系统免疫炎症指数与肝泡型包虫病患者预后的相关性分析

陈小彬; 袁加琪; 王志鑫; 樊海宁; 许召君; 梅学鹏; 王海久; 马佳敏; 周瀛; 侯立朝

doi:10.3969/j.issn.1001-5256.2021.02.025

系统免疫炎症指数与肝泡型包虫病患者预后的相关性分析

DOI: 10.3969/j.issn.1001-5256.2021.02.025

陈小彬¹,
袁加琪¹,
王志鑫^{1, 2, ,},
樊海宁^{1, 2},
许召君¹,
梅学鹏¹,
王海久^{1, 2},
马佳敏¹,
周瀛^{1, 2},
侯立朝^{1, 2}

1.
青海大学附属医院肝胆胰外科，西宁 810001
2.
青海省包虫病重点实验室，西宁 810001

基金项目:

青海省人畜包虫病防控策略与创新技术应用 (2016-SF-A5);

青海大学中青年科研基金项目 (2016-QYY-4)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突，特此声明。

作者贡献声明：陈小彬负责课题设计、资料分析及撰写论文；袁加琪负责收集数据及修改论文；王志鑫、樊海宁、许召君、梅学鹏、王海久、马佳敏、周瀛、侯立朝负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

作者简介:
陈小彬(1992-)，男，主要从事肝包虫病、普通外科临床研究

袁加琪(1993-)，男，主要从事肝包虫病、普通外科临床研究

通信作者:
王志鑫，zhixin_wang001@sina.com

二者对本文贡献相同，同为第一作者

中图分类号: R575;R532.32
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出版历程
- 收稿日期: 2020-08-20
- 录用日期: 2020-10-30
- 出版日期: 2021-02-20

Correlation between systemic immune-inflammation index and prognosis in patients with hepatic alveolar echinococcosis

Xiaobin CHEN¹,
Jiaqi YUAN¹,
Zhixin WANG^{1, 2
, ,},
Haining FAN^{1, 2},
Zhaojun XU¹,
Xuepeng MEI¹,
Haijiu WANG^{1, 2},
Jiamin MA¹,
Ying ZHOU^{1, 2},
Lizhao HOU^{1, 2}

1.
Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, Xining 810001, China
2.
Qinghai Province Key Laboratory of Hydatid Disease Research, Xining 810001, China

