全身免疫炎症指数与预后营养...病合并肌肉减少症的预测研究_吴优.pdf

494 论著 中国医刊 2023 年 第58卷 第5期22 吴杰,霍继荣,王东,等.Wnt及整合素信号通路在大肠侧向发育型肿瘤中的表达及与其内镜形态学之间的关系 J.南方医科大学学报,2017,37(9):1234-1241.23 YAMADA M,SAITO Y,SAKAMOTO T,et al.Endoscopic predictors of deep submucosal invasion in colorectal laterally spreading tumors J.Endoscopy,2016,48(5):456-464.24 DAMICO F,AMATO A,IANNONE A,et al.Risk of covert submucosal cancer in patients with granular mixed laterally spreading tumors J.Clin Gastroenterol Hepatol,2021,19(7):1395-1401.25 ZHAO X,ZHAN Q,XIANG L,et al.Clinicopathological characteristics of laterally spreading colorectal tumor J.PLoS One,2014,9(4):e94552.26 SHEN X,ZHANG Y,ZHAO Y,et al.The coexistence of colorectal polyps in the right colon increases the malignant risk of laterally spreading tumors J.Gastroenterol Res Pract,2020,2020:3180420.27 肖文静,罗和生.大肠侧向发育型肿瘤合并息肉的临床特征及其癌变分析J.胃肠病学和肝病学杂志,2022,31(4):419-423.（收稿日期：2023-01-29；修回日期：2023-03-12）（本文编辑：安静）全身免疫炎症指数与预后营养指数对炎症性肠病 合并肌肉减少症的预测研究吴优1，陈丽1，倪培萍1，钟晓琳1，吕沐瀚1，汪敏2*（1.西南医科大学附属医院 消化内科，四川 泸州 646000；2.西南医科大学附属医院 临床营养科，四川 泸州 646000）摘要：目的探讨全身免疫炎症指数（system immune inflammation index，SII）及预后营养指数（prognostic nutritional index，PNI）对炎症性肠病（inflammatory bowel disease，IBD）患者发生肌肉减少症的预测价值。方法选取2019年1月至2021年12月西南医科大学附属医院住院确诊的108例IBD患者作为研究对象，根据第3腰椎层面骨骼肌质量指数（skeletal muscle index，SMI）分为肌肉减少症组（81例）和非肌肉减少症组（27例）。比较两组患者的临床特征，采用logistic回归分析、ROC曲线探讨SII及PNI对IBD患者发生肌肉减少症的预测价值。结果肌肉减少症组患者的PNI为46.549.34，SII为2397.804884.88，与非肌肉减少症组的50.134.70和1140.60954.0比较，差异均有显著性（P0.05）。Logistic回归分析显示，SII1297.74（OR=5.917，95%CI 1.7427.42）和PNI47.90（OR=3.25，95%CI 1.1615.55）均为IBD患者发生肌肉减少症的独立危险因素。ROC曲线分析显示SII预测IBD患者发生肌肉减少症的最佳截断值为1207.19，敏感度和特异度分别为64.20%和77.80%（P=0.004）；PNI预测IBD患者发生肌肉减少症的最佳截断值为48.48，敏感度和特异度分别为61.73%和77.78%（P=0.008）。结论SII及PNI与IBD患者发生肌肉减少症存在相关性，可用于预测IBD患者肌肉减少症的发生。关键词：全身免疫炎症指数；预后营养指数；炎症性肠病；肌肉减少症中图分类号：R574文献标识码：A文章编号：1008-1070（2023）05-0494-05doi:10.3969/j.issn.1008-1070.2023.05.008The predictive value of SII and PNI in inflammatory bowel disease complicated with sarcopeniaWu You1,Chen Li1,Ni Peiping1,Zhong Xiaolin1,Lyu Muhan1,Wang Min2*(1.Department of Gastroenterology,Affiliated Hospital of Southwest Medical University,Sichuan Luzhou 646000,China;2.Department of Clinical Nutrition,Affiliated Hospital of Southwest Medical University,Sichuan Luzhou 646000,China)*Corresponding author,E-mail:Abstract:Objective To explore the predictive value of system immune inflammation index(SII)and prognostic nutritional index(PNI)in inflammatory bowel disease(IBD)complicated with sarcopenia.Method 108 IBD patients diagnosed in