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摘要：
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摘要：目的 探讨全身免疫炎症指数（systemic immune-inflammation index，SII）评估失代偿期肝硬化
患者预后的价值。方法 回顾性分析2016年2月至2019年9月宜宾市第一人民医院消化内科收治的196例
失代偿期肝硬化患者的临床资料。收集患者性别、年龄、病史及病因等一般人口学资料和入院后首
次实验室检查资料，包括总胆红素（total bilirubin，TBil）、γ-谷氨酰转移酶（ γ-glutamyltransferase，
GGT）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、碱性磷酸酶（alkaline phosphatase，
ALP）、天门冬氨酸氨基转移酶（aspartate aminotransferase，AST）、白蛋白（albumin，ALB）、
血肌酐（serum creatinine，SCr）、尿素氮（blood urea nitrogen，BUN）、血清胱抑素（cystatin，
Cys）、尿酸、总胆固醇（total cholesterol，TC）、甘油三酯（triglyceride，TG）、高密度脂蛋白胆
固醇（high density liptein cholesterol，HDL-C）、血清Na+
、国际标准化比值（international normalized
ratio，INR）、白细胞计数（white blood count，WBC）、中性粒细胞计数、淋巴细胞计数、血小板
（platelet，PLT）、血红蛋白（hemoglobin，Hb）、凝血酶原时间（prothrombin time，PT）等。计算
SII、Child-Turcotte-Pugh（CTP）评分和终末期肝病模型（model for end-stage liver disease，MELD）
评分。根据随访1年的疾病转归将患者分为存活组（136例）和病死组（60例），比较两组上述指标
的差异。采用Cox比例风险回归模型分析失代偿期肝硬化患者预后的影响因素；绘制受试者工作特征
（receiver operating characteristic，ROC）曲线，评估SII、CTP评分和MELD评分对终末期肝硬化患者预
后的预测价值；根据最佳截断值，将患者分为高SII组（96例）和低SII组（100例），采用Kaplan-Meier
法分析两组生存率。结果 病死组患者入院时并发上消化道出血（25例vs 22例）、WBC [（6.44 ±
2.21）× 109
/L vs（4.39 ± 1.51）× 109
/L]、中性粒细胞计数[（4.76 ± 1.46）× 109
/L vs（2.76 ± 1.00）× 109
/L]、
淋巴细胞计数[（0.65 ± 0.23）× 109
/L vs（0.94 ± 0.37）× 109
/L]、PT [（19.22 ± 3.10）s vs（17.27 ± 3.16）s]、
INR（1.74 ± 0.34 vs 1.41 ± 0.33）、TBil [（57.87 ± 14.27）μmol/L vs（44.69 ± 14.94）μmol/L]、SII
[（472.04 ± 104.01）× 109
/L vs（287.55 ± 93.44）× 109
/L]、CTP评分[（14.21 ± 1.91）分 vs（10.24 ± 2.06）分]
和MELD评分[（16.36 ± 2.80）分 vs（10.85 ± 1.76）分]显著高于存活组，PLT [（54.95 ± 12.99）× 109
/L vs
（62.02 ± 14.20）× 109
/L]、ALB [（23.44 ± 3.09）g/L vs（30.50 ± 3.70）g/L]和血清Na+
[（129.77 ± 9.70）mmol/L
vs（138.48 ± 14.85）mmol/L]显著低于存活组，差异有统计学意义（P均＜ 0.05）。Cox回归分
析表明，结果表明SII（HR = 1.442，95%CI：1.198～1.735）、CTP评分（HR = 1.129，95%CI：
1.002～1.271）和MELD评分（HR = 1.199，95%CI：1.100～1.308）是影响失代偿期肝硬化患者1年预
后的独立危险因素，ALB（HR = 0.844，95%CI：0.782～0.911）和血清Na+
（HR = 0.933，95%CI：
0.914～0.953）为保护因素（P ＜ 0.05）。ROC曲线表明，SII值、CTP评分和MELD评分预测失代偿
期肝硬化患者预后的曲线下面积分别为0.909（95%CI：0.868～0.951，P ＜ 0.001）、0.679（95%CI：
0.590～0.769，P ＜ 0.001）、0.727（95%CI：0.637～0.817，P ＜ 0.001），SII值曲线下面积显著高
于CTP评分和MELD评分（z = 8.592、6.937，P均＜ 0.001）。SII值最佳阈值为330.29 × 109
/L，敏感
性为91.7%，特异度为72.8%。Kaplan-Meier生存曲线表明，高SII组总生存率显著低于低SII组[64.4%
（59/96）vs 77.0%（77/100）]，差异有统计学意义（χ
2
= 5.570，P = 0.018）。结论 SII值可较好地预
测失代偿期肝硬化患者预后，SII ＞ 330.29 × 109
/L提示患者病死风险增加。
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Abstract: Objective To investigate the value of systemic immune inflammatory index (SII) on evaluating
the prognosis of patients with decompensated liver cirrhosis. Methods The clinical data of 196 patients
with decompensated liver cirrhosis admitted to the digestive department of the First People’s Hospital of Yibin
from February 2016 to September 2019 were analyzed retrospectively. General demographic data such as gender,
age, medical history and etiology, and the first laboratory examination data after admission including total bilirubin
(TBil), gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), alkaline phosphatase (ALP), aspartate
