目的：探讨全身免疫炎症指数（systemic immune inflammatory index,SII）对慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）患者主要不良心脏事件（major adverse cardiac events,MACE）的评判价值。方法：本研究是一项回顾性观察队列研究。从2020年1月至2023年1月,连续招募了376例在本院住院的AECOPD患者作为研究对象。主要结局是SII测量后180天内出现MACE的时间。所有患者入院后进行血常规检查,并计算SII。结果：35例（9.3%）患者在出院后180天内发生了MACE事件,包括22例非致死性心肌梗死、5例靶血管血运重建、8例需要住院治疗的不稳定型心绞痛。与无MACE患者相比,MACE患者的年龄,心率,合并肝脏疾病、心力衰竭、慢性肾病例数,接受无创机械通气、有创机械通气例数,以及SII、高敏肌钙蛋白（high-sensitivity troponin,hsTrop）水平显著增加,和收缩压、白蛋白、红细胞压积水平均显著降低。多变量分析,SII（HR=1.004,95%CI：1.003~1.005）可作为MACE事件发生的独立影响因素。根据SII三分位数比较患者的MACE事件发生风险,结果显示从T1到T3组MACE事件的发生率显著增加[Log Rank (Mantel-Cox)=29.655,P<0.001],T3组MACE事件的发生风险较T1组、T2组增加了6.4倍、5.2倍。入院时hsTrop水平与SII水平呈显著正相关性（r=0.248,P<0.001）。ROC分析显示,SII（截断值为552）预测MACE事件的AUC为0.792（95%CI：0.701~0.884）,敏感度为74.3%,特异度为71.3%。结论：SII水平升高可能是预测AECOPD患者MACE事件的有用工具。
Abstract
Objective To explore the evaluation value of systemic immune inflammatory index (SII) on major adverse cardiac events (MACE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This study was a retrospective cohort study. From January 2020 to January 2023, 376 AECOPD patients hospitalized in our hospital were recruited as the research object. The main outcome was the time when MACE appeared within 180 days after SII measurement. All patients were examined by routine blood tests after admission and SII was calculated. Results MACE events occurred in 35 patients (9.3%) within 180 days after discharge, including 22 cases of nonfatal myocardial infarction, 5 cases of target vessel revascularization and 8 cases of unstable angina requiring hospitalization. Compared with patients without MACE, the age, heart rate, the number of patients complicated with liver diseases, heart failure and chronic kidney disease, the number of patients receiving non-invasive mechanical ventilation and invasive mechanical ventilation, the levels of SII and high-sensitivity troponin (hsTrop) increased significantly, and the average systolic blood pressure, albumin and hematocrit decreased significantly. Multivariate analysis showed that SII (HR=1.004, 95%CI: 1.003-1.005) could be used as an independent influencing factor of MACE. The risk of MACE events in patients was compared according to the quartile of SII. The results showed that the incidence of MACE events in T1 to T3 group increased significantly [Log Rank (Mantel-Cox)=29.655, P<0.001], and the risk of MACE events in T3 group increased by 6.4 times and 5.2 times compared with that in T1 and T2 groups. There was a significant positive correlation between hsTrop level and SII level at admission (r=0.248, P<0.001). ROC analysis shows that the AUC of SII (cut-off value was 552) in predicting MACE events was 0.792(95%CI: 0.701-0.884), with sensitivity of 74.3% and specificity of 71.3%. Conclusion The increase of SII level may be a useful tool to predict MACE events in patients with AECOPD.
关键词
全身免疫炎症指数 /
慢性阻塞性肺疾病急性加重 /
主要不良心脏事件 /
高敏肌钙蛋白
Key words
systemic immune inflammatory index /
acute exacerbation of chronic obstructive pulmonary disease /
major adverse cardiac events /
high-sensitivity troponin
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基金
河北省中医药管理局科研计划项目“全身免疫炎症指数对AE-COPD患者主要不良心脏事件的评判价值”（2024312）
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