评估SII及CONUT评分对老年患者颈动脉 内膜切除术后隐性脑梗死的影响

Assessing the Impact of SII and CONUT Score on Covert Brain Infarction after Carotid Endarterectomy in Elderly Patients

摘要: 目的：探讨老年患者术前全身免疫炎症指数(SII)及控制营养状况(CONUT)评分与择期颈动脉内膜切除术(CEA)后隐性脑梗死(CBI)的相关性。方法：回顾性分析2023年1月至2025年3月间在青岛大学附属医院因严重颈动脉狭窄行颈动脉内膜切除术的老年患者。收集患者相关临床资料，通过相关影像学图像特点(有无隐性脑梗死现象)分为CBI组和非CBI组。使用SPSS 27.0统计学软件对CBI组及非CBI组两组间相关影响因素行单因素线性回归分析和多因素Logistic回归分析，从而分析出全身免疫炎症指数(SII)及控制营养状况(CONUT)评分是否为择期颈动脉内膜切除术后的隐形脑梗死(CBI)的独立危险因素。结果：本项研究共纳入了212例符合既定标准的患者，有43例表现为CBI，169例无CBI。单因素分析显示CBI组SII、CONUT评分显著升高(P < 0.05)；多因素Logistic回归显示CONUT评分是CBI的独立危险因素(OR = 8.501, 95% CI: 3.463~20.868, P < 0.001)；SII在校正混杂因素后未达到独立显著性(P = 0.572)。结论：SII与CBI存在单因素关联，但并非独立危险因素，其预测作用可能受年龄、高血压等因素介导。CONUT评分是一个简单且易于获得的仅客观实验室数值的参数，与接受CEA患者的CBI风险独立相关。

Abstract: Objective: To investigate whether the Systemic Immune-Inflammation Index (SII) and the Controlling Nutritional Status (CONUT) score were associated with covert brain infarction (CBI) after elective carotid endarterectomy in a propensity-matched cohort of elderly patients. Methods: A retrospective analysis was conducted on elderly patients who underwent carotid endarterectomy for severe carotid artery stenosis at the Affiliated Hospital of Qingdao University between January 2023 and March 2025. Relevant clinical data were collected, and patients were divided into CBI group and non-CBI group according to postoperative imaging findings. SPSS 27.0 statistical software was used to perform univariate analysis, multivariate linear regression analysis, and binary logistic regression analysis on relevant influencing factors between the CBI and non-CBI groups. This was done to determine whether the Systemic Immune-Inflammation Index (SII) and the Controlling Nutritional Status (CONUT) score are independent risk factors for covert brain infarction (CBI) after elective carotid endarterectomy. Results: A total of 212 patients who met the eligibility criteria were enrolled in this study. Postoperatively, 43 patients (20.3%) developed covert brain infarction (CBI), while 169 patients (79.7%) did not. Univariate linear regression and multivariate Logistic regression analyses were performed using SPSS 27.0 to compare related risk factors between the CBI group and the non-CBI group. The results showed that SII and CONUT scores were significantly higher in the CBI group (P < 0.05). Multivariate Logistic regression revealed that the CONUT score was an independent risk factor for CBI (OR = 8.501, 95% CI: 3.463~20.868, P < 0.001). After adjusting for confounding factors, SII did not reach independent statistical significance (P = 0.572). Conclusions: SII is correlated with CBI in univariate analysis but not an independent risk factor, and its predictive effect may be mediated by age, hypertension and other factors. As a simple and easily accessible parameter based on routine laboratory indicators, CONUT score is independently associated with the risk of postoperative CBI in patients undergoing CEA.