patients were collected and SII of patients three days before surgery was calculated according to the formula(platelet count×neutrophil/lymphocyte).According to the diagnostic criteria and grading of pancreatic fistula of the International Pancreatic Surgery Study Group in 2016,the patients were divided into clinically relevant pancreatic fistula(CRPF)group 31 cases and non-CRPF group 275 cases.Risk factors affecting the occurrence of postoperative pancreatic fistula in patients were screened by univariate and multivariate regression analysis,and receiver operating characteristic(ROC)curves for postoperative pancreatic leakage by indices of triglycerides(TG),serum albumin(Alb),and SII and assessment of their diagnostic value were evaluated.Results In this study,31 patients(10.2%)developed CRPF,of which 24 patients with grade B pancreatic fistula and seven patients with grade C pancreatic fistula.Univariate analysis found that neutrophil rate(NEU-R)and TG levels in the CRPF group were higher than in the non-CRPF group,and serum Alb level was lower than in the non-CRPF group(P<0.05).The SII was in the CRPF group higher than in the non-CRPF group(P<0.05).Multifactorial regression analysis revealed that Alb,TG and SII were risk factors for the development of pancreatic fistula after LPD,and Alb was an independent protective factor for the development of pancreatic fistula after LPD(P<0.05).The AUC value of SII was 0.945.The AUC value of TG was 0.911,95%CI(0.918-0.971),and the index of Yoden was 0.733,the cutoff value was 5.62 mmol/L,Z=4.78,P<0.001.The AUC value for Alb was 0.771,95%CI(0.674-0.867),Yoden index was 0.515,and the cutoff value was 35.1 g/L,Z=4.34,P<0.001.Compared to TG and Alb,the SII curve had the largest area under ROC,and it had higher predictive efficacy.The ROC curves to determine the optimal critical value of SII was 984.6×10^(9)/L,with a sensitivity of 0.782 and a specificity of 0.736.Conclusion SII is an independent risk factor for pancreatic leakage after LPD,and compared with TG and serum ALB,systemic SII has a higher diagnostic value.