目的：探讨尿酸联合系统免疫炎症指数（systemic immune-inflammation index,SII）与脑卒中高危患者颈动脉病变程度和预后的关系。方法：这项单中心回顾性研究分析了2018年1月至2019年1月期间于本院接受颈动脉支架植入术（carotid stent implantation,CAS）的129名患者。SII定义为外周血小板计数×中性粒细胞计数/淋巴细胞计数。该研究的主要终点是长期（从出院到5年随访）主要不良心脑血管事件（major adverse cardiovascular eventsts,MACCE）的发生率,包括全因死亡率、卒中和心肌梗死。次要终点是住院期间和长期随访期间的卒中发生率以及全因死亡。结果：根据SII三分位数将患者分为三组（Q1、Q2、Q3）,三组在斑块面积、血小板、中性粒细胞、白细胞、尿酸、SII水平存在显著差异。Q1到Q3组的卒中、MACCE发生率逐渐增加,较高的SII水平与较高的发生率相关。Kaplan-Meier曲线显示,根据SII的增加,MACCE的累积发生率逐渐增加[Log Rank （Mantel-Cox）=13.128,P=0.001]。Cox回归分析显示,SII[风险比（HR）=1.004,95%CI：1.002~1.006]、年龄（HR=1.107,95%CI：1.018~1.203）、尿酸（HR=1.004,95%CI：1.001~1.007）是与长期MACCE发病率相关的独立影响因素。Pearson相关性分析显示,SII与尿酸水平（r=0.226,P=0.011）和斑块大小（r=0.274,P=0.003）呈显著正相关性。ROC分析显示,SII的AUC为0.741（95%CI：0.616~0.866;P<0.001）,和尿酸的AUC为0.723（95%CI：0.604~0.843;P<0.001）,二者联合的AUC显著提高（0.910,95%CI：0.843~0.977;P<0.001）。结论：SII和尿酸水平增加是接受CAS卒中高危患者长期MACCE发生的独立预测因子,并且二者联合应用在识别长期MACCE方面具有较高应用价值。
Abstract
Objective To explore the relationship between uric acid combined with systemic immune inflammatory index (SII) and the severity and prognosis of carotid artery lesions in high-risk patients with stroke. Methods This single-center retrospective study analyzed 129 patients who received carotid artery stenting (CAS) in our hospital from January 2018 to January 2019. SII was defined as peripheral platelet count × neutrophil/lymphocyte count. The main end point of this study was the incidence of major adverse cerebrovascular events (MACCE) in the long term (from discharge to 5-year follow-up), including all-cause mortality, stroke and myocardial infarction. Secondary end points were the incidence of stroke and all-cause death during hospitalization and long-term follow-up. Results Patients were divided into three groups (Q1, Q2 and Q3) according to the trivalence of SII, and there were significant differences in plaque area, platelet, neutrophil, leukocyte, uric acid and SII levels among the three groups (P<0.05). The incidence of stroke and MACCE in Q1 to Q3 groups increased gradually, and higher SII level was correlated with higher incidence (all P<0.01). Kaplan-Meier curve showed that with the increase of SII, the cumulative incidence of MACCE increased gradually [Log Rank (Mantel-Cox)=13.128, P=0.001]. Cox regression analysis showed that SII [hazard ratio (HR)=1.004, 95%CI: 1.002-1.006], age (HR=1.107, 95%CI: 1.018-1.203), uric acid (HR=1.004, 95%CI: 1.001-1.007). Pearson analysis showed that SII was positively correlated with uric acid level (r=0.226, P=0.011) and plaque size (r=0.274, P=0.003). ROC analysis showed that the AUC of SII was 0.741 (95%CI: 0.616-0.866; P<0.001), and the AUC of uric acid was 0.723 (95%CI: 0.604-0.843; P<0.001), the AUC of the combination of them increased significantly (0.910, 95%CI: 0.843-0.977; P<0.001). Conclusions Increased levels of SII and uric acid are independent predictors of long-term MACCE in high-risk patients with CAS stroke, and their combined application has high application value in identifying long-term MACCE.
关键词
尿酸 /
系统免疫炎症指数 /
脑卒中高危患者 /
颈动脉支架植入术 /
主要不良心脑血管事件
Key words
uric acid /
systemic immune inflammatory index /
high-risk patients with stroke /
carotid stent implantation /
major adverse cardiovascular eventsts
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基金
安徽省卫生健康科研基金项目“尿酸和免疫炎症指数联合检测对脑卒中患者颈动脉病变程度和预后的评估价值”（20210171）
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