Value of systemic immune-inflammation index distinguishing acute cholecystitis from chronic cholecystitis
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摘要:目的
探讨术前全身免疫炎症指数（systemic immune-inflammation index, SII）对急慢性胆囊炎的鉴别价值。
方法选择2020年8月至2023年11月于复旦大学附属金山医院行胆囊切除术的胆囊炎患者297例，分为急性胆囊炎组（n＝192）和慢性胆囊炎组（n＝105），将急性胆囊炎组分为重度亚组（n＝114）和轻度亚组（n＝78）。采用ROC曲线评估SII和中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）对急慢性胆囊炎的鉴别价值。
结果与慢性胆囊炎组相比，急性胆囊炎组男性多，年龄大，高血压合并者比例高，引流量多，引流时间、住院时间、手术时长均延长，白细胞计数、中性粒细胞数、单核细胞数增加，总胆红素、直接胆红素、肌酐水平升高，SII和NLR升高（P＜0.05）。与重度亚组相比，轻度亚组引流量减少，引流时间、住院时间、手术时长均缩短，白细胞计数、中性粒细胞数、单核细胞数减少，总胆红素水平降低，淋巴细胞数增加，SII和NLR降低（P＜0.05）。SII和NLR鉴别急性胆囊炎的最佳截断值为797.96和3.65，AUC为0.847和0.869，灵敏度为73.2%和74.2%，特异度为86.7%和89.5%；SII和NLR鉴别急性重度胆囊炎的最佳截断值分别为1 056.59和4.65，AUC为0.768和0.779，灵敏度为77.0%和82.3%，特异度为67.5%和62.3%。SII与NLR鉴别急性胆囊炎和急性重度胆囊炎的效能差异无统计学意义。
结论SII是一种良好的鉴别急慢性胆囊炎的血液学指标，与NLR鉴别能力相似。
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关键词:
- 急性胆囊炎 /
- 全身免疫炎症指数 /
- 中性粒细胞与淋巴细胞比值 /
- 预测
Abstract:ObjectiveTo explore the value of systemic immune-inflammation index (SII) in differentiating acute and chronic cholecystitis.
MethodsA total of 297 patients with cholecystitis who underwent cholecystectomy in Jinshan Hospital, Fudan University from August 2020 to November 2023 were selected, and were divided into acute cholecystitis group (n＝192) and chronic cholecystitis group (n＝105). The patients in acute cholecystitis group were further divided into severe subgroup (n＝114) and mild subgroup (n＝78). The differential diagnosis values of SII and neutrophil-to-lymphocyte ratio (NLR) in acute and chronic cholecystitis were evaluated by ROC curve.
ResultsCompared with chronic cholecystitis group, males were more, older, the incidence of hypertension was higher, drainage volume increased, drainage time, hospital time, and surgical duration were all longer, blood cells, neutrophil count, monocyte count increased, total bilirubin, direct bilirubin, and creatinine were higher, SII and NLR increased in the acute cholecystitis group (P<0.05). Compared with the severe subgroup, the drainage volume decreased, drainage time, hospital stay, and surgical duration were shorter, white blood cell count, neutrophil count, monocyte count, and total bilirubin decreased, while lymphocyte count increased, SII and NLR decreased in the mild subgroup (P<0.05). The optimal cutoff values of SII and NLR for distinguishing acute cholecystitis from chronic cholecystitis were 797.96 and 3.65, and the AUC were 0.847 and 0.869, with 73.2% and 74.2% of sensitivity, and 86.7% and 89.5% of specificity. The optimal cutoff values of SII and NLR for distinguishing acute severe cholecystitis from mild cholecystitis were 1 056.59 and 4.65, the AUC were 0.768 and 0.779, with 77.0% and 82.3% of sensitivity, and 67.5% and 62.3% of specificity. There was no statistically significant difference between the values of SII and NLR for distinguishing acute severe and acute cholecystitis.
ConclusionSII is a good hematological indicator for distinguishing acute cholecystitis from chronic cholecystitis with similar value to NLR.
