系统性免疫炎症指数与糖尿病黄斑前膜的相关性研究

Correlation between systemic immune inflammation index and diabetic epiretinal membranes

目的初步探讨系统性免疫炎症指数(SII)及其他代谢指标与糖尿病黄斑前膜(dERM)的相关性。方法回顾性病例对照研究。2022年3月至2023年7月于浙江大学医学院附属金华医院眼科住院行眼底筛查确诊的dERM患者81例81只眼(dERM组)纳入研究。选取同期年龄、性别、糖尿病病程匹配的眼底筛查双眼均无dERM、糖尿病黄斑水肿的糖尿病患者81例81只眼作为对照组。患者均行光相干断层扫描(OCT)检查以及实验室外周血中性粒细胞、淋巴细胞、血小板计数和血清白蛋白、血脂、尿酸、糖化血红蛋白(HbA1c)检测。计算SII。留取随机尿液标本行尿微量白蛋白/尿肌酐比值(ACR)检测。OCT设备自带分析软件获取黄斑容积系数,包括黄斑中心凹厚度(CMT)、黄斑容积、黄斑区平均厚度。两组间黄斑容积系数、SII、血清白蛋白、血脂、尿酸、HbA1c、ACR比较采用配对t检验或Mann-Whitney U检验。采用条件logistic回归分析,评估dERM发生的危险因素;采用Spearman相关性分析法分析dERM患者CMT、SII、ACR与内层视网膜结构紊乱(DRIL)、视网膜内囊样积液(IRC)、强反射点(HRF)的相关性。结果dERM组、对照组患者CMT、黄斑容积、黄斑区平均厚度、SII、血清白蛋白、ACR比较,差异均有统计学意义(Z=−7.234、−6.306、−6.400、−3.063、−2.631、−3.868,P<0.05)。条件logistics回归分析结果显示,高SII[比值比(OR)=3.919,95%可信区间(CI)1.591~9.654,P=0.003]、ACR(OR=4.432,95%CI 1.885~10.420,P=0.001)是dERM发生的危险因素。Spearman相关性分析结果显示,HRF、IRC、DRIL与CMT呈正相关(Rs=0.234、0.330、0.248,P=0.036、0.003、0.026);HRF与SII、ACR呈正相关(Rs=0.233、0.278,P=0.036、0.012)。结论SII、ACR升高是dERM发生的独立危险因素。

Objective To investigate the correlation between systemic immune inflammatory index(SII)and other metabolic indicators and diabetic epiretinal membranes(dERM).Methods A retrospective case-control study.From March 2022 to July 2023,81 patients(81 eyes)with dERM in Department of Ophthalmology,Affiliated Jinhua Hospital of Zhejiang University of Medicine School diagnosed by fundus screening were included in the study.A total of 81 patients(81 eyes)with diabetes who were matched in age,gender,and duration of diabetes and had no dERM or diabetic macular edema in both eyes during fundus screening were selected as the control group.All patients underwent optical coherence tomography(OCT)examination and laboratory tests for peripheral blood neutrophil,lymphocyte,platelet counts,serum albumin,blood lipids,uric acid,and glycosylated hemoglobin(HbA1c).SII was calculated.Random urine samples were collected for urinary albumin/creatinine ratio(ACR)testing.The OCT device's own analysis software obtained the macular volume coefficient,including central foveal thickness(CMT),macular volume,and average macular thickness.The macular volume coefficient,SII,serum albumin,blood lipids,uric acid,HbA1c,and ACR between the two groups were compared using paired t tests or Mann-Whitney U tests.Conditional logistic regression analysis was performed to evaluate the risk factors for dERM;Spearman correlation test was used to analyze the correlation between CMT,SII,ACR,disorganization of retinal inner layers(DRIL),intraretinal cyst(IRC),and hyper-reflective foci(HRF)in patients with dERM.Results There were significant differences in CMT,macular volume,average macular thickness,SII,serum albumin,and ACR between the dERM group and the control group(Z=−7.234,−6.306,−6.400,−3.063,−2.631,−3.868;P<0.05).Conditional logistics regression analysis showed that high SII[odds ratio(OR)=3.919,95%confidence interval(CI)1.591-9.654,P=0.003]and ACR(OR=4.432,95%CI 1.885-10.420,P=0.001)were risk factors for dERM.Spearman correlation analysis showed that HRF,IRC,DRIL were positively correlated with CMT(Rs=0.234,0.330,0.248;P=0.036,0.003,0.026);HRF was positively correlated with SII and ACR(Rs=0.233,0.278;P=0.036,0.012).Conclusion Elevated SII and ACR are independent risk factors for the occurrence of dERM.