基于SII、ESR及血清炎症因子构建感染性心内膜炎患者不良预后预测模型  

A predictive model for poor prognosis based on systemic immune inflammation index,erythrocyte sedimentation rate nd serum inflammatory factors in patients with infective endocarditis

作　　者：张晓猛 张伟[1] 王慧[1] 石晓卉[1] 杨舒婷 宗玉珍 Zhang Xiaomeng;Zhang Wei;Wang Hui;Shi Xiaohui;Yang Shuting;Zong Yuzhen(Department of Severe Heart Disease,People's Hospital,Xinjiang Uygur Autonomous Region,Urumchi 830001,China;不详)

机构地区：[1]新疆维吾尔自治区人民医院心脏重症科,乌鲁木齐830001 [2]新疆维吾尔自治区人民医院临床检验中心,乌鲁木齐830001 [3]新疆维吾尔自治区人民医院心脏外二科,乌鲁木齐830001

出　　处：《中国循证心血管医学杂志》2024年第10期1203-1207,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：新疆维吾尔自治区自然科学基金(2020D01C096)。

摘　　要：目的探究感染性心内膜炎患者系统免疫炎症指数(SII)、红细胞沉降率(ESR)及血清炎症因子表达水平特征并构建不良预后预测模型。方法选取2021年1月至2023年3月于新疆维吾尔自治区人民医院收治的感染性心内膜炎患者144例作为研究对象。根据患者治疗后6个月内预后情况分为预后良好组(n=112)和预后不良组(n=32),比较两组患者一般临床资料[年龄、性别比例、体质指数、吸烟史、饮酒史、高血压病史、2型糖尿病病史、累及心脏瓣膜位置、累及心脏瓣膜数量、纽约心脏病协会(NYHA)分级、起病至就诊时间]及炎症指标[ESR、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、降钙素原(PCT)、C反应蛋白(CRP)、预后营养指数(PNI)、SII]的差异。通过Spearman相关性分析及Logistic回归分析筛选感染性心内膜炎患者预后不良的危险因素并构建预测列线图。通过ROC曲线、校准曲线及决策曲线分析(DCA)评价该预测模型的效能及准确性。结果预后不良组患者中2型糖尿病患者比例、NYHAⅢ~Ⅳ级比例均显著高于预后良好组患者(P<0.05),平均ESR、IL-6、PCT、SII水平均显著较高(P<0.05),而平均PNI水平显著较低(P<0.05)。Spearman相关性分析表明合并2型糖尿病(r=0.166,P=0.047)、NYHAⅢ~Ⅳ级(r=0.168,P=0.044)、ESR(r=0.381,P<0.001)、IL-6(r=0.281,P=0.001)、PCT(r=0.227,P=0.006)、SII(r=0.323,P<0.001)水平与患者预后不良呈正相关,PNI水平与预后不良呈负相关(r=-0.324,P<0.001)。Logistic回归分析表明ESR(OR=1.17,95%CI:1.02~1.96,P=0.043)、IL-6(OR=1.18,95%CI:1.02~1.86,P=0.047)、PCT(OR=5.92,95%CI:1.94~7.30,P=0.038)及SII(OR=1.21,95%CI:1.01~3.01,P=0.003)水平较高,PNI水平较低(OR=0.86,95%CI:0.77~0.95,P=0.006)均是感染性心内膜炎患者预后不良的危险因素。ROC曲线[AUC=0.892(0.827~0.957)]、校准曲线及DCA曲线表明该预测模型具有较高预测效能和准确性。结论ESR、IL-6、PCT、SII等炎症指标升高及PNI降�Objective To investigate the characteristics of expressions of systemic immune inflammation index(SII),erythrocyte sedimentation rate(ESR)and serum inflammatory factors in patients with infective endocarditis(IE),and to establish a predictive model for poor prognosis.Methods IE patients(n=144)were chosen from People's Hospital,Xinjiang Uygur Autonomous Region from Jan 2021 to Mar.2023.All patients were divided,according to prognosis status within 6 months after treated,into good prognosis group(n=112)and poor prognosis group(n=32).The general clinical materials[age,gender,body mass index(BMI),history of smoking,drinking,hypertension and type 2 diabetes mellitus(T2DM),position and number of involved heart valves,heart function classification of New York Heart Association(NYHA grades),time from disease onset to hospital visit],and inflammatory indexes[ESR,interleukin-6(IL-6),interleukin-8(IL-8),procalcitonin(PCT),C-reactive protein(CRP),prognostic nutrition index(PNI)and SII]were compared between 2 groups.The risk factors of poor prognosis were screened by using Spearman correlation analysis,and Logistic regression analysis and a predictive model was established.The efficacy and accuracy of the predictive model were reviewed by using ROC curve analysis,calibration curve and decision curve analysis(DCA).Results The percentages of T2DM and gradesⅢtoⅣof NYHA were significantly higher(P<0.05),levels of ESR,IL-6,PCT and SII were significantly higher(P<0.05),and PNI level was significantly lower(P<0.05)in poor prognosis group.The results of Spearman correlation analysis showed that T2DM(r=0.166,P=0.047),gradesⅢtoⅣof NYHA(r=0.168,P=0.044),ESR(r=0.381,P<0.001),IL-6(r=0.281,P=0.001),PCT(r=0.227,P=0.006)and SII(r=0.323,P<0.001)were positively correlated to poor prognosis,and PNI(r=-0.324,P<0.001)was negatively correlated to poor prognosis.The results of Logistic regression analysis showed that higher levels of ESR(OR=1.17,95%CI:1.02~1.96,P=0.043),IL-6(OR=1.18,95%CI:1.02~1.86,P=0.047),PCT(OR=5.92,95%CI:1.94~7.30,P=0.0

关 键 词：感染性心内膜炎 系统免疫炎症指数 炎症因子 预后评估 

分 类 号：R542.41[医药卫生—心血管疾病]