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急性胆囊炎（acute cholecystitis, AC）是普外科常见的急腹症，常表现为右上腹痛、发热、恶心呕吐、黄疸等。腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）是目前治疗AC的标准方式，一般能取得良好的疗效。但发病超过72 h时，胆囊壁易水肿粘连，导致Calot三角等解剖结构不清，手术风险增加。AC患者有0.1%~1%的死亡率和6%~9%的主要并发症发生率，重度胆囊炎患者行LC后均更高[1-3]。因此，识别重度胆囊炎以及选择合适的治疗方案是目前AC研究的热点。
血小板和中性粒细胞增多可反映全身炎症情况，而淋巴细胞减少提示细胞免疫损伤[4-5]。2014年Hu等[6]提出了一种基于淋巴细胞、中性粒细胞和血小板计数的预测炎症反应的指标，即全身免疫炎症指数（systemic immune-inflammation index, SII）。SII反映炎症反应与免疫反应之间的平衡情况，升高常提示炎症加重或预后不良。但是，目前将SII用于预测AC的研究较少。本研究探讨急慢性胆囊炎患者术前SII、中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）水平对急慢性胆囊炎及急性胆囊炎严重程度的鉴别作用。
1. 资料与方法
1.1 一般资料
选择2020年8月至2023年11月在复旦大学附属金山医院进行LC或开腹胆囊切除术的患者297例，包括AC 192例（重度114例、轻度78例）、慢性胆囊炎105例。纳入标准：（1）通过临床症状、体征、影像学检查、病理检查确诊为胆囊炎；（2）在本院行胆囊切除术；（3）临床资料完整。排除标准：（1）胆囊炎发病至手术时间间隔≥5 d；（2）合并胆总管结石、急性胰腺炎等其他炎症性疾病；（3）合并肝硬化、恶性肿瘤、血液系统疾病、全身免疫性疾病、既往重要器官功能不全等。
1.2 观察指标及诊断标准
收集患者年龄、性别、身高、体质量、既往史、住院时间、引流量、引流时间、术中情况及术后病理等临床资料，以及术前48 h内血常规及肝肾功能等血液指标。SII＝血小板计数×中性粒细胞计数/淋巴细胞计数；NLR＝中性粒细胞计数/淋巴细胞计数。急慢性胆囊炎依据病理检查结果诊断。急性胆囊炎患者出现化脓、穿孔、出血、坏疽等继发性改变，合并器官功能障碍，和（或）病理检查提示黄色肉芽肿性胆囊炎，诊断为急性重度胆囊炎；否则诊断为急性轻度胆囊炎。
1.3 统计学处理
采用SPSS 26.0进行统计学分析。对计量资料采用Kolmogorov-Smirnov检验进行正态性检验，符合正态分布时以x±s表示，3组间比较采用单因素方差分析，两组间比较采用独立样本t检验；不符合正态分布时以M(P25, P75)表示，3组间比较进行Kruskal-Wallis检验，两组间比较进行Mann-Whitney U检验。计数资料以n(%)表示，组间比较采用χ2检验、连续校正的χ2检验或Fisher确切概率法。采用ROC曲线分析SII和NLR鉴别急慢性胆囊炎及程度的价值，进行log-rank检验。检验水准（α）为0.05。
2. 结果
2.1 急慢性胆囊炎患者组间临床及实验室指标比较
结果（表 1）显示：与慢性胆囊炎组相比，AC组患者男性多、年龄大、高血压合并者多、转开腹手术者多，引流量多，引流时间、住院时间、手术时长均延长（P＜0.05）。与慢性胆囊炎组相比，AC组白细胞计数、中性粒细胞数、单核细胞数增加，总胆红素、直接胆红素增加，肌酐水平、SII和NLR升高（P＜0.01）；淋巴细胞数、血小板计数减少，白蛋白水平下降（P＜0.01）。
表 1 急慢性胆囊炎组间一般临床及实验室资料比较Table 1. Comparison of clinical and laboratory data between acute and chronic cholecystitis groupsIndex Acute cholecystitis group (n＝192) Chronic cholecystitis group (n＝105) Z/χ2 value P value Gender n(%) 11.711 0.001 Male 100(52.08) 33(31.43) Female 92(47.92) 72(68.57) Age/year 59(48, 72) 53(40, 66) ﹣3.015 0.003 BMI/(kg·m﹣2) 24.18(22.03, 26.83) 24.03(21.51, 26.37) ﹣1.006 0.315 Hypertension n(%) 