全身免疫炎症指数在支气管扩张急性加重中的临床意义

Clinical significance of systemic immunoinflammatory index in acute exacerbation of bronchiectasis

目的探讨全身免疫炎症指数(SII)在支气管扩张急性加重中的临床意义。方法选择2021年5月-2024年3月在上海杨思医院、上海市浦东新区浦南医院呼吸科病房住院的280例支气管扩张急性加重患者为研究对象,根据支气管扩张严重程度指数(BSI),将研究对象分为轻度组(n=76)、中度组(n=96)、重度组(n=108);记录三组患者入院时的年龄,测定血常规、肺功能,计算SII、BMI、mMRC评分;询问患者既往因急性加重住院情况、既往1年内急性加重次数、铜绿假单胞菌定植情况、其他微生物定植情况;根据患者胸部HRCT支扩病灶统计累及范围。比较三组患者上述指标之间的差异,计算SII与其他指标的相关性;并比较三组患者离院时的死亡率。结果入院时三组患者两两比较,SII、BSI、FEV1占预计值(%)、既往因加重住过院患者百分比、既往1年内急性加重次数、mMRC、铜绿假单胞菌定植患者百分比、其他微生物定植患者百分比、影像累及3叶及以上或囊状支扩患者百分比之间的差异,均有统计学意义(P均<0.05);而年龄、BMI之间的差异,均无统计学意义(P均>0.05)。三组患者SII与BSI、既往因加重住过院患者百分比、既往1年内急性加重次数、mMRC、铜绿假单胞菌定植患者百分比、其他微生物定植患者百分比、影像累及3叶及以上或囊状支扩患者百分比均呈正相关性,与FEV1占预计值(%)呈负相关性,与年龄、BMI无相关性。重度组患者死亡率明显高于轻度组、中度组,中度组患者死亡率明显高于轻度组,差异均有统计学意义(P均<0.05)。结论SII与支气管扩张急性加重病情严重程度有明确的正相关性,病情越重,SII越高,死亡率越高。

Objective To investigate the clinical significance of systemic immunoinflammatory index(SII)in acute exacerbation of bronchiectasis.Methods A total of 280 patients with acute exacerbation of bronchiectasis who were hospitalized in respiratory wards of Shanghai Yangsi Hospital and Punan Hospital of Shanghai Pudong New District from May 2021 to March 2024 were selected as study subjects.According to bronchiectasis severity index(BSI),the subjects were divided into the mild group(n=76),the moderate group(n=96),and the severe group(n=108).At admission,their age was recorded.Routine blood test and lung function were measured.SII,BMI and mMRC scores were calculated.The patients were inquired about their previous hospitalization due to the acute exacerbation of bronchiectasis,number of the acute exacerbations of bronchiectasis in the past year,previous colonization of pseudomonas aeruginosa and other microorganisms.The extent of lung involvement of bronchiectasis was calculated according to chest high-resolution CT.The differences of the above indexes among the three groups were compared,the correlation between the SII and other parameters were analyzed,and their mortality at discharge were compared among the three groups.Conclusion There were statistical differences in SII,BSI,the percentage of FEV 1 in the predicted value,the percentage of the patients with previous hospitalization due to exacerbation,the number of the acute exacerbations within the previous year,mMRC,the percentage of the patients with colonization of pseudomonas aeruginosa,the percentage of the patients with colonization of other microorganisms,and the percentage of the patients with 3 or more lobes of lung involvement or cystic bronchiectasis among the three groups at admission(all P<0.05).There was no statistical difference in age and BMI(both P>0.05).SII was positively correlated with BSI,the percentage of the patients with previous hospitalization due to exacerbation,the number of the acute exacerbations within the previous year,mMRC,the percentage of the patients with colonization of pseudomonas aeruginosa,the percentage of the patients with colonization of other microorganisms,and the percentage of the patients with 3 or more lobes of lung involvement or cystic bronchiectasis,whereas was negatively correlated with the percentage of FEV 1 in the predicted value,and was not correlated with age or BMI.The mortality of the patients in the severe group was significantly higher than that in the mild and moderate groups,whereas that in the moderate group was significantly higher than that in the mild group(all P<0.05).Conclusion SII is positively correlated with the severity of acute exacerbation of bronchiectasis.The severer the exacerbation,the higher the value of SII and the mortality.