全身免疫炎症指数与慢性阻塞性肺疾病急性加重期病情严重程度相关性分析

doi:10.3877/cma.j.issn.1674-6902.2024.04.014

目的

分析全身免疫炎症指数(systemic immune-inflammation index, SII)与慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)病情严重程度的相关性。

方法

选择2023年3月至2024年3月在上海杨思医院及上海市浦东新区浦南医院呼吸科收治的174例中、重度AECOPD患者为对象，中度AECOPD患者90例为对照组、重度AECOPD患者84例为观察组；记录患者入院时、入院第10天的血常规、血清C反应蛋白(C-reactive protein, CPR)、血清降钙素原(procalcitonin, PCT)、动脉氧分压(arterial oxygen pressure, PaO₂)、动脉氧二氧化碳分压(partial pressure of carbon dioxide in arterial blood, PaCO₂)、呼吸困难评分，比较两组治疗前、后指标差异，及SII与其他指标相关性。

结果

入院时对照组SII (1354.5±324.5)×10⁹/L、血清CRP(60.2±16.4)mg/L、血清PCT(3.26±0.58)ng/ml、pH(7.18±2.11)、PaO₂(55.9±13.8)mmHg、PaCO₂(56.6±16.8)mmHg、氧合指数(266.4±60.2)mmHg、呼吸困难评分(2.54±0.51)分，观察组(1 892.3±511.2)×10⁹/L、(78.3±20.1)mg/L、(7.32±2.21)ng/ml、(7.09±2.16)、(46.5±11.4)mmHg、(76.5±23.4)mmHg、(222.1±45.5)mmHg、(3.44±0.66)分；入院第10天，对照组SII (667.1±156.1)×10⁹/L、血清CRP(25.4±5.4)mg/L、血清PCT(1.49±0.39)ng/ml、pH(7.34±2.32)、PaO₂(76.2±18.8)mmHg、PaCO₂(45.7±14.2)mmHg、氧合指数(362.8±88.7)mmHg、呼吸困难评分(1.08±0.36)分，观察组(987.2±261.3)×10⁹/L、(33.2±10.9)mg/L、(2.11±0.90)ng/ml、(7.32±2.21)、(66.2±15.3)mmHg、(55.3±17.8)mmHg、(318.3±73.5)mmHg、(2.15±0.59)分。两组入院时和入院第10天，SII、血清CRP、血清PCT、pH、PaO₂、PaCO₂、氧合指数、呼吸困难评分差异有统计学意义(P<0.05)；两组入院时与第10天指标差异有统计学意义(P<0.05)。两组入院时及入院第10天SII与血清CRP、PCT、PaCO₂、呼吸困难评分呈正相关性，与pH、PaO₂、氧合指数呈负相关性。观察组生存74例(88.10%)，死亡10例(11.90%)；对照组生存88例(97.78%)，死亡2例(2.22%)，观察组病死率高于对照组(P<0.05)。

结论

SII与AECOPD病情严重程度呈正相关性，病情越重SII越高。

关键词: 急性加重期，肺疾病，慢性阻塞性, 全身免疫炎症指数, 病情严重程度

Objective

To analyze the correlation between systemic immune-inflammation index (SII) and severity of moderate-severe patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods

A total of 174 patients with AECOPD hospitalized in respiratory wards of Shanghai Yangsi Hospital and Shanghai Pudong New District Punan Hospital from March, 2023 to March, 2024 were selected as study participants. According to severity of AECOPD, all the participants were divided into control group (n=90), and observation group (n=84). Routine blood test, serum C-reactive protein (CRP), serum procalcitonin (PCT), arterial blood gas analysis, dyspnea scores, and SII, were recorded for two groups, at admission and 10 days after admission. The abovementioned parameters were compared between two groups, before and after treatment. Correlation between the SII and other parameters was analyzed.

Results

At the admission, control group SII (1 354.5±324.5)×10⁹/L, CRP(60.2±16.4)mg/L, PCT(3.26±0.58)ng/ml, pH(7.18±2.11), PaO₂(55.9±13.8)mmHg, PaCO₂(56.6±16.8)mmHg, oxygenation index(266.4±60.2)mmHg、dyspnea score (2.54±0.51). observation group(1 892.3±511.2)×10⁹/L, (78.3±20.1)mg/L, (7.32±2.21)ng/ml, (7.09±2.16), (46.5±11.4)mmHg, (76.5±23.4)mmHg, (222.1±45.5)mmHg, (3.44±0.66); 10 days after the admission, control group SII (667.1±156.1)×10⁹/L, CRP(25.4±5.4)mg/L, PCT(1.49±0.39)ng/ml, pH(7.34±2.32), PaO₂(76.2±18.8)mmHg, PaCO₂(45.7±14.2)mmHg, oxygenation index(362.8±88.7)mmHg, dyspnea score(1.08±0.36), observation group(987.2±261.3)×10⁹/L, (33.2±10.9)mg/L, (2.11±0.90)ng/ml, (7.32±2.21), (66.2±15.3)mmHg, (55.3±17.8)mmHg, (318.3±73.5)mmHg, (2.15±0.59). There were statistical differences between pairwise comparison among the control group and observation group, in the SII, serum CRP, serum PCT, pH, PaO₂, PaCO₂, oxygenation index and dyspnea score, at the admission and 10 days after the admission, respectively (P<0.05). The abovementioned parameters at the admission were statistically different from those 10 days after the admission, in each group (P<0.05). The SII was positively correlated with the serum CRP, PCT, PaCO₂ and dyspnea score, whereas negatively correlated with the pH, PaO₂ and oxygenation index, at the admission and 10 days after the admission, for the two groups. In the observation group, 74 cases survived(88.10%), 10 cases death (11.90%). In the control group, 88 cases survived(97.78%), 2 cases death (2.22%), the mortality rate of the observation group was statistically higher than control group (P<0.05).

