系统免疫炎症指数在亚急性甲状腺炎中的诊断价值

郭洁云; 杨迪; 马慧青; 解鸿翔; 沈燕; 张容

doi:10.16766/j.cnki.issn.1674-4152.003970

系统免疫炎症指数在亚急性甲状腺炎中的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.003970

郭洁云¹,
杨迪²,
马慧青¹,
解鸿翔^{3, 4, ,},
沈燕⁴,
张容⁵

1.
东阳市红会医院检验科，浙江金华 322100
2.
山东省警官总医院监管医疗科，山东济南 250004
3.
山东第一医科大学第一附属医院山东省千佛山医院检验科，山东济南 250013
4.
浙江省人民医院(附属人民医院)，杭州医学院，检验医学中心检验中心，浙江杭州 310014
5.
杭州医学院检验医学院生物工程学院，浙江杭州 311399

基金项目:

浙江省医药卫生科技计划项目 2021KY017

浙江省医药卫生科技计划项目 2022KY027

山东省自然科学基金项目 ZR2020MH116

浙江省教育厅一般科研项目 Y202146133

浙江省中医药科技计划项目 2023ZL009

浙江省高校基本科研经费专项 KYYB202216

详细信息

通讯作者:
解鸿翔，E-mail：xiehongxiang007@163.com

中图分类号: R581.4 R446.11
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出版历程
- 收稿日期: 2024-01-14
- 网络出版日期: 2025-06-30

Diagnostic Value of Systemic Immune-Inflammation Index in Subacute Thyroiditis

1.
Department of Laboratory, Dongyang Honghui Hospital, Jinhua, Zhejiang 322100, China

摘要

摘要: 目的评估系统免疫炎症指数(SII)在亚急性甲状腺炎(SAT)患者中的诊断价值。方法回顾性分析2020年1月—2022年9月浙江省人民医院门诊及住院的127例SAT患者(SAT组)和100例健康体检者(健康对照组)的人口统计学和实验室数据。比较2组SII、中性粒细胞计数与淋巴细胞计数比值(NLR)、血小板计数与淋巴细胞计数比值(PLR)、CRP、ESR和TSH，并分析SAT患者SII与其他指标的相关性。采用逐步logistic回归分析筛选独立预测因素，使用ROC曲线评估SII对SAT的诊断效能。结果与健康对照组比较，SAT组SII、NLR、PLR、CRP、ESR均显著升高，TSH明显降低(P＜0.001)。相关性分析显示，SAT患者SII与NLR(r=0.867，P＜0.001)、PLR(r=0.788，P＜0.001)、CRP(r=0.415，P＜0.001)和ESR(r=0.414，P＜0.001)呈正相关关系，与TSH(r=-0.384，P＜0.001)呈负相关关系。多因素回归分析显示，SII(OR=1.004，P＜0.001)、CRP(OR=1.228，P＜0.001)、ESR(OR=1.085，P＜0.001)和FT4(OR=1.748，P＜0.001)均为SAT的独立影响因素。当SII截断点为555.8时，预测SAT的AUC为0.91(95% CI：0.87~0.95)，灵敏度为90.0%，特异度为83.4%。结论 SII可作为SAT潜在的标志物，可用于SAT疾病的诊断。
- 亚急性甲状腺炎 /
- 系统免疫炎症指数 /
- C反应蛋白 /
- 红细胞沉降率 /
- 促甲状腺激素
Abstract: Objective To evaluate the diagnostic value of the systemic immune-inflammation index (SII) in cases of subacute thyroiditis (SAT). Methods A retrospective analysis was conducted on the demographic and laboratory data of 127 patients with SAT and 100 healthy controls who were seen in both outpatient and inpatient departments of Zhejiang Provincial People' s Hospital from January 2020 to September 2022. SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), CRP, ESR and TSH were compared between patients with SAT and healthy controls, and the correlation between SII and NLR, PLR, CRP, ESR and TSH was analyzed. Stepwise logistic regression analysis was used to screen for independent predictors, and the area under the ROC curve was used to evaluate the diagnostic value of SII in SAT. Results In comparison with the healthy control group, the SAT patient group demonstrated significantly elevated SII, NLR, PLR, CRP and ESR, while TSH was significantly reduced (P < 0.001). A significant positive correlation between SII and NLR (r=0.867, P < 0.001), PLR (r=0.788, P < 0.001), CRP (r=0.415, P < 0.001) and ESR (r=0.414, P < 0.001), while SII demonstrated a significant negative correlation with TSH (r=-0.384, P < 0.001). Multivariate regression analysis demonstrates that SII (OR=1.004, P < 0.001), CRP (OR=1.228, P < 0.001), ESR (OR=1.085, P < 0.001) and FT4 (OR=1.748, P < 0.001) were independently influential factors for SAT. When the SII cut-off point was set at 555.8, the AUC was 0.91 (95% CI: 0.87-0.95), with sensitivity set at 90.0% and specificity at 83.4%. Conclusion SII has potential application as a practical marker for the diagnosis of SAT disease.
- Systemic immune inflammation index /
- Subacute thyroiditis /
- C-reactive protein /
- Erythrocyte sedimentation rate /
- Thyrotropin