5.494 0.019 No 129(67.19) 84(80.00) Yes 63(32.81) 21(20.00) Diabetes n(%) 0.264 0.607 No 170(88.54) 95(90.48) Yes 22(11.46) 10(9.52) Operative procedure n(%) 9.248 0.002 Laparoscopic cholecystectomy 176(80.37) 105(100.00) Conversion to open cholecystectomy 16(7.31) 0 Drainage volume/mL 122.00(70.00, 202.50) 65.50(27.25, 130.25) ﹣4.983 ＜0.001 Drainage time/d 4(3, 6) 2(2, 3) ﹣7.474 ＜0.001 Hospital stay/d 7(5, 9) 5(4, 6) ﹣7.411 ＜0.001 Surgical duration/min 62.50(53.00, 84.00) 43(34.50, 56.00) ﹣8.736 ＜0.001 WBC/(×109·L﹣1) 10.30(7.70, 12.90) 5.70(4.75, 6.80) ﹣10.659 ＜0.001 Neutrophil/% 74.80(48.55, 83.95) 43.30(0.59, 62.60) ﹣8.678 ＜0.001 Neutrophil/(×109·L﹣1) 8.28(5.49, 11.01) 3.38(2.67, 4.35) ﹣11.258 ＜0.001 Lymphocyte/(×109·L﹣1) 1.22(0.85, 1.64) 1.71(1.33, 2.10) ﹣6.162 ＜0.001 Monocyte/(×109·L﹣1) 0.65(0.43, 0.89) 0.32(0.24, 0.46) ﹣9.037 ＜0.001 Hb/(g·L﹣1) 133.42±16.30 132.70±18.76 0.348 0.728 PLT/(×109·L﹣1) 201.50(166.00, 245.25) 222.00(186.00, 268.50) ﹣2.601 0.009 Alb/(g·L﹣1) 40.00(36.00, 43.00) 43.00(39.00, 45.75) ﹣3.738 ＜0.001 TBIL/(μmol·L﹣1) 19.70(13.00, 28.78) 13.00(10.10, 18.00) ﹣5.28 ＜0.001 DBIL/(μmol·L﹣1) 4.40(3.00, 7.30) 3.00(2.00, 5.40) ﹣4.051 ＜0.001 ALT/(U·L﹣1) 24.50(17.00, 39.75) 23.00(15.00, 32.50) ﹣1.362 0.173 AST/(U·L﹣1) 26.00(20.00, 35.75) 24.00(20.00, 31.50) ﹣1.288 0.198 BUN/(mmol·L﹣1) 4.80(4.00, 5.88) 5.00(4.00, 5.95) ﹣0.414 0.679 sCr/(μmol·L﹣1) 65.00(56.00, 78.00) 60.00(51.50, 69.00) ﹣3.021 0.003 NLR 6.80(3.49, 12.00) 1.92(1.49, 2.71) ﹣10.539 ＜0.001 SII 1 307.65(735.56, 2 314.40) 423.35(305.59, 618.54) ﹣9.928 ＜0.001 BMI: body mass index; WBC: white blood cell; Hb: hemoglobin; Alb: albumin; PLT: platelet; TBIL: total bilirubin; DBIL: direct bilirubin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: urea nitrogen; sCr: serum creatinine; NLR: neutrophil-to-lymphocyte ratio; SII: systemic immune-inflammation index. 2.2 急性轻重度胆囊炎患者临床与实验室指标比较
结果（表 2）显示：与急性轻度亚组相比，急性重度亚组引流量增加，引流时间、住院时间、手术时长较长，白细胞计数、中性粒细胞数、单核细胞数增加，总胆红素水平、SII及NLR升高，淋巴细胞数减少（P＜0.05）。
