系统免疫炎症指数、C反应蛋白/清蛋白比值评估糖尿病足溃疡病情严重程度和预后的价值

目的 探讨外周血系统免疫炎症指数(SII)、C反应蛋白/清蛋白比值(CRP/ALB)与糖尿病足溃疡(DFU)患者病情严重程度及预后的关系。 方法 回顾性分析某医院2020年6月—2021年12月收治157例DFU患者的临床资料, 根据6个月随访结果分为预后良好组(n=108)和预后不良组(n=49), 分析SII和CRP/ALB与病情严重程度的关系, 以及对DFU患者预后的预测作用, 并分析DFU患者预后不良的危险因素。 结果 DFU患者SII和CRP/ALB随Wagner分级增加及感染程度和缺血程度的加重而逐渐升高(均P < 0.05);SII、CRP/ALB与白细胞数、C反应蛋白、肾小球滤过率、糖化血红蛋白呈正相关, 与清蛋白、踝肱指数呈负相关(均P < 0.05)。SII、CRP/ALB预测DFU患者不良预后最佳界值分别为427.5、3.05, 受试者工作特征曲线下面积分别为0.797(95%CI: 0.715~0.879)、0.869(95%CI: 0.809~0.930), 均P < 0.05。Logistic多因素回归分析发现, C反应蛋白、清蛋白、肾小球滤过率、踝肱指数、糖化血红蛋白、SII、CRP/ALB是DFU患者预后不良的独立影响因素(均P < 0.05)。 结论 SII和CRP/ALB与DFU患者的病情严重程度相关, 是预后不良的影响因素, 可以用于评估DFU患者的预后。

Value of systemic immune-inflammation index and C-reactive protein/albumin ratio in evaluating severity and prognosis of diabetic foot ulcer

Objective To explore the relationship between peripheral blood systemic immune-inflammation index (SII), ratio of C-reactive protein/albumin (CRP/ALB) and the severity as well as prognosis of patients with diabe-tic foot ulcer (DFU). Methods Clinical data of 157 DFU patients admitted to a hospital from June 2020 to December 2021 were retrospectively analyzed. According to the 6-month follow-up results, they were divided into the good prognosis group (n=108) and the poor prognosis group (n=49). The relationship between SII, CRP/ALB and di-sease severity as well as the predictive effect on the prognosis of DFU patients was analyed, and risk factors for poor prognosis in DFU patients were identified. Results SII and CRP/ALB in DFU patients gradually increased with the increase of Wagner''s grade, aggravation of infection and ischemia (all P < 0.05). SII was positively correlated with white blood cell count, CRP, glomerular filtration rate and glycated hemoglobin, while negatively correlated with albumin and ankle-brachial index (all P < 0.05). The best cut-off point of SII and CRP/ALB for predicting the poor prognosis of DFU patients were 427.5 and 3.05, respectively, and the area under the receiver operating characteristic curve were 0.797 (95%CI: 0.715-0.879) and 0.869 (95%CI: 0.809-0.930, both P < 0.05), respectively. Logistic regression analysis showed that C-reactive protein, albumin, glomerular filtration rate, ankle-brachial index, glycated hemoglobin, SII and CRP/ALB were independent factors for the poor prognosis of DFU patients (all P < 0.05). Conclusion SII and CRP/ALB are related with the severity of the disease in DFU patients. They are factors for poor prognosis, and can be used to evaluate the prognosis of DFU patients.