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图 1 不同指标诊断SAT的ROC曲线

Figure 1. ROC curves of various indexes for diagnosing SAT

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表 1 SAT组与对照组一般资料及实验室相关参数比较

Table 1. Comparison of general information and laboratory parameters between the SAT and healthy control groups

组别	例数	性别(男性/ 女性, 例)	年龄[M(P₂₅, P₇₅), 岁]	白细胞计数[M(P₂₅, P₇₅), 10⁹/L]	中性粒细胞计数[M(P₂₅, P₇₅), 10⁹/L]	淋巴细胞计数[M(P₂₅, P₇₅), 10⁹/L]	血小板计数(x±s, 10⁹/L)	NLR [M(P₂₅, P₇₅)]	PLR [M(P₂₅, P₇₅)]
SAT组	127	32/95	48(40, 55)	7.45(6.40, 9.40)	5.17(4.39, 6.90)	1.71(1.38, 2.06)	310±84	3.15(2.50, 4.21)	174.60(137.50, 229.00)
对照组	100	25/75	43(36, 54)	5.69(4.85, 6.49)	3.08(2.55, 3.85)	1.94(1.61, 2.34)	228±45	1.59(1.25, 1.97)	115.10(97.50, 140.40)
统计量		0.001^a	1.729^b	8.243^b	10.190^b	3.463^b	8.732^c	10.208^b	8.317^b
P值		0.973	0.084	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	SII [M(P₂₅, P₇₅)]		TSH [M(P₂₅, P₇₅), mIU/L]	FT3 [M(P₂₅, P₇₅), ng/L]	FT4 [M(P₂₅, P₇₅), ng/L]	CRP [M(P₂₅, P₇₅), mg/L]		ESR [M(P₂₅, P₇₅), mm/h]
SAT组	127	949.70(665.10, 1 399.0)		0.02(0.01, 0.23)	4.59(3.60, 6.01)	18.49(10.89, 30.14)	36.00(11.10, 69.20)		57.00(30.00, 86.00)
对照组	100	347.90(279.10, 458.00)		1.87(1.34, 2.83)	3.24(3.03, 3.62)	8.86(8.04, 9.85)	0.50(0.20, 2.10)		11.50(6.00, 20.75)
统计量		10.700^b		10.311^b	8.261^b	8.899^b	11.793^b		10.450^b
P值		＜0.001		＜0.001	＜0.001	＜0.001	＜0.001		＜0.001
注：^a为χ²值，^b为Z值，^c为t值。

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表 2 复发组与无复发组SAT患者实验室相关参数比较[M(P₂₅, P₇₅)]

Table 2. Comparison of laboratory parameters between the recurrent and non-recurrent groups in patients with SAT[M(P₂₅, P₇₅)]