摘要

摘要: 目的探讨分析系统免疫炎症指数(SⅡ)与肝泡型包虫病患者预后的相关性分析。方法回顾性分析2015年1月-2018年12月青海大学附属医院肝胆胰外科收治的242例行肝泡型包虫病手术患者的临床资料，计算SⅡ数值。计数资料两组间比较采用χ²检验。相关性分析采用Spearman相关分析。应用受试者工作特征曲线(ROC曲线)确定SⅡ的最佳临界值，Kaplan-Meier法绘制生存曲线，对两组患者的总生存时间进行分析，并用log-rank比较两组生存率差异；采用单因素和多因素Cox回归模型分析肝泡型包虫病患者预后的影响因素。结果 SⅡ与肝泡型包虫病患者术后病死率呈正相关(r=0.267，P < 0.001)。应用ROC曲线确定术前SⅡ的最佳临界值为758.92，将242例患者分为低SⅡ组(SⅡ≤758.92，126例)和高SⅡ组(SⅡ>758.92，n=116例)。低SⅡ组与高SⅡ组肝泡型包虫患者术后1、3、5年生存率分别为98.20%、88.47%、66.10%和90.80%、53.05%、27.40%，低SⅡ组累积生存率>50%，平均生存时间为55.584个月(95%CI：53.550~57.617)；高SⅡ组累积生存率 < 50%，平均生存时间为39.384个月(95%CI：35.070~43.698)，中位生存时间为43个月(95%CI：34.694~51.306)，低SⅡ组肝泡型包虫病患者生存率明显优于高SⅡ组，两组总体生存率差异有统计学意义(χ²=46.979，P < 0.05)。单因素分析结果显示SⅡ>758.92是肝泡型包虫病患者总体生存时间的影响因素(HR=5.907，95% CI：3.386~10.306，P=0.001)；Cox多因素分析显示术前外周血SⅡ是肝泡型包虫病患者总体生存率的独立危险因素(HR=3.507，95% CI：1.911~6.435，P=0.001)。结论术前SⅡ水平与肝泡型包虫病患者预后有明确的相关性，可作为临床评估患者预后的指标，术前外周血SⅡ越高，患者预后越差。
- 棘球蚴病, 肝 /
- 系统免疫炎症指数 /
- 预后 /
- 危险因素
Abstract: Objective To investigate the correlation between systemic immune-inflammation index (SⅡ) and prognosis in patients with hepatic alveolar echinococcosis. Methods A retrospective analysis was performed for the clinical data of 242 patients who were admitted to Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, from January 2015 to December 2018 and underwent surgery for hepatic alveolar echinococcosis, and SⅡ was calculated. The chi-square test was used for comparison of categorical data between two groups, and a Spearman correlation analysis was performed. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of SⅡ; the Kaplan-Meier method was used to plot survival curves and analyze overall survival time in the two groups, and the log-rank test was used for comparison of survival rates between the two groups; univariate and multivariate Cox regression analyses were used to identify the influencing factors for the prognosis of patients with hepatic alveolar echinococcosis. Results The Spearman correlation analysis showed that SⅡ was positively correlated with the postoperative fatality rate of patients with hepatic alveolar echinococcosis (r=0.267, P < 0.001). The ROC curve showed that the optimal cut-off value of SⅡ before surgery was 758.92, and based on this, 242 patients with hepatic alveolar echinococcosis were divided into low SⅡ (SⅡ ≤758.92) group with 126 patients and high SⅡ (SⅡ >758.92) group with 116 patients. The low SⅡ group had 1-, 3-, and 5-year survival rates of 98.20%, 88.47%, and 66.10%, respectively, and the high SⅡ group had 1-, 3-, and 5-year survival rates of 90.80%, 53.05%, and 27.40%, respectively. The low SⅡ group had a cumulative survival rate of >50% and a mean survival time of 55.584 months (95% confidence interval[CI]: 53.550-57.617), while the high SⅡ group had a cumulative survival rate of < 50%, a mean survival time of 39.384 months (95% CI: 35.070-43.698), and a median survival time of 43 months (95% CI: 34.694-51.306). The low SⅡ group had a significantly better survival rate than the high SⅡ group, and there was a significant difference in overall survival rate between the two groups (χ²=46.979, P < 0.05). The univariate analysis showed that SⅡ >758.92 (hazard ratio [HR]=5.907, 95% CI: 3.386-10.306, P=0.001) was an influencing factor for the overall survival time of patients with hepatic alveolar echinococcosis, and the multivariate Cox regression analysis showed that preoperative peripheral blood SⅡ (HR=3.507, 95% CI: 1.911-6.435, P=0.001) was an independent risk factor for the overall survival rate of patients with hepatic alveolar echinococcosis. Conclusion Preoperative SⅡ level is clearly correlated with the prognosis of patients with hepatic alveolar echinococcosis and can thus be used as a clinical indicator to evaluate the prognosis of patients. The higher the peripheral blood SⅡ before surgery, the worse the prognosis of patients.
- Echinococcosis, Hepatic /
- Systemic Immune Inflammatory /
- Prognosis /
- Risk Factors

