系统免疫炎症指数对肿瘤坏死因子拮抗剂治疗类风湿关节炎的疗效预测价值  

The predictive value of the systemic immune inflammatory index on the efficacy of tumor necrosis factor antagonists in the treatment of rheumatoid arthritis

作　　者：刘亚静 徐胜珍[2] 武智强[1] 李海燕[2] 赵旭 李红宁 LIU Yajing;XU Shengzhen;WU Zhiqiang;LI Haiyan;ZHAO Xu;LI Hongning(Department of Clinical Laboratory,Baoding First Chinese Triditional Medicine Hospital,Baoding 071000,Hebei,China;Department of Nephrology and Rheumatology,Baoding First Chinese Triditional Medicine Hospital,Baoding 071000,Hebei,China)

机构地区：[1]保定市第一中医院检验科,河北保定071000 [2]保定市第一中医院肾病风湿科,河北保定071000

出　　处：《西部医学》2023年第3期432-437,共6页Medical Journal of West China

基　　金：保定市科技计划项目(2041ZF124)。

摘　　要：目的探讨系统免疫炎症指数(SII)对肿瘤坏死因子拮抗剂治疗类风湿关节炎(RA)的疗效预测价值。方法选取2019年1月—2021年6月我院收治的200例RA患者,根据患者接受肿瘤坏死因子拮抗剂治疗后的疗效分为无效组42例和有效组158例。对比两组患者的基线资料、血常规指标、疾病活动性评分(DAS28)、视觉模拟评分(VAS)、晨僵时长以及不良反应,分析肿瘤坏死因子拮抗剂治疗RA的疗效与临床病理特征的关系,绘制SII预测肿瘤坏死因子拮抗剂疗效的ROC曲线并确定SII的最佳临界值,分析SII临界值与肿瘤坏死因子拮抗剂疗效的关系,COX回归分析临床病理特征与肿瘤坏死因子拮抗剂疗效的预测因素。以预测因素建立预测模型,其中模型一不包含SII值,模型二包含全部因素,对两个预测模型进行Hosmer-Lemeshow检验。结果200例患者的治疗总有效率为79.00%。治疗前,两组患者DAS28、VAS和晨僵时长比较差异无统计学意义(P>0.05);治疗后,有效组DAS28、VAS、晨僵时长均小于无效组,且均小于治疗前,差异具有统计学意义(均P<0.05)。SII值对肿瘤坏死因子拮抗剂的疗效预测价值较高,ROC曲线下面积为0.874(95%CI:0.792~0.963,P<0.001),灵敏度为81.2%,特异性为78.8%,C-index为0.947(95%CI:0.880~0.989,P<0.001),最佳临界值为710.28。患者的SII水平越低,肿瘤坏死因子拮抗剂的疗效越好。COX回归分析显示中性粒细胞计数(N)、血小板计数(PLT)、淋巴细胞计数(L)、SII、C-反应蛋白(CRP)、类风湿因子(RF)、红细胞沉降率(ESR)、CCP、DAS28、VAS与晨僵时长均具有一定的肿瘤坏死因子拮抗剂疗效预测能力(P<0.05)。预测模型一P值为0.763,预测模型二P值为0.975,均提示拟合优度良好。结论SII对肿瘤坏死因子拮抗剂治疗RA的疗效具有预测价值。Objective To explore the predictive value of the systemic immune inflammation index(SII)on the efficacy of tumor necrosis factor antagonists in the treatment of rheumatoid arthritis(RA).Methods A total of 200 RA patients admitted to our hospital from January 2019 to June 2021 were selected and divided into ineffective group(42 cases)and effective group(158 cases)according to the efficacy of tumor necrosis factor antagonist treatment.Baseline data,blood routine indicators,disease activity score(DAS28),visual analogue scale(VAS),morning stiffness duration and adverse reactions were compared between the two groups.The relationship between the efficacy of tumor necrosis factor antagonist in the treatment of RA and clinicopathological features was analyzed.The ROC curve of SII for predicting the efficacy of TNF-antagonist was drawn and the optimal cut-off value of SII was determined.The relationship between the cut-off value of SII and the efficacy of TNF-antagonist was analyzed.The clinicopathological characteristics and predictors of TNF-antagonist efficacy were analyzed by COX regression.The prediction model was built with the predictors,model one did not include SII value,and model two included all factors.The Hosmer-Lemeshow test was used to investigate the two prediction models.Results The total effective rate of treatment for 200 patients was 79.00%.Before treatment,there was no significant difference in DAS28,VAS and morning stiffness duration between the two groups(P>0.05).After treatment,the DAS28,VAS and morning stiffness duration in the effective group were less than those in the ineffective group,and the difference was statistically significant(all P<0.05).The SII value has a high predictive value for the efficacy of tumor necrosis factor antagonists.The area under the ROC curve is 0.874(95%CI:0.792~0.963,P<0.001),the sensitivity is 81.2%,and the specificity is 78.8%,C-index is 0.947(95%CI:0.880~0.989,P<0.001),and the best critical value is 710.28.The lower the patient’s SII level,the better the efficac

关 键 词：系统免疫炎症指数 肿瘤坏死因子拮抗剂 类风湿关节炎 炎症 自身免疫 

分 类 号：R593.22[医药卫生—内科学]