组别	例数	SII	白细胞计数(10⁹/L)	NLR	PLR	CRP(mg/L)
SAT复发组	32	1 080.25(616.24, 1 395.51)	7.43(6.33, 9.12)	3.55(2.78, 4.40)	183.84(138.18, 235.34)	43.90(12.05, 75.00)
SAT无复发组	95	924.00(665.10, 1 399.00)	7.45(6.42, 9.45)	3.07(2.37, 4.17)	167.46(136.64, 224.85)	32.00(10.55, 67.75)
Z值		0.605	0.175	1.052	0.639	0.702
P值		0.545	0.861	0.293	0.523	0.482

组别	例数	ESR(mm/h)	TSH(mIU/L)	FT3(ng/L)		FT4(ng/L)
SAT复发组	32	93.50(55.00, 107.50)	0.01(0.01, 0.01)	6.01(4.05, 7.39)		27.90(23.88, 46.96)
SAT无复发组	95	57.69(30.00, 80.00)	0.02(0.01, 0.15)	4.70(3.61, 6.34)		18.31(11.11, 29.97)
Z值		3.244	2.840	2.335		3.912
P值		0.001	0.005	0.020		＜0.001

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表 3 SAT影响因素的逐步logistic回归分析

Table 3. Logistic regression analysis of factors influencing SAT

变量	B	SE	Waldχ²	P值	OR值	95% CI
SII	0.004	0.001	16.002	＜0.001	1.004	1.002~1.005
CRP	0.206	0.047	19.050	＜0.001	1.228	1.120~1.347
ESR	0.081	0.015	29.560	＜0.001	1.085	1.053~1.117
FT4	0.558	0.116	23.086	＜0.001	1.748	1.392~2.195
注：本表仅列出差异有统计学意义的结果。

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表 4 不同指标对SAT的诊断性能分析

Table 4. Analysis of diagnostic performance of SAT by different indexes

项目	临界值	灵敏度(%)	特异度(%)	AUC(95% CI)	P值
SII	555.8	90.0	83.4	0.91(0.87~0.95)	＜0.001
CRP(mg/L)	6.3	83.5	96.0	0.95(0.93~0.97)	＜0.001
ESR(mm/h)	28.5	78.0	96.0	0.90(0.86~0.94)	＜0.001
SII+CRP+ESR	0.53	92.9	99.0	0.98(0.95~0.99)	＜0.001

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参考文献(16)

