系统免疫炎症指数对老年急性肺栓塞预后预测价值研究

Study on Prognostic Predictive Value of Systemic Immune Inflammation Index for Acute Pulmonary Embolism in Older Adults

摘要: 目的：探讨系统免疫炎症指数(systemic immune inflammation index, SII)对老年急性肺栓塞(acute pulmonary embolism, APE)患者病情预后的预测价值。方法：采用回顾性分析研究，收集2019年1月至2023年10月义乌中心医院收治老年APE患者的临床资料，采用单因素方差分析和多因素Logistic回归分析肺栓塞严重指数(Pulmonary Embolism Severity Index, PESI)、SII对老年APE患者肺栓塞发病6个月内相关死亡的相关关系，同时，绘制受试者工作特征(Receiver Operating Characteristic, ROC)曲线，以分析PESI、SII对老年APE患者肺栓塞预后的预测价值。结果：本研究共纳入227例患者，存活组197例，死亡组30例。死亡组年龄、心率、超敏C反应蛋白(hypersensitive C-reactive protein, hs-CRP)、B型尿钠肽(Brain natriuretic peptide, BNP)水平、PESI评分、SII分别为(81.17 ± 10.36)岁、(96.80 ± 17.61)次/分、(95.10 ± 90.51) mg/L、(648.05 ± 861.99) ng/L、(104.17 ± 19.17)分、(4231.59 ± 5021.36) × 10⁹/L，均高于存活组(P < 0.05)。死亡组舒张压[(71.40 ± 15.02) mmHg]低于存活组[(76.67 ± 13.22) mmHg] (P < 0.05)。多因素Logistic回归分析结果显示，hs-CRP、SII、心率是老年APE患者肺栓塞相关死亡的独立危险因素(P < 0.05)。ROC曲线分析结果显示，hs-CRP预测APE患者肺栓塞相关死亡的曲线下面积(Area Under Curve, AUC)为0.77，SII预测肺栓塞相关死亡的AUC为0.84，心率预测APE患者肺栓塞相关死亡的曲线下面积(AUC)为0.65。结论：SII能有效评估老年APE患者预后，可作为评估患者病情的预测指标之一。

Abstract: Objective: To explore the predictive value of the systemic immune inflammatory index (SII) for the prognosis of elderly patients with acute pulmonary embolism (APE). Method: A retrospective analysis was conducted to collect clinical data of elderly APE patients admitted to Yiwu Central Hospital from January 2019 to October 2023. Single factor analysis of variance and multiple factor logistic regression was used to analyze the correlation between the Pulmonary Embolism Severity Index (PESI) and SII and related deaths within 6 months of pulmonary embolism in elderly APE patients. At the same time, Receiver Operating Characteristic (ROC) curves were drawn to analyze the predictive value of PESI and SII on the prognosis of pulmonary embolism in elderly APE patients. As a result, a total of 227 patients were included in this study, with 197 in the survival group and 30 in the death group. The age, heart rate, hs-CRP, B-type natriuretic peptide levels, PESI score, and SII of the deceased group were (81.17 ± 10.36) years old, (96.80 ± 17.61) beats/minute, (95.10 ± 90.51) mg/L, (648.05 ± 861.99) ng/L, (104.17 ± 19.17) points, and (4231.59 ± 5021.36) × 10⁹/L, respectively, all higher than those of the surviving group (P < 0.05). The diastolic blood pressure of the death group [(71.40 ± 15.02) mmHg] was lower than that of the survival group [(76.67 ± 13.22) mmHg] (P < 0.05). The results of multiple logistic regression analysis showed that hs-CRP, SII, and heart rate were independent risk factors for pulmonary embolism related mortality in elderly APE patients (P < 0.05). The ROC curve analysis results showed that the Area under Curve (AUC) of hs-CRP predicting pulmonary embolism related death in APE patients was 0.77, the AUC of SII predicting pulmonary embolism related death was 0.84, and the AUC of heart rate predicting pulmonary embolism related death in APE patients was 0.65. Conclusion: SII can effectively evaluate the prognosis of elderly APE patients and can be used as one of the predictive indicators for evaluating the patient’s condition.