aminotransferase (AST), albumin (ALB), serum creatinine (SCr), blood urea nitrogen (BUN), serum cystatin
(Cys), uric acid, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), serum Na,
international normalized ratio (INR), white blood cell count (WBC), neutrophil count, lymphocyte count, platelet
(PLT), hemoglobin (Hb) and prothrombin time (PT) were collected. The patients were divided into survival group
(136 cases) and death group (60 cases) according to the outcome of one year follow-up. The clinical data of the two
groups were compared. Cox proportional risk regression model was used to analyze the prognostic factors of patients
with decompensated liver cirrhosis. The receiver operating characteristic (ROC) curve was drawn to evaluate
the prediction effect of SII CTP score and MELD score on prognosis. According to the best cutoff value, the
patients were divided into high SII group (96 cases) and low SII group (100 cases). The survival rates of the
two groups were analyzed by Kaplan-Meier method. Results The upper gastrointestinal hemorrhage (25 cases vs
22 cases), WBC [(6.44 ± 2.21) × 109
/L vs (4.39 ± 1.51) × 109
/L], neutrophil count [(4.76 ± 1.46) × 109
/L vs (2.76 ±
1.00) × 109
/L], lymphocyte count [(0.65 ± 0.23) × 109
/L vs (0.94 ± 0.37) × 109
/L], PT [(19.22 ± 3.10) s vs (17.27 ± 3.16) s],
INR (1.74 ± 0.34 vs 1.41 ± 0.33), TBil [(57.87 ± 14.27) μmol/L vs (44.69 ± 14.94) μmol/L], SII [(472.04 ± 104.01) ×
109
/L vs (287.55 ± 93.44) × 109
/L], CTP score (14.21 ± 1.91 vs 10.24 ± 2.06) and MELD score (16.36 ± 2.80 vs
10.85 ± 1.76) of patients in death group were higher than those of survival group, PLT [(54.95 ± 12.99) × 109
/L vs
(62.02 ± 14.20) × 109
/L], ALB [(23.44 ± 3.09) g/L vs (30.50 ± 3.70) g/L] and serum Na+
[(129.77 ± 9.70) mmol/L
vs (138.48 ± 14.85) mmol/L] of patients in death group were lower than those of survival group, the
differences were statistically significant (all P ＜ 0.05). Cox regression analysis showed that SII (HR = 1.442,
95%CI: 1.198～1.735), CTP score (HR = 1.129, 95%CI: 1.002～1.271) and MELD score (HR = 1.199, 95%CI:
1.100～1.308) were independent risk factors for the prognosis of patients with decompensated cirrhosis, ALB
(HR = 0.844, 95%CI: 0.782～0.911) and serum Na+
(HR = 0.933, 95%CI: 0.914～0.953) were protective factors.
ROC curve showed that the area under the curve of SII value, CTP score and MELD score were 0.909 (95%CI:
0.868～0.951, P ＜ 0.001), 0.679 (95%CI: 0.590～0.769, P ＜ 0.001) and 0.727 (95%CI: 0.637～0.817，P ＜
0.001), respectively, the area under the curve of SII value were significantly higher than those of CTP score and
MELD score (z = 8.592, 6.937; all P ＜ 0.001). The best threshold of SII was 330.29 × 109
/L, the sensitivity was
91.7%, and the specificity was 72.8%. Kaplan-Meier survival analysis showed that the overall survival rate of
high SII group was lower than that of low SII group [64.4% (59/96) vs 77.0% (77/100); χ
2
= 5.570, P = 0.018].
Conclusions SII can better predict the prognosis of patients with decompensated liver cirrhosis, SII ＞ 330.29 ×
109
/L suggests an increasing risk of death.
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