系统免疫炎症指数与中国 2 型糖尿病患者糖尿病肾病的相关性：一项横断面研究。
Association of systemic immune-inflammation index with diabetic kidney disease in patients with type 2 diabetes: a cross-sectional study in Chinese population.
机构信息
Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China.
出版信息
Front Endocrinol (Lausanne). 2024 Jan 4;14:1307692. doi: 10.3389/fendo.2023.1307692. eCollection 2023.
OBJECTIVE
Systemic immune-inflammation index (SII), a novel inflammatory marker, has been reported to be associated with diabetic kidney disease (DKD) in the U.S., however, such a close relationship with DKD in other countries, including China, has not been never determined. We aimed to explore the association between SII and DKD in Chinese population.
METHODS
A total of 1922 hospitalized patients with type 2 diabetes mellitus (T2DM) included in this cross-sectional study were divided into three groups based on estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR): non-DKD group, DKD stages 1-2 Alb group, and DKD-non-Alb+DKD stage 3 Alb group. The possible association of SII with DKD was investigated by correlation and multivariate logistic regression analysis, and receiver-operating characteristic (ROC) curves analysis.
RESULTS
Moving from the non-DKD group to the DKD-non-Alb+DKD stage 3 Alb group, SII level was gradually increased ( for trend <0.01). Partial correlation analysis revealed that SII was positively associated with urinary ACR and prevalence of DKD, and negatively with eGFR (all <0.01). Multivariate logistic regression analysis showed that SII remained independently significantly associated with the presence of DKD after adjustment for all confounding factors [(odds ratio (OR), 2.735; 95% confidence interval (CI), 1.840-4.063; < 0.01)]. Moreover, compared with subjects in the lowest quartile of SII (Q1), the fully adjusted OR for presence of DKD was 1.060 (95% CI 0.773-1.455) in Q2, 1.167 (95% CI 0.995-1.368) in Q3, 1.266 (95% CI 1.129-1.420) in the highest quartile (Q4) ( for trend <0.01). Similar results were observed in presence of DKD stages 1-2 Alb or presence of DKD-non- Alb+DKD stage 3 Alb among SII quartiles. Last, the analysis of ROC curves revealed that the best cutoff values for SII to predict DKD, Alb DKD stages 1- 2, and DKD-non-Alb+ DKD stage 3 Alb were 609.85 (sensitivity: 48.3%; specificity: 72.8%), 601.71 (sensitivity: 43.9%; specificity: 72.3%), and 589.27 (sensitivity: 61.1%; specificity: 71.1%), respectively.
CONCLUSION
Higher SII is independently associated with an increased risk of the presence and severity of DKD, and SII might be a promising biomarker for DKD and its distinct phenotypes in Chinese population.
目的
全身性免疫炎症指数（SII）是一种新的炎症标志物，在美国被报道与糖尿病肾病（DKD）有关，然而，在包括中国在内的其他国家，这种与 DKD 的密切关系尚未得到确定。我们旨在探讨 SII 与中国人群 DKD 之间的关系。
方法
本横断面研究共纳入 1922 例 2 型糖尿病住院患者，根据估计肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（ACR）将其分为三组：非 DKD 组、DKD 1-2 期 Alb 组和 DKD-非 Alb+DKD 3 期 Alb 组。通过相关性和多变量 logistic 回归分析以及受试者工作特征（ROC）曲线分析来探讨 SII 与 DKD 之间的可能关联。
结果
从非 DKD 组到 DKD-非 Alb+DKD 3 期 Alb 组，SII 水平逐渐升高（趋势<0.01）。偏相关分析显示，SII 与尿 ACR 和 DKD 的患病率呈正相关，与 eGFR 呈负相关（均<0.01）。多变量 logistic 回归分析表明，在调整所有混杂因素后，SII 仍然与 DKD 的存在显著相关[比值比（OR），2.735；95%置信区间（CI），1.840-4.063；<0.01)]。此外，与 SII 最低四分位数（Q1）的受试者相比，SII 第 2、3 和第 4 四分位数（Q2、Q3 和 Q4）的 DKD 存在的完全调整 OR 分别为 1.060（95%CI，0.773-1.455）、1.167（95%CI，0.995-1.368）和 1.266（95%CI，1.129-1.420）（趋势<0.01）。在 SII 四分位数中，DKD 1-2 期或 DKD-非 Alb+DKD 3 期 Alb 期的 DKD 存在时也观察到类似的结果。最后，ROC 曲线分析显示，SII 预测 DKD、Alb DKD 1-2 期和 DKD-非 Alb+DKD 3 期 Alb 的最佳截断值分别为 609.85（灵敏度：48.3%；特异性：72.8%）、601.71（灵敏度：43.9%；特异性：72.3%）和 589.27（灵敏度：61.1%；特异性：71.1%）。
结论
较高的 SII 与 DKD 的发生和严重程度增加独立相关，SII 可能是中国人群 DKD 及其不同表型的有前途的生物标志物。
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