the Affiliated Hospital of Southwest Medical University from January 2019 to December 2021 were selected as research subjects.Patients were divided into the sarcopenia group and the non-sarcopenia group according to the skeletal muscle index(SMI)at the L3 level.Clinical characteristics were compared between the sarcopenia and the non-sarcopenia groups.Logistic regression analysis and ROC curves were used to analyze the predictive value of SII and PNI in IBD complicated with sarcopenia.Result The PNI of patients in the sarcopenia group was 46.549.34,which was lower than that of the non-sarcopenia group(50.134.70),with a significant difference(P0.05).The SII of patients in the sarcopenia group was 2397.804884.88,which was higher than that of the non-sarcopenia group(1140.60954.0),with a significant difference(P0.05).Logistic regression analysis showed that SII1297.74(OR=5.917,95%CI 1.74-27.42)and PNI47.90(OR=3.25,95%CI 1.16-15.55)were independent risk factors for IBD complicated with sarcopenia.The ROC analysis indicted that the cut-off value of SII for IBD complicated with sarcopenia was 1207.19,with the sensitivity and specificity 64.20%and 77.80%(P=0.004),respectively;the cut-off value of PNI for IBD complicated with sarcopenia at 48.48,with the sensitivity and specificity 61.73%and 77.78%(P=0.008),respectively.Conclusion SII and PNI are related to IBD complicated with sarcopenia,which can be used to predict the occurrence of sarcopenia in IBD patients.Keywords:System immune inflammation index;Prognostic nutritional index;Inflammatory bowel disease;Sarcopenia*通信作者，E-mail:论著 495中国医刊 2023 年 第58卷 第5期炎症性肠病（inflammatory bowel disease，IBD）包括溃疡性结肠炎和克罗恩病，是一种胃肠道慢性炎症性疾病，近年来其发病率在全球呈逐渐上升趋势1-2。IBD 患者常出现腹痛、腹泻、进食量减少、进食种类受限及消化吸收障碍等，从而导致营养不良3-4，而营养不良可促进肌肉减少症的发生5。肌肉减少症是一种进行性发展的全身性骨骼肌疾病，与跌倒、骨折、身体残疾和死亡等不良预后有关6。KITAMURA 等7对 1851 名日本老年人进行 5.8 年的随访研究发现，肌肉减少症的全因死亡率和残疾发生风险是对照组的 2 倍。因此，肌肉减少症也给社会带来了巨大的经济负担8。IBD合并肌肉减少症时，可对疾病预后产生不良影响。在急性重症溃疡性结肠炎患者中，约 70%合并肌肉减少症，需要药物抢救或手术治疗9。LIU 等10研究发现，IBD 合并肌肉减少症时，其手术率、再入院率及死亡率均高于对照组。全身免疫炎症指数（system immune inflammation index，SII）和预后营养指数（prognostic nutritional index，PNI）与多种疾病的严重程度及预后相关，具有检测费用低、非侵入性等优点，对 IBD 的诊治有一定指导作用11。本研究旨在探讨 IBD 合并肌肉减少症患者的临床特征，评估 SII 及 PNI 对 IBD 患者发生肌肉减少症的预测作用。1资料与方法 1.1研究对象回顾性分析 2019 年 1 月至 2021 年12 月在本院住院确诊的 108 例 IBD 患者的临床资料。本研究经西南医科大学附属医院伦理委员会批准（审批号：KY2022039），该研究方案已在中国临床试验注册中心注册（注册号：ChiCTR2200056940）。纳入标准：基本临床资料及入院前后 2 周内的腹部CT、增强 CT 或 CT 血管造影术检查图像资料完整；年龄不限，符合炎症性肠病诊断与治疗的共识意见（2018 年，北京）中 IBD 的诊断标准12。排除标准：缺失身高、体重等信息；合并糖尿病、甲状腺功能亢进、人类免疫缺陷病毒感染或恶性肿瘤等疾