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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (6): 1067-1073. doi: 10.19723/j.issn.1671-167X.2025.06.008

• 论著 • 上一篇    下一篇

SII和SIRI对白塞病葡萄膜炎的风险预测及疾病活动度和预后的评估

高雅静1,2,3, 李正芳1,3, 马梦思1,2,3, 武丽君1,3,*()   

  1. 1. 新疆维吾尔自治区人民医院风湿免疫科，乌鲁木齐 830000
    2. 新疆医科大学，乌鲁木齐 830000
    3. 新疆类风湿关节炎临床医学研究中心，乌鲁木齐 830000
  • 收稿日期:2025-08-12 出版日期:2025-12-18 发布日期:2025-10-30
  • 通讯作者: 武丽君
  • 基金资助:
    新疆常见自身免疫病诊断评估关键技术研发及应用项目(2022B03002-1)

Role of the SII and SIRI in risk prediction, disease activity assessment, and prog-nostic evaluation of Behçet disease uveitis

Yajing GAO1,2,3, Zhengfang LI1,3, Mengsi MA1,2,3, Lijun WU1,3,*()   

  1. 1. Department of Rheumatology and Immunology, People's Hospital of Xinjiang Uygur Autonomous Region, Uygur 830000, China
    2. Xinjiang Medical University, Uygur 830000, China
    3. Xinjiang Clinical Research Center for Rheumatoid Arthritis, Uygur 830000, China
  • Received:2025-08-12 Online:2025-12-18 Published:2025-10-30
  • Contact: Lijun WU
  • Supported by:
    the Key Research and Development Project of Xinjiang Uygur Autonomous Region(2022B03002-1)

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摘要：

目的: 探讨全身免疫炎症指数(systemic immune inflammation index，SII)和全身炎症反应指数(systemic inflammatory response index，SIRI)与白塞病葡萄膜炎(Behçet disease uveitis, BU)的相关性，及其在BU患者疾病活动度及临床预后评估中的预测价值。方法: 回顾性纳入194例白塞病(Behçet disease, BD)患者和122例健康志愿者，按BD疾病活动与否分为疾病活动期(90例)和疾病稳定期(104例)，按是否发生葡萄膜炎分为BU组(49例)与非BU组(145例)，BU组按葡萄膜炎是否活动分为炎症活动期BU组(26例)与炎症稳定期BU组(23例)。基于常规血液检验指标(血小板、中性粒细胞、淋巴细胞、单核细胞计数)计算SII和SIRI。采用Spearman相关性分析评估SII和SIRI与BU发病风险、疾病活动及炎症标志物的相关性；通过受试者工作特征(receiver operating characteristic, ROC)曲线分析确定SII和SIRI预测BU发病风险及疾病活动的最佳阈值与预测效能。结果: BD疾病活动期的SII和SIRI水平均高于BD疾病稳定期(P < 0.05)；有葡萄膜炎或血管受累BD患者的SII和SIRI水平高于有其他临床表现的患者(P < 0.05)。BU组患者的SII与SIRI水平均显著高于非BU组及健康对照组(P < 0.001)，其中炎症活动期BU组的SII与SIRI高于炎症稳定期BU组