全身免疫炎症指数预测老年患者内镜逆行胰胆管造影术后胰腺炎的价值研究

Predictive value of systemic immune-inflammation index for the severity of post endoscopic retrograde cholangiopancreatography pancreatitis in elderly patients

摘要:

目的 探讨全身免疫炎症指数（SII）在老年患者内镜逆行胰胆管造影术后胰腺炎（PEP）中的表达及其与疾病严重程度的关系。方法 回顾性分析2020年1月－2022年12月该院189例行内镜逆行胰胆管造影术（ERCP）的老年患者（≥ 60岁）的病例资料和实验室检查资料，根据是否发生PEP和PEP的严重程度分为：正常组（n = 98）、轻-中度PEP组（n = 79）和重度PEP组（n = 12）。分析SII与老年患者PEP严重程度的相关性，并绘制受试者操作特征曲线（ROC curve），评估其对老年患者PEP严重程度的预测能力。结果 相较于正常组，轻-中度PEP组和重度PEP组ERCP术后24和48 h的血清白细胞计数及SII均明显较高，住院时间明显较长，血清钙水平明显较低，差异均有统计学意义（P < 0.05）。进一步分析，重度PEP组SII水平和急性胰腺炎严重程度床边指数（BISAP）评分明显高于轻-中度PEP组，住院时间明显长于轻-中度PEP组，差异均有统计学意义（P < 0.05），但两组患者白细胞计数和血清钙水平比较，差异均无统计学意义（P > 0.05）。根据SII随时间变化的规律，绘制ROC curve，SII水平在ERCP术后24和48 h的曲线下面积（AUC）分别为0.68和0.94（P < 0.05），其预测重度PEP的最佳临界值分别为1 490.51（敏感度为83%，特异度为57%）和1 686.97（敏感度为91%，特异度为89%）。结论 SII能够用于预测老年患者PEP的发生风险，且ERCP术后48 h的SII对重度PEP老年患者的预测能力更强。

Abstract:

Objective To investigate the predictive value of systemic immune-inflammation index (SII) on the clinical prognosis of elderly patients with severe post endoscopic retrograde cholangiopancreatography pancreatitis（PEP）.Methods From January 2020 to December 2022, 189 elderly patients (aged ≥ 60 years) who developed PEP were evaluated retrospectively. Patients were divided into normal group (n = 98), mild-to-moderate PEP group (n = 79) and severe PEP group (n = 12) according to whether pancreatitis occurred and the severity of pancreatitis based on the prolongation of planned hospitalization. Then compare the levels of SII in each group, analyze the correlation of the SII levels and severity of PEP. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive value for PEP severity in the elderly.Results Compared to the normal group, the mild-to-moderate PEP group and severe PEP group had significantly higher level of blood cell count and SII level stay on 24 and 48 h after ERCP, longer length of hospital, but the serum calcium level was lower, the differences were statistically significant (P < 0.05). The SII level and bedside index for severity in acute pancreatitis (BISAP) score were higher in the severe PEP group compared with the mild-to-moderate PEP group, the length of hospital stay was longer in the severe PEP group compared with the mild-to-moderate PEP group, the differences were statistically significant (P < 0.05), but there were no significant changes in serum calcium level and white blood cell count. The area under the curve of the SII on 24 and 48 h for severe PEP was 0.68 and 0.94 (P < 0.05), respectively. The prediction of severe PEP was 1 490.51 (sensitivity was 83%, specificity was 57%) and 1 686.97 (sensitivity was 91%, specificity was 89%), respectively.Conclusion SII can predict the severity of PEP in elderly patients, and SII on 48 h post-ERCP is a reliable prognostic marker of severe PEP.