表 2 急性轻重度胆囊炎及慢性胆囊炎组间一般临床资料和实验室指标比较Table 2. Comparison of clinical and laboratory data between acute mild, severe cholecystitis and chronic cholecystitisIndex Acute severe subgroup (n＝114） Acute mild subgroup (n＝78） Chronic cholecystitis group (n＝105） Z/χ2 value P value Gender n(%) 11.723 0.003 Male 59(51.75) 41(52.56) 33(31.43)*△ Female 55(48.25) 37(47.44) 72(68.57) Age/year 63(50, 72) 56(46, 72) 53(40, 66)*△ 11.955 0.003 BMI/(kg·m﹣2) 24.44(22.08, 27.22) 23.65(21.74, 26.63) 24.03(21.51, 26.37) 2.428 0.297 Hypertension n(%) 6.868 0.032 No 73(64.04) 56(71.79) 84(80.00)* Yes 41(35.96) 22(28.21) 21(20.00) Diabetes n(%) 1.107 0.575 No 99(86.84) 71(91.03) 95(90.48) Yes 15(13.16) 7(8.97) 10(9.52) Operative procedure n(%) 27.147 ＜0.001 Laparoscopic cholecystectomy 98(85.96) 78(100.00)* 105(100.00)* Conversion to open cholecystectomy 16(14.04) 0 0 Drainage volume/mL 145.00 (78.50, 255.00) 107.00 (60.75, 158.75)* 65.50 (27.25, 130.25)*△ 31.710 ＜0.001 Drainage time/d 4(3, 6) 3(2, 5)* 2(2, 3)*△ 71.541 ＜0.001 Hospital stay/d 7(6, 10) 6(5, 8)* 5(4, 6)*△ 68.081 ＜0.001 Surgical duration/min 76.50(59.75, 95.25) 55.00(46.50, 63.00)* 43.00(34.50, 56.00)*△ 106.114 ＜0.001 WBC/(×109·L﹣1) 11.80(9.48, 15.03) 8.35(6.20, 10.50)* 5.70(4.75, 6.80)*△ 141.792 ＜0.001 Neutrophil/% 79.65(0.91, 86.35) 67.45(55.38, 78.78)* 43.30(0.59, 62.60)*△ 81.277 ＜0.001 Neutrophil/(×109·L﹣1) 9.66(7.37, 13.17) 5.83(4.00, 8.63)* 3.38(2.67, 4.35)*△ 157.956 ＜0.001 Lymphocyte/(×109·L﹣1) 1.02(0.76, 1.47) 1.47(1.13, 1.81)* 1.71(1.33, 2.10)*△ 55.629 ＜0.001 Monocyte/(×109·L﹣1) 0.74(0.54, 0.96) 0.51(0.36, 0.76)* 0.32(0.24, 0.46)*△ 93.869 ＜0.001 Hb/(g·L﹣1) 134.00 (124.00, 143.25) 134.00 (123.00, 146.25) 132.00 (121.00, 145.50) 0.044 0.978 PLT/(×109·L﹣1) 197.50 (166.00, 246.25) 206.50 (165.00, 243.75) 222.00 (186.00, 268.50)△ 7.057 0.029 Alb/(g·L﹣1) 40.00(36.00, 42.00) 41.50(37.75, 44.00) 43.00(39.00, 45.75)*△ 17.084 ＜0.001 TBIL/(μmol·L﹣1) 23.00(15.00, 33.75) 14.55(11.00, 24.00)* 13.00(10.10, 18.00)*△ 37.976 ＜0.001 DBIL/(μmol·L﹣1) 5.00(3.00, 8.00) 4.00(2.78, 6.20) 