来源：风湿病与关节炎,2024,13（1）:24-29.

系统免疫炎症指数及预后营养指数对痛风患者病情活动的评估价值（临床研究）

张春泽¹，苏　娟²

　　【摘　要】目的：探讨系统免疫炎症指数（SII）及预后营养指数（PNI）对痛风患者病情活动的评估价值。方法：回顾性选取2015年5月至2022年10月于青海大学附属医院风湿免疫科及内分泌科就诊的痛风初治住院患者248例为痛风组，其中急性期组151例，间歇期组97例。同时选取医院体检中心年龄和性别相匹配的健康体检者100例为对照组。比较痛风组与对照组、急性期组与间歇期组SII、PNI水平和其他相关指标；采用Spearman相关性分析评价痛风患者SII、PNI与红细胞沉降率（ESR）、C反应蛋白（CRP）、尿酸（UA）的相关性；绘制受试者工作特征（ROC）曲线判断SII、PNI对痛风患者病情活动的评估效能。结果：吸烟、饮酒与痛风相关（P < 0.05）；痛风组体质量指数以及ESR、CRP、中性粒细胞计数（NEU）、单核细胞计数（MO）、血小板计数（PLT）、纤维蛋白原（FIB）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、甘油三酯（TG）、UA、SII水平高于对照组（P < 0.05），淋巴细胞计数（LY）、白蛋白（ALB）、PNI水平低于对照组（P < 0.05）；急性期组ESR、CRP、NEU、MO、PLT、FIB、PT、APTT、SII水平高于间歇期组（P < 0.05），LY、ALB、TG、PNI水平低于间歇期组（P < 0.05）；Spearman相关性分析结果显示，SII与ESR、CRP呈正相关（r分别为0.565、0.519，P < 0.001），与UA无相关性（P = 0.286）；PNI与ESR、CRP呈负相关（r分别为-0.283、-0.431，P < 0.001），与UA呈正相关（r = 0.254，P < 0.001）；ROC曲线分析结果显示，SII、PNI评估痛风患者急性期与间歇期的ROC曲线下面积（AUC）分别为0.798、0.686，约登指数分别为0.474、0.306，对应的最佳临界值分别为426.280、47.275，灵敏度及特异性分别为74.2%、73.2%和45.0%、85.6%。结论：SII、PNI对痛风患者病情活动具有较高的评估效能，提示其可能作为一种新颖且可靠的判断痛风病情活动的炎症标志物。

　　【关键词】　痛风；系统免疫炎症指数；预后营养指数；病情活动；评估价值

The Evaluation Value of Systemic Immune Inflammation Index and Prognostic Nutritional Index in the Disease Activity of Patients with Gout

ZHANG Chun-ze,SU Juan

　　【ABSTRACT】Objective:To explore the evaluation value of systemic immune inflammation index（SII）and prognostic nutritional index（PNI）in the disease activity of patients with gout.Methods:A retrospective study was conducted to select 248 newly treated gout inpatients from the Rheumatology and Immunology Department and Endocrinology Department of Qinghai University Affiliated Hospital from May 2015 to October 2022 as the gout group,including 151 patients in the acute phase group and 97 patients in the intermittent phase group.At the same time,100 healthy examinees who matched the age and gender of the hospital's physical examination center were selected as the control group.Compare the levels of SII,PNI,and other related indicators between the gout group and the control group,the acute phase group and the intermittent phase group;Spearman correlation analysis was used to evaluate the correlation between SII,PNI,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,and uric acid（UA）in patients with gout;the receiver operating characteristic（ROC）curves was drawn to assess the effectiveness of SII and PNI in assessing the disease activity of the patients.Results:Smoking and alcohol consumption were associated with gout（P < 0.05）;the levels of BMI,ESR,CRP,NEU,MO,PLT,FIB,PT,APTT,TG,UA,and SII in the gout group were higher than those in the control group（P < 0.05）,while the levels of LY,ALB,and PNI were lower than those in the control group（P < 0.05）;the levels of ESR,CRP,NEU,MO,PLT,FIB,PT,APTT,and SII in the acute phase group were higher than those in the intermittent phase group（P < 0.05）,while the levels of LY,ALB,TG,and PNI were lower than those in the intermittent phase group（P < 0.05）;The Spearman correlation analysis results showed that SII was positively correlated with ESR and CRP（r = 0.565,0.519,P < 0.001）,but not with UA（P = 0.286）;PNI is negatively correlated with ESR and CRP（r = -0.283,-0.431,P < 0.001）,and positively correlated with UA（r = 0.254,P < 0.001）;The ROC curve analysis results showed that the area under the ROC curve（AUC）of SII and PNI for evaluating acute and intermittent gout patients were 0.798 and 0.686,respectively.The Jordan index was 0.474 and 0.306,respectively,with the corresponding optimal critical values of 426.28 and 47.275.The sensitivity and specificity were 74.2%,73.2%,45.0%,and 85.6%,respectively.Conclusion:SII and PNI have high efficacy in evaluating the disease activity of patients with gout ,suggesting that they may serve as novel and reliable inflammatory markers for judging gout activity.

　　【Keywords】 gout;systemic immune inflammation index;prognostic nutritional index;disease activity;evaluation value