全身免疫炎症指数与维持性血液透析患者蛋白质能量消耗及预后的关系  

Association of systemic immune-inflammation index with protein-energy wasting and prognosis in patients on maintenance hemodialysis

作　　者：冉燕[1] 吴琴宁 龙艳君[1] 李倩[1] 吴静[1] 达静静[1] 何平红[1] 袁静[1] 查艳[1] Ran Yan;Wu Qinning;Long Yanjun;Li Qian;Wu Jing;Da Jingjing;He Pinghong;Yuan Jing;Zha Yan(Department of Nephrology,Guizhou Provincial People′s Hospital,Guiyang 550002,China;Hemodialysis Center,the Second People′s Hospital of Guizhou Province,Guiyang 550004,China)

机构地区：[1]贵州省人民医院肾内科,贵阳550002 [2]贵州省第二人民医院血液透析室,贵阳550004

出　　处：《中华医学杂志》2021年第28期2223-2227,共5页National Medical Journal of China

基　　金：贵州省高层次创新人才项目(黔科合平台人才(2018)5636号);贵州省人民医院青年基金(GZSYQN[2018]11)。

摘　　要：目的探讨全身免疫炎症指数(SII)与维持性血液透析(MHD)患者蛋白质能量消耗(PEW)及预后的相关性。方法队列研究。纳入2019年7至9月就诊于贵州省11家血液透析中心并行MHD的患者,将患者按照是否存在PEW分为PEW组和非PEW组。随访12个月,患者死亡为终点事件。采用多因素logistic回归分析MHD患者发生PEW的独立相关因素,采用受试者工作特征(ROC)曲线分析SII对MHD患者PEW的预测价值,计算SII的最佳临界值,应用Kaplan-Meier法绘制生存曲线,log-rank检验比较组间生存率的差异。结果共纳入859例MHD患者,男540例(62.9%),女319例(37.1%),年龄(54±15)岁;PEW组220例(25.6%),非PEW组639例(74.4%)。PEW组SII值高于非PEW组[600(440,915)比475(353,633),P<0.01],差异有统计学意义。多因素logistic回归分析结果显示,SII为PEW的独立相关因素之一(OR=1.001,95%CI:1.000~1.002,P=0.02)。ROC曲线分析结果显示,SII预测MHD患者PEW的灵敏度为69%,特异度为70%,曲线下面积(AUC)为0.725(95%CI:0.683~0.766)。859例患者进行12个月随访,45例死亡(病死率5.24%)。Kaplan-Meier分析结果显示,SII>520组的1年累积生存率(92.3%)低于SII≤520组(97.1%),两组之间累积生存率差异有统计学意义(χ_(2)_(log-rank)=9.707,P=0.002)。进一步行亚组分析显示,合并PEW的MHD患者中,SII>520组累积生存率(88.5%)也低于SII≤520组(92.3%),两组之间累积生存率差异有统计学意义(χ_(2)_(log-rank)=7.226,P=0.007)。结论SII为MHD患者发生PEW的独立相关因素,SII水平越高,患者长期生存率越低,预后越差。Objective To explore the association of systemic immune-inflammation index(SII)with protein-energy wasting(PEW)and prognosis in maintenance hemodialysis(MHD)patients.Methods A multicenter cohort study was conducted in 11 hemodialysis centers of Guizhou province from July to September 2019.The patients were divided into the PEW group and non-PEW group.After 12 months of follow-up,death was the endpoint event.Multivariate logistic regression analysis was used to assess the independent risk factors of PEW in MHD patients.The receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of SII for PEW,and the optimal cut-off value of SII was calculated.The Kaplan-Meier method was used to draw the survival curve,and log-rank test was employed to compare the difference of survival rate between the two groups.Results A total of 859 patients were included[540 males and 319 females,aged(54±15)years],and there were 220 cases(25.6%)and 639 cases(74.4%)in PEW and non-PEW groups,respectively.SII was higher in the PEW group than that of the non-PEW group[600(440,915)vs 475(353,633),P<0.01].Multivariate logistic regression analysis showed that SII was an independent predictor for PEW(OR=1.001,95%CI:1.000-1.002,P=0.02).ROC curve analysis showed that the area under the curve for SII to predict PEW in MHD patients was 0.725(95%CI:0.683-0.766),with the sensitivity and specificity of 69%and 70%,respectively.All patients were followed up for 12 months,and 45 died(with a mortality rate of 5.24%).Patients were divided into SII>520 group and SII≤520 group according to the optimal cut-off value,and subsequent Kaplan-Meier survival analysis showed that the 1-year cumulative survival rate of the SII>520 group(92.3%)was lower than that of SII≤520 group(97.1%)(χ_(2)_(log-rank)=9.707,P=0.002).Further subgroup analysis revealed that,in PEW patients with MHD,the 1-year cumulative survival rate of the SII>520 group(88.5%)was also lower than that of SII≤520 group(92.3%)(χ_(2)_(log-rank)=7.226,P=0.007

关 键 词：肾透析 蛋白质能量消耗 全身免疫炎症指数 预后 

分 类 号：R459.5[医药卫生—治疗学]