转化医学杂志

目的 分析全身免疫炎症指数（SII）对老年射血分数中间值心力衰竭（HFmrEF）患者预后的预测价值。方法 选择2019年11月至2024年4月首都医科大学附属北京潞河医院收治的152例老年HFmrEF患者为研究对象，根据1年随访情况分为预后不良组（44例）与预后良好组（108例）。所有患者入院后检测血小板计数（PLT）、中性粒细胞计数（NEUT）、淋巴细胞计数，并计算SII。分析比较两组一般资料及SII，采用受试者工作特征（ROC）曲线评估SII对老年HFmrEF患者预后的预测价值，采用多因素Logistic回归分析老年HFmrEF患者预后的相关影响因素。结果 预后不良组美国纽约心脏病协会（NYHA）心功能分级及肌酸激酶同工酶、超敏C反应蛋白（hs-CRP）、胱抑素C(Cys C)、N末端B型钠尿肽前体（NT-proBNP）、PLT、NEUT、中性粒细胞/淋巴细胞比值（NLR）、SII水平均高于预后良好组（P<0.05）,LC、左心室射血分数（LVEF）低于预后良好组（P<0.05）。ROC曲线分析显示，PLT、NLR及SII预测老年HFmrEF患者预后不良的曲线下面积（95%CI）分别为0.847(0.797～0.897)、0.858(0.808～0.908)、0.902(0.852～0.952)，经De-Long检验，SII的预测效能显著优于PLT、NLR(Z=2.341、2.018，均P<0.05)。多因素Logistic回归分析显示，外周血hs-CRP>5.68 mg/L(OR=2.423)、Cys C>1.33 mg/L(OR=1.790)、NT-proBNP>1 286.62 pg/mL(OR=3.404)、SII>1 220.22(OR=2.776)为老年HFmrEF患者预后不良的危险因素（P<0.05）。结论 SII与老年HFmrEF患者预后密切相关，可有效预测患者预后不良发生。

Objective To analyze the predictive value of the systemic immune-inflammation index(SII) for the prognosis of elderly patients with heart failure with mid-range ejection fraction(HFmrEF). Methods A total of 152 elderly patients with HFmrEF admitted to Beijing Luhe Hospital, Capital Medical University from November 2019 to April 2024 were selected as the study subjects. Based on the one-year follow-up results, they were divided into a poor prognosis group(n=44) and a good prognosis group(n=108). After admission, all patients underwent measurements of platelet count(PLT), neutrophil count(NEUT), lymphocyte count, and related indicators, and SII was calculated. General data and SII were compared between the two groups. The predictive value of SII for the prognosis of elderly HFmrEF patients was evaluated using receiver operating characteristic(ROC) curve analysis, and multivariate logistic regression was used to analyze factors influencing prognosis. Results The poor prognosis group had higher NYHA cardiac function classification, creatine kinase isoenzyme, high-sensitivity C-reactive protein(hs-CRP), cystatin C(Cys C), N-terminal pro-brain natriuretic peptide(NT-proBNP), PLT, NEUT, neutrophil-to-lymphocyte ratio(NLR), and SII levels compared to the good prognosis group(P<0.05), while LC and left ventricular ejection fraction(LVEF) were lower(P<0.05). ROC curve analysis showed that the areas under the curve(95%CI) of PLT, NLR, and SII for predicting poor prognosis in elderly HFmrEF patients were 0.847(0.797–0.897), 0.858(0.808–0.908), and 0.902(0.852–0.952), respectively. DeLong's test revealed that the predictive efficacy of SII was significantly better than that of PLT and NLR(Z=2.341, 2.018, both P<0.05). Multivariate logistic regression analysis indicated that peripheral blood hs-CRP>5.68 mg/L(OR=2.423), Cys C>1.33 mg/L(OR=1.790), NT-proBNP>1 286.62 pg/mL(OR=3.404), and SII>1 220.22(OR=2.776) were risk factors for poor prognosis in elderly HFmrEF patients(P<0.05). Conclusion SII is closely associated with the prognosis of elderly HFmrEF patients and can effectively predict the occurrence of poor prognosis.