Zeng Di, Wang Shaofeng, Cheng Nansheng, Li Bei, Xiong Xianze, Lu Jiong
Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
PLoS One. 2025 Jul 21;20(7):e0328400. doi: 10.1371/journal.pone.0328400. eCollection 2025.
Chronic hepatitis B virus (HBV) infection is a significant global health issue, leading to liver-related morbidity and mortality. The systemic immune-inflammation index (SII), a marker of systemic inflammation and immune response, may predict disease outcomes. However, its role in HBV infection and its relationship with HBV surface antibody (HBsAb) status is not well understood. This study investigates the association between SII, HBsAb status, and their combined effects on all-cause and cardiovascular disease (CVD) mortality.
We analyzed data from 43,539 participants in the National Health and Nutrition Examination Survey (NHANES), categorizing them into four groups based on SII and HBsAb status: high/low SII with HBsAb-negative/positive. Mortality outcomes were assessed using Cox proportional hazards models adjusted for age, sex, race/ethnicity, BMI, and comorbidities.
In the analysis of 43,539 participants, the fully adjusted model revealed that SII was significantly associated with both all-cause mortality (HR = 1.138, p < 0.001) and cardiovascular disease mortality (HR = 1.402, p < 0.0001), indicating that higher SII independently increases the risk of both outcomes. While the crude model showed a protective effect of HBV surface antibody on all-cause mortality (HR = 0.491, p < 0.0001) and cardiovascular disease mortality (HR = 0.478, p < 0.0001), this effect diminished after full adjustment. Additionally, the combined effect of SII and HBV surface antibody on both mortality outcomes remained significant in the fully adjusted model (HR = 1.402, p < 0.0001).
Higher SII is independently associated with increased risks of all-cause and cardiovascular disease mortality. The protective effect of HBV surface antibody on mortality diminished after adjustment for confounders. The combined effect of SII and HBV surface antibody on mortality highlights the complex interaction between inflammation and immune response in chronic HBV infection. SII may serve as a useful predictor of long-term health risks in HBV-infected individuals.
慢性乙型肝炎病毒（HBV）感染是一个重大的全球健康问题，可导致肝脏相关的发病和死亡。全身免疫炎症指数（SII）作为全身炎症和免疫反应的一个标志物，可能预测疾病转归。然而，其在HBV感染中的作用及其与乙肝表面抗体（HBsAb）状态的关系尚不清楚。本研究调查SII、HBsAb状态之间的关联以及它们对全因死亡率和心血管疾病（CVD）死亡率的综合影响。
我们分析了美国国家健康与营养检查调查（NHANES）中43539名参与者的数据，根据SII和HBsAb状态将他们分为四组：高/低SII且HBsAb阴性/阳性。使用经年龄、性别、种族/民族、体重指数和合并症调整的Cox比例风险模型评估死亡率结局。
在对43539名参与者的分析中，完全调整模型显示SII与全因死亡率（HR = 1.138，p < 0.001）和心血管疾病死亡率（HR = 1.402，p < 0.0001）均显著相关，表明较高的SII独立增加两种结局的风险。虽然粗模型显示乙肝表面抗体对全因死亡率（HR = 0.491，p < 0.0001）和心血管疾病死亡率（HR = 0.478，p < 0.0001）有保护作用，但在完全调整后这种作用减弱。此外，在完全调整模型中，SII和乙肝表面抗体对两种死亡率结局的综合影响仍然显著（HR = 1.402，p < 0.0001）。
较高的SII独立与全因死亡率和心血管疾病死亡率增加相关。在调整混杂因素后，乙肝表面抗体对死亡率的保护作用减弱。SII和乙肝表面抗体对死亡率的综合影响突出了慢性HBV感染中炎症与免疫反应之间的复杂相互作用。SII可能作为HBV感染个体长期健康风险的有用预测指标。