Conclusions

There is a definite positive correlation between SII and severity of moderate-severe patients with AECOPD. The severer the AECOPD, the higher the SII.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Systemic immune-inflammation index, Severity

表1 两组AECOPD患者SII、血清CRP、PCT、动脉血气、呼吸评分结果(

±s)

检测指标	对照组(n＝90)		观察组(n＝84)
检测指标	入院时	入院第10天	入院时	入院第10天
SII(×10⁹/L)	1 354.5±324.5	667.1±156.1^a	1 892.3±511.2^a	987.2±261.3^bc
血清CPR(mg/L)	60.2±16.4	25.4±5.4^a	78.3±20.1^a	33.2±10.9^bc
血清PCT(ng/ml)	3.26±0.58	1.49±0.39^a	7.32±2.21^a	2.11±0.90^bc
pH	7.18±2.11	7.34±2.32^a	7.09±2.16^a	7.32±2.21^bc
PaO₂(mmHg)	55.9±13.8	76.2±18.8^a	46.5±11.4^a	66.2±15.3^bc
PaCO₂(mmHg)	56.6±16.8	45.7±14.2^a	76.5±23.4^a	55.3±17.8^bc
氧合指数(mmHg)	266.4±60.2	362.8±88.7^a	222.1±45.5^a	318.3±73.5^bc
呼吸困难评分(分)	2.54±0.51	1.08±0.36^a	3.44±0.66^a	2.15±0.59^bc

表1 两组AECOPD患者SII、血清CRP、PCT、动脉血气、呼吸评分结果(

±s)

检测指标	对照组(n＝90)		观察组(n＝84)
检测指标	入院时	入院第10天	入院时	入院第10天
SII(×10⁹/L)	1 354.5±324.5	667.1±156.1^a	1 892.3±511.2^a	987.2±261.3^bc
血清CPR(mg/L)	60.2±16.4	25.4±5.4^a	78.3±20.1^a	33.2±10.9^bc
血清PCT(ng/ml)	3.26±0.58	1.49±0.39^a	7.32±2.21^a	2.11±0.90^bc
pH	7.18±2.11	7.34±2.32^a	7.09±2.16^a	7.32±2.21^bc
PaO₂(mmHg)	55.9±13.8	76.2±18.8^a	46.5±11.4^a	66.2±15.3^bc
PaCO₂(mmHg)	56.6±16.8	45.7±14.2^a	76.5±23.4^a	55.3±17.8^bc
氧合指数(mmHg)	266.4±60.2	362.8±88.7^a	222.1±45.5^a	318.3±73.5^bc
呼吸困难评分(分)	2.54±0.51	1.08±0.36^a	3.44±0.66^a	2.15±0.59^bc

表2 两组AECOPD患者SII与血清CRP、PCT、动脉血气、呼吸评分相关性

检测指标	对照组(n＝90)		观察组(n＝84)
检测指标	入院时	入院第10天	入院时	入院第10天
血清CPR(mg/L)	0.632	0.615	0.572	0.642
血清PCT(ng/ml)	0.589	0.582	0.625	0.663
pH	－0.645	－0.587	－0.598	－0.712
PaO₂(mmHg)	－0.556	－0.639	－0.652	－0.711
PaCO₂(mmHg)	0.699	0.597	0.645	0.704
氧合指数(mmHg)	－0.611	－0.649	－0.667	－0.608
呼吸困难评分(分)	0.655	0.602	0.725	0.701

表2 两组AECOPD患者SII与血清CRP、PCT、动脉血气、呼吸评分相关性

检测指标	对照组(n＝90)		观察组(n＝84)
检测指标	入院时	入院第10天	入院时	入院第10天
血清CPR(mg/L)	0.632	0.615	0.572	0.642
血清PCT(ng/ml)	0.589	0.582	0.625	0.663
pH	－0.645	－0.587	－0.598	－0.712
PaO₂(mmHg)	－0.556	－0.639	－0.652	－0.711
PaCO₂(mmHg)	0.699	0.597	0.645	0.704
氧合指数(mmHg)	－0.611	－0.649	－0.667	－0.608
呼吸困难评分(分)	0.655	0.602	0.725	0.701

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Correlation analysis between systemic immune-inflammation index and severity of acute exacerbation of chronic obstructive pulmonary disease

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Correlation analysis between systemic immune-inflammation index and severity of acute exacerbation of chronic obstructive pulmonary disease