3.00(2.00, 5.40)*△ 18.253 ＜0.001 ALT/(U·L﹣1) 25.50(17.00, 45.25) 23.00(17.00, 34.50) 23.00(15.00, 32.50) 2.115 0.347 AST/(U·L﹣1) 26.50(21.00, 39.25) 25.00(20.00, 31.00) 24.00(20.00, 31.50) 3.076 0.215 BUN/(mmol·L﹣1) 5.00(4.00, 6.00) 4.30(3.85, 5.55) 5.00(4.00, 5.95) 2.965 0.227 sCr/(μmol·L﹣1) 65.00(56.00, 81.00) 63.50(56.00, 76.50) 60.00(51.50, 69.00)*△ 9.529 0.009 NLR 9.45(5.17, 15.30) 4.21(2.37, 7.36)* 1.92(1.49, 2.71)*△ 143.915 ＜0.001 SII 1 729.00 (1 067.97, 2 926.40) 830.22 (433.10, 1 391.10)* 423.35 (305.59, 618.54)*△ 132.277 ＜0.001 BMI: body mass index; WBC: white blood cell; Hb: hemoglobin; Alb: albumin; PLT: platelet; TBIL: total bilirubin; DBIL: direct bilirubin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: urea nitrogen; sCr: serum creatinine; NLR: neutrophil-to-lymphocyte ratio; SII: systemic immune-inflammation index. *P＜0.05 compared with acute severe subgroup; △P＜0.05 compared with acute mild subgroup. 2.3 SII、NLR对急慢性胆囊炎的鉴别价值
结果（图 1）显示：SII最佳截断值为797.96（约登指数为0.599）时，其鉴别AC的AUC为0.847（95%CI 0.804~0.891），灵敏度为73.2%、特异度为86.7%。NLR最佳截断值为3.65（约登指数为0.637）时，其鉴别AC的AUC为0.869（95%CI 0.828~0.910），灵敏度为74.2%、特异度为89.5%。SII和NLR对AC的鉴别价值差异无统计学意义（Z＝1.715, P＝0.086）。
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图 1 SII、NLR鉴别急性胆囊炎的ROC曲线Figure 1. ROC curves of SII and NLR distinguishing acute cholecystitis from chronic cholecystitis2.4 SII、NLR对急性轻重度胆囊炎的鉴别价值
结果（图 2）显示：SII最佳截断值为1 056.59（约登指数为0.445）时，其鉴别急性重度胆囊炎的AUC为0.768（95%CI 0.699~0.836），灵敏度为77.0%、特异度为67.5%。NLR最佳截断值为4.65（约登指数为0.446）时，其鉴别急性重度胆囊炎的AUC为0.779（95%CI 0.713~0.845），灵敏度为82.3%、特异度为62.3%。SII和NLR对急性重度胆囊炎的鉴别价值差异无统计学意义（Z＝0.789, P＝0.430）。
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图 2 SII和NLR鉴别急性重度胆囊炎的ROC曲线Figure 2. ROC curves of SII and NLR distinguishing acute severe cholecystitis from mild cholecystitis3. 讨论
AC病程复杂、多样，单个标志物常难以反映患者疾病状态，因此越来越多的研究结合多种生物学标志物来判断胆囊炎的严重程度[7-9]。目前，重度胆囊炎诊断通常依赖超声、CT、MRI等检查，但这些方法价格相对较高、可重复性较差、灵敏度不足[10-11]。东京急性胆管炎和胆囊炎管理指南2013年版[12]和2018年版[13]基于临床特征、白细胞计数、C反应蛋白水平，以及是否存在脓毒症指标变化，制定了评估局部炎症和全身受累情况的量表，但未提出术前预测AC患者手术风险的指标。NLR、血小板与淋巴细胞比值（platelet-to-lymphocyte ratio, PLR）、SII等联合指标症已被广泛应用于预测炎症性疾病严重程度[14-18]。