[1]	中华医学会内分泌学分会, 《中国甲状腺疾病诊治指南》编写组. 中国甲状腺疾病诊治指南: 甲状腺炎[J]. 中华内科杂志, 2008, 47(9): 784-788. Endocrinology Branch of Chinese Medical Association, Compilation Group of Guidelines for Diagnosis and Treatment of Thyroid Diseases in China. Chinese guidelines for the diagnosis and treatment of thyroid diseases: thyroiditis[J]. Chin J Internal Med, 2008, 47(9): 784-788.
[2]	STASIAK M, LEWINSKI A. New aspects in the pathogenesis and management of subacute thyroiditis[J]. Rev Endocr Metab Disord, 2021, 22(4): 1027-1039. doi: 10.1007/s11154-021-09648-y
[3]	HUANG C, SHEN S, YAO J. Subacute thyroiditis presenting as simple acute headache was misdiagnosed as meningitis: case report and literature review[J]. BMC Endocr Disord, 2023, 23(1): 53. DOI: 10.1186/s12902-023-01313-6.
[4]	MIHAI A, CARUNTU A, OPRIS-BELINSKI D, et al. The predictive role of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocytes-to-lymphocyte ratio (MLR) and Gammaglobulins for the development of cutaneous vasculitis lesions in primary Sjogren' s syndrome[J]. J Clin Med, 2022, 11(19): 5525. DOI: 10.3390/jcm11195525.
[5]	靳璐璐, 黄景慧, 王明明, 等. NLR与PLR在非小细胞肺癌患者化疗疗效及预后评估中的价值[J]. 西部医学, 2023, 35(9): 1310-1314. JIN L L, HUANG J H, WANG M M, et al. Value of peripheral blood neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluating chemotherapy response and prognosis of patients with NSCLC[J]. Med J W China, 2023, 35(9): 1310-1314.
[6]	ISLAM M M, SATICI M O, EROGLU S E. Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: an extensive literature review[J]. Turk J Emerg Med, 2024, 24(1): 8-19. doi: 10.4103/tjem.tjem_198_23
[7]	周阳阳, 刘静, 朱叶青, 等. 全身免疫炎症指数对HER2阴性晚期胃癌患者一线化疗疗效及生存结局的预测价值[J]. 中华全科医学, 2023, 21(12): 2031-2035. doi: 10.16766/j.cnki.issn.1674-4152.003283 ZHOU Y Y, LIU J, ZHU Y Q, et al. Value of systemic immune inflammation index in predicting the efficacy of first-line chemotherapy and survival outcome in patients with HER2 negative advanced gastric cancer[J]. Chin J Gen Pract, 2023, 21(12): 2031-2035. doi: 10.16766/j.cnki.issn.1674-4152.003283
[8]	LIU B, WANG J, LI Y Y, et al. The association between systemic immune-inflammation index and rheumatoid arthritis: evidence from NHANES 1999-2018[J]. Arthritis Res Ther, 2023, 25(1): 34. DOI: 10.1186/s13075-023-03018-6.
[9]	LANGE T, LUEBBER F, GRASSHOFF H, et al. The contribution of sleep to the neuroendocrine regulation of rhythms in human leukocyte traffic[J]. Semin Immunopathol, 2022, 44(2): 239-254. doi: 10.1007/s00281-021-00904-6
[10]	CALAPKULU M, SENCAR M E, SAKIZ D, et al. The prognostic and diagnostic use of hematological parameters in subacute thyroiditis patients[J]. Endocrine, 2020, 68(1): 138-143. doi: 10.1007/s12020-019-02163-w
[11]	PORTIER I, CAMPBELL R A. Role of platelets in detection and regulation of infection[J]. Arterioscler Thromb Vasc Biol, 2021, 41(1): 70-78. doi: 10.1161/ATVBAHA.120.314645
[12]	文向阳, 如泽, 高新, 等. 肌层浸润性膀胱癌患者在根治性膀胱切除术前的NLR、PLR和LMR与术后预后的关系[J]. 新医学, 2019, 50(5): 336-340. WEN X Y, RU Z, GAO X, et al. Correlation between NLR, PLR and LMR before radical cystectomy and postoperative prognosis in patients with muscle invasive bladder cancer[J]. J New Med, 2019, 50(5): 336-340.
[13]	CENGIZ H, VARIM C, DEMIRCI T, et al. Hemogram parameters in the patients with subacute thyroiditis[J]. Pak J Med Sci, 2020, 36(2): 240-245.
[14]	ZORNITZKI T, MILDINER S, SCHILLER T, et al. Subacute thyroiditis-still a diagnostic challenge: data from an observational study[J]. Int J Environ Res Public Health, 2022, 19(15): 9388. DOI: 10.3390/ijerph19159388.
[15]	孙秀芹, 赵怡, 包柄楠. 红细胞沉降速率联合C反应蛋白在亚急性甲状腺炎诊断中的应用价值[J]. 中华全科医学, 2017, 15(4): 600-601, 629. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.017 SUN X Q, ZHAO Y, BAO B N. Role of erythrocyte sedimentation rate combined C reactive protein in the diagnosis of subacutethyroiditis[J]. Chin J Gen Pract, 2017, 15(4): 600-601, 629. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.017
[16]	BAHADIR C T, YILMAZ M, KILICKAN E. Factors affecting recurrence in subacute granulomatous thyroiditis[J]. Arch Endocrinol Metab, 2022, 66(3): 286-294.