系统免疫炎症指数与成人糖尿病患者全因及心血管疾病死亡率的相关性研究

Correlation of systemic immune-inflammatory index with all-cause and cardiovascular disease mortality in adults with diabetes mellitus

目的探讨成人糖尿病患者的系统免疫炎症指数(SII)与全因死亡率及心血管疾病(CVD)死亡率的相关性。方法本研究为队列研究。纳入2005至2018年美国国家健康与营养调查中3170例成人糖尿病患者进行回顾性研究,收集研究对象的性别、年龄、种族、体重指数、吸烟状况、糖尿病病程、丙氨酸转氨酶、血肌酐、估算的肾小球滤过率、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白,以及高血压、CVD、慢性阻塞性肺疾病、糖尿病肾脏病的患病情况,通过截止至2019年12月31日的国家死亡指数来确定死亡率结果。建立Cox风险模型研究SII与全因死亡率、CVD死亡率之间的关联,使用限制性立方样条探索非线性关系,构建拐点两侧的分段线性回归进行验证,加权Kaplan-Meier曲线和亚组分析用于描述SII与全因死亡率和CVD死亡率的相关性。结果在中位随访6.58年期间,发生了632例全因死亡和179例CVD死亡。在调整性别、年龄、种族、体重指数、吸烟状况、糖尿病病程、丙氨酸转氨酶、血肌酐、估算的肾小球滤过率、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、高血压、CVD、慢性阻塞性肺疾病、糖尿病肾脏病等协变量后,Cox回归分析结果显示,较高的SII与全因及CVD死亡风险相关。lnSII每增加1个单位,全因及CVD死亡风险分别升高40%(HR=1.40)、123%(HR=2.23)(P<0.05)。SII与全因及CVD死亡率之间呈U型相关,lnSII的阈值分别是6.528和6.124,当lnSII高于阈值时与死亡率呈正相关(全因死亡HR 3.03,95%CI 2.29~4.00;CVD死亡HR 3.07,95%CI 2.12~4.44,P<0.001)。加权Kaplan-Meier曲线显示,较高的SII个体全因及CVD死亡风险明显升高(P<0.001)。结论SII可能是预测成人糖尿病患者全因、CVD死亡风险有价值的潜在工具,SII与死亡率之间呈U型相关,尤其对于血糖控制基本达标的糖尿病人群,SII作为炎症标志物对于CVD风险的预测更有意义。

Objective To investigate the association between baseline systemic immune inflammation index(SII)and all-cause and cardiovascular disease(CVD)mortality in adults with diabetes mellitus.Methods This study was a cohort study.A retrospective study of 3170 adults with diabetes mellitus from the 2005—2018 National Health and Nutrition Examination Survey was included,the clinical data such as sex,age,race,body mass index,smoking status,duration of diabetes mellitus,alanine aminotransferase,serum creatinine,estimated glomerular filtration rate,triglyceride,total cholesterol,low-density lipoprotein cholesterol,glycated hemoglobin A 1c,hypertension,cardiovascular disease,chronic obstructive pulmonary disease,and diabetic renal disease were collected,and mortality outcomes were determined by the National Death Index as of 31 December 2019.A Cox risk model was constructed to examine the association between SII and all-cause and CVD mortality,using restricted cubic spline to explore non-linear correlations and constructing segmented linear regressions on either side of the inflection point for validation.Weighted Kaplan-Meier curves and subgroup analyses to characterise the association of SII with all-cause and CVD mortality.Results During a median follow-up of 6.58 years,there were 632 deaths from all causes and 179 deaths from CVD.After adjusting for covariates including sex,age,race,body mass index,smoking status,duration of diabetes mellitus,alanine aminotransferase,serum creatinine,estimated glomerular filtration rate,triglyceride,total cholesterol,low-density lipoprotein cholesterol,glycated hemoglobin A 1c,hypertension,cardiovascular disease,chronic obstructive pulmonary disease,and diabetic renal disease,the Cox regression analysis results showed that higher SII was associated with the risk of all-cause and CVD deaths associated.For each 1-unit increase in lnSII,the risk of all-cause and CVD mortality was elevated by 40%(HR=1.40)and 123%(HR=2.23),respectively(P<0.05).There was a U-shaped correlation between SII and all-cause and CVD mortality,with thresholds of 6.528 and 6.124 for lnSII,respectively,and a positive correlation with mortality when lnSII was higher than the thresholds(all-cause mortality HR 3.03,95%CI 2.29-4.00,CVD mortality HR 3.07,95%CI 2.12-4.44,P<0.001).Weighted Kaplan-Meier curves showed that individuals with higher SII had a significantly higher risk of all-cause and CVD mortality(P<0.001).Conclusions The SII may be a valuable potential tool for predicting the risk of all-cause and CVD mortality in adults with diabetes mellitus.The relationship between SII and mortality showed a U-shaped correlation,especially for the diabetic population with basic glycemic control,SII as an inflammatory marker is more predictive of CVD risk.