SII代表 3种途径的免疫反应，能较全面反映机体炎症状态，近年来备受关注。越来越多的研究表明，SII能反映多种肿瘤[19-21]患者的炎症状态及炎症疾病[22-23]的严重程度。一项回顾性研究[24]发现，SII与急性胰腺炎（acute pancreatitis, AP）患者的死亡率相关，可作为AP患者的预后标志物。Xie等[22]发现，SII在溃疡性结肠炎（ulcerative colitis, UC）患者中明显升高，并与UC疾病活动度密切相关。然而，目前仅有国外少量文献报道了SII与AC炎症严重程度之间的相关性。Cakcak等[25]认为，高SII对接受药物治疗的AC患者行胆囊造瘘有指导意义。
本研究中，SII在AC患者中升高，最佳截断值为797.96时，鉴别AC的AUC为0.847，灵敏度为73.2%、特异度为86.7%，对急慢性胆囊炎的鉴别价值与NLR相当。但是，Feng等[26]在坏死性小肠结肠炎研究中发现，低SII与接受手术和预后不佳相关。本研究与Feng等研究的差异可能与研究人群的选择不同有关，Feng等的研究中包括新生儿，其中大多数是早产儿，提示年龄、人群、疾病类型等可能影响SII的临床应用。
Serban等[27]纳入235例因AC紧急入院的患者，发现SII在重度胆囊炎组较轻度组明显升高（P＜0.001），SII＞1 422.4时，诊断重度胆囊炎的灵敏度为63.8%、特异度为80.7%，AUC为0.787；NLR＞4.19时，诊断重度胆囊炎的灵敏度为85.5%、特异度为66.9%，AUC为0.824。本研究中，SII最佳截断值为1 056.59时，鉴别重度胆囊炎的AUC为0.768，灵敏度为77.0%、特异度为67.5%；NLR最佳截断值为4.65时，鉴别重度胆囊炎的AUC为0.779，灵敏度为82.3%、特异度为62.3%。两者对重度胆囊炎均有较高的诊断价值，且差异无统计学意义。本研究与Serban等[27]的研究结果存在差异，可能与轻重度胆囊炎的定义、患者情况、检测方法及试剂等不同有关。
此外，本研究中，AC患者的年龄以及高血压合并率更高，同时手术时长、住院时间较长，转开腹手术占比更高，引流量更多、引流管留置时间更长；AC患者胆红素、肌酐水平更高，可能与胆囊水肿压迫胆道及患者全身炎症反应有关。本研究还发现，AC组较慢性胆囊炎组血小板更低（P＝0.009），其原因有待进一步探讨。
综上所述，本研究表明，SII可以较好地区分急慢性胆囊炎及急性轻重度胆囊炎。由于SII相关指标淋巴细胞、中性粒细胞和血小板计数获取方便，SII有较高的临床应用价值。但由于相关研究较少，SII对急慢性胆囊炎的鉴别价值还须更大样本量的前瞻性研究证实，并须进一步分层分析。
伦理声明 本研究通过复旦大学附属金山医院伦理委员会批准（JIEC 2024-S12），患者签署知情同意书。利益冲突 所有作者声明不存在利益冲突。作者贡献 汤杰：研究设计、实施，数据收集、整理，文章撰写；赵文生、黄文海：数据收集、整理；黄安中：研究实施及文章撰写指导。 -
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图 1 SII、NLR鉴别急性胆囊炎的ROC曲线
Figure 1. ROC curves of SII and NLR distinguishing acute cholecystitis from chronic cholecystitis
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图 2 SII和NLR鉴别急性重度胆囊炎的ROC曲线
Figure 2. ROC curves of SII and NLR distinguishing acute severe cholecystitis from mild cholecystitis
表 1 急慢性胆囊炎组间一般临床及实验室资料比较
Table 1 Comparison of clinical and laboratory data between acute and chronic cholecystitis groups