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图 1 术前SⅡ预测肝包虫病患者总生存期的ROC曲线

下载: 全尺寸图片幻灯片

图 2 两组肝泡型包虫病患者术后总体生存曲线

下载: 全尺寸图片幻灯片

表 1 SⅡ与肝泡型包虫病患者临床病理因素的关系

指标	高SⅡ组(n=116)	低SⅡ组(n=126)	χ²值	P值
年龄[例(%)]			2.385	0.130
≤30岁	42(36.2)	34(27.0)
>30岁	74(63.8)	92(73.0)
性别[例(%)]			0.517	0.511
男	43(37.1)	53(42.1)
女	73(62.9)	73(57.9)
手术方式[例(%)]			20.197	< 0.001
根治性治疗	75(64.7)	112(88.9)
姑息治疗	41(35.3)	14(11.1)
术中出血量[例(%)]			22.278	< 0.001
< 1000 ml	50(43.1)	92(73.0)
≥1000 ml	66(56.9)	34(27.0)
包虫分期[例(%)]			0.942	0.040
早、中期	47(40.5)	68(54.0)
晚期	69(59.5)	58(46.0)
病灶数[例(%)]			0.223	0.693
单发	68(58.6)	77(61.1)
多发	48(41.4)	49(38.9)
Child-Pugh分级[例(%)]			9.489	0.003
A级	38(32.8)	66(52.4)
B级	78(67.2)	60(47.6)
并发症[例(%)]			48.624	< 0.001
有	90(77.6)	41(32.5)
无	26(22.4)	85(67.5)
ALT[例(%)]			6.947	0.010
≤40 U/L	43(37.1)	68(54.0)
>40 U/L	73(62.9)	58(46.0)
AST[例(%)]			5.415	0.021
≤40 U/L	48(41.4)	71(56.3)
>40 U/L	68(58.6)	55(44.7)
TBil[例(%)]			9.238	0.002
≤32.4 μmol/L	52(44.8)	81(64.3)
>32.4 μmol/L	64(55.2)	45(35.7)
Alb[例(%)]			4.990	0.031
≤35 g/L	84(72.4)	74(58.7)
>35 g/L	32(27.6)	52(41.3)
ALP[例(%)]			5.973	0.020
≤150 U/L	18(15.5)	36(28.6)
>150 U/L	98(84.5)	90(71.4)
PT[例(%)]			6.947	0.010
≤16 s	43(37.1)	68(54.0)
>16 s	73(62.9)	58(46.0)
中性粒细胞[例(%)]			1.865	0.232
≤6.3×10⁹/L	104(89.7)	119(94.4)
>6.3×10⁹/L	12(10.3)	7(5.6)
血小板[例(%)]			21.158	< 0.001
≤300×10⁹/L	44(37.9)	85(67.5)
>300×10⁹/L	72(62.1)	41(32.5)
白细胞[例(%)]			5.543	0.06
≤10×10⁹ /L	93(80.2)	112(88.9)
>10×10⁹/L	23(19.8)	14(11.1)

下载: 导出CSV

表 2 影响肝泡型包虫病患者生存的单因素及多因素Cox回归分析

指标	单因素分析		多因素分析
指标	HR(95% CI)	P值	HR(95% CI)	P值
年龄(≤30岁vs >30岁)	1.272(0.744~2.175)	0.324
性别(男vs女)	1.268(0.791~2.033)	0.379
手术方式(根治性治疗vs姑息治疗)	3.195(1.973~5.176)	0.001	2.053(1.138~3.704)	0.019
术中出血量(< 1000 ml vs ≥1000 ml)	6.832(3.893~11.990)	0.001	4.615(2.545~8.369)	0.001
包虫分期(早期vs中、晚期)	3.841(2.017~7.318)	0.009
病灶数(单发vs多发)	1.104(0.688~1.773)	0.681
SⅡ(>758.92 vs ≤758.92)	5.907(3.386~10.306)	0.001	3.507(1.911~6.435)	0.001
Child-Pugh分级(A级vs B级)	3.066(2.716~6.449)	0.028	1.973(1.084~3.588)	0.041
并发症(有vs无)	2.278(1.398~3.711)	0.001
ALT(≤40 U/L vs >40 U/L)	1.201(0.748~1.931)	0.448
AST(≤40 U/L vs >40 U/L)	1.436(0.894~2.307)	0.134
ALP(≤150 U/L vs >150 U/L)	2.237(1.180~4.790)	0.015
PT(≤16 s vs >16 s)	1.824(1.113~2.991)	0.017

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