Index Acute cholecystitis group (n＝192) Chronic cholecystitis group (n＝105) Z/χ2 value P value Gender n(%) 11.711 0.001 Male 100(52.08) 33(31.43) Female 92(47.92) 72(68.57) Age/year 59(48, 72) 53(40, 66) ﹣3.015 0.003 BMI/(kg·m﹣2) 24.18(22.03, 26.83) 24.03(21.51, 26.37) ﹣1.006 0.315 Hypertension n(%) 5.494 0.019 No 129(67.19) 84(80.00) Yes 63(32.81) 21(20.00) Diabetes n(%) 0.264 0.607 No 170(88.54) 95(90.48) Yes 22(11.46) 10(9.52) Operative procedure n(%) 9.248 0.002 Laparoscopic cholecystectomy 176(80.37) 105(100.00) Conversion to open cholecystectomy 16(7.31) 0 Drainage volume/mL 122.00(70.00, 202.50) 65.50(27.25, 130.25) ﹣4.983 ＜0.001 Drainage time/d 4(3, 6) 2(2, 3) ﹣7.474 ＜0.001 Hospital stay/d 7(5, 9) 5(4, 6) ﹣7.411 ＜0.001 Surgical duration/min 62.50(53.00, 84.00) 43(34.50, 56.00) ﹣8.736 ＜0.001 WBC/(×109·L﹣1) 10.30(7.70, 12.90) 5.70(4.75, 6.80) ﹣10.659 ＜0.001 Neutrophil/% 74.80(48.55, 83.95) 43.30(0.59, 62.60) ﹣8.678 ＜0.001 Neutrophil/(×109·L﹣1) 8.28(5.49, 11.01) 3.38(2.67, 4.35) ﹣11.258 ＜0.001 Lymphocyte/(×109·L﹣1) 1.22(0.85, 1.64) 1.71(1.33, 2.10) ﹣6.162 ＜0.001 Monocyte/(×109·L﹣1) 0.65(0.43, 0.89) 0.32(0.24, 0.46) ﹣9.037 ＜0.001 Hb/(g·L﹣1) 133.42±16.30 132.70±18.76 0.348 0.728 PLT/(×109·L﹣1) 201.50(166.00, 245.25) 222.00(186.00, 268.50) ﹣2.601 0.009 Alb/(g·L﹣1) 40.00(36.00, 43.00) 43.00(39.00, 45.75) ﹣3.738 ＜0.001 TBIL/(μmol·L﹣1) 19.70(13.00, 28.78) 13.00(10.10, 18.00) ﹣5.28 ＜0.001 DBIL/(μmol·L﹣1) 4.40(3.00, 7.30) 3.00(2.00, 5.40) ﹣4.051 ＜0.001 ALT/(U·L﹣1) 24.50(17.00, 39.75) 23.00(15.00, 32.50) ﹣1.362 0.173 AST/(U·L﹣1) 26.00(20.00, 35.75) 24.00(20.00, 31.50) ﹣1.288 0.198 BUN/(mmol·L﹣1) 4.80(4.00, 5.88) 5.00(4.00, 5.95) ﹣0.414 0.679 sCr/(μmol·L﹣1) 65.00(56.00, 78.00) 60.00(51.50, 69.00) ﹣3.021 0.003 NLR 6.80(3.49, 12.00) 1.92(1.49, 2.71) ﹣10.539 ＜0.001 SII 1 307.65(735.56, 2 314.40) 423.35(305.59, 618.54) ﹣9.928 ＜0.001 BMI: body mass index; WBC: white blood cell; Hb: hemoglobin; Alb: albumin; PLT: platelet; TBIL: total bilirubin; DBIL: direct bilirubin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: urea nitrogen; sCr: serum creatinine; NLR: neutrophil-to-lymphocyte ratio; SII: systemic immune-inflammation index. 
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表 2 急性轻重度胆囊炎及慢性胆囊炎组间一般临床资料和实验室指标比较
Table 2 Comparison of clinical and laboratory data between acute mild, severe cholecystitis and chronic cholecystitis
Index Acute severe subgroup (n＝114） Acute mild subgroup (n＝78） Chronic cholecystitis group (n＝105） Z/χ2 value P value Gender n(%) 11.723 0.003 Male 59(51.75) 41(52.56) 33(31.43)*△ Female 55(48.25) 37(47.44) 72(68.57) Age/year 63(50, 72) 56(46, 72) 53(40, 66)*△ 11.955 0.003 BMI/(kg·m﹣2) 24.44(22.08, 27.22) 23.65(21.74, 26.63) 24.03(21.51, 26.37) 2.428 0.297 Hypertension n(%) 6.868 0.032 No 73(64.04) 56(71.79) 84(80.00)* Yes 41(35.96) 22(28.21) 21(20.00) Diabetes n(%) 1.107 0.575 No 99(86.84) 71(91.03) 95(90.48) Yes 15(13.16) 7(8.97) 10(9.52) Operative procedure n(%) 27.147 ＜0.001 Laparoscopic cholecystectomy 98(85.96) 78(100.00)* 105(100.00)* Conversion to open cholecystectomy 16(14.04) 0 0 Drainage volume/mL 145.00 (78.50, 255.00) 107.00 (60.75, 158.75)* 65.50 (27.25, 130.25)*△ 31.710 ＜0.001 Drainage time/d 4(3, 6) 3(2, 5)* 2(2, 3)*△ 71.541 ＜0.001 Hospital stay/d 7(6, 10) 6(5, 8)* 5(4, 6)*△ 68.081 ＜0.001 Surgical duration/min 76.50(59.75, 95.25) 55.00(46.50, 63.00)* 43.00(34.50, 56.00)*△ 106.114 ＜0.001 WBC/(×109·L﹣1) 11.80(9.48, 15.03) 8.35(6.20, 10.50)* 5.70(4.75, 6.80)*△ 141.792 ＜0.001 Neutrophil/% 79.65(0.91, 86.35) 67.45(55.38, 78.78)* 43.30(0.59, 62.60)*△ 81.277 ＜0.001 Neutrophil/(×109·L﹣1) 9.66(7.37, 13.17) 5.83(4.00, 8.63)* 3.38(2.67, 4.35)*△ 157.956 ＜0.001 Lymphocyte/(×109·L﹣1) 1.02(0.76, 1.47) 1.47(1.13, 1.81)* 1.71(1.33, 2.10)*△ 55.629 ＜0.001 Monocyte/(×109·L﹣1) 0.74(0.54, 0.96) 0.51(0.36, 0.76)* 0.32(0.24, 0.46)*△ 93.869 ＜0.001 Hb/(g·L﹣1) 134.00 (124.00, 143.25) 134.00 (123.00, 146.25) 132.00 (121.00, 145.50) 0.044 0.978 PLT/(×109·L﹣1) 197.50 (166.00, 246.25) 206.50 (165.00, 243.75) 222.00 (186.00, 268.50)△ 7.057 0.029 Alb/(g·L﹣1) 40.00(36.00, 42.00) 41.50(37.75, 44.00) 43.00(39.00, 45.75)*△ 17.084 ＜0.001 TBIL/(μmol·L﹣1) 23.00(15.00, 33.75) 14.55(11.00, 24.00)* 13.00(10.10, 18.00)*△ 37.976 ＜0.001 DBIL/(μmol·L﹣1) 5.00(3.00, 8.00) 4.00(2.78, 6.20) 3.00(2.00, 5.40)*△ 18.253 ＜0.001 ALT/(U·L﹣1) 25.50(17.00, 45.25) 23.00(17.00, 34.50) 23.00(15.00, 32.50) 2.115 0.347 AST/(U·L﹣1) 26.50(21.00, 39.25) 25.00(20.00, 31.00) 24.00(20.00, 31.50) 3.076 0.215 BUN/(mmol·L﹣1) 5.00(4.00, 6.00) 4.30(3.85, 5.55) 5.00(4.00, 5.95) 2.965 0.227 sCr/(μmol·L﹣1) 65.00(56.00, 81.00) 63.50(56.00, 76.50) 60.00(51.50, 69.00)*△ 9.529 0.009 NLR 9.45(5.17, 15.30) 4.21(2.37, 7.36)* 1.92(1.49, 2.71)*△ 143.915 ＜0.001 SII 1 729.00 (1 067.97, 2 926.40) 830.22 (433.10, 1 391.10)* 423.35 (305.59, 618.54)*△ 132.277 ＜0.001 BMI: body mass index; WBC: white blood cell; Hb: hemoglobin; Alb: albumin; PLT: platelet; TBIL: total bilirubin; DBIL: direct bilirubin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: urea nitrogen; sCr: serum creatinine; NLR: neutrophil-to-lymphocyte ratio; SII: systemic immune-inflammation index. *P＜0.05 compared with acute severe subgroup; △P＜0.05 compared with acute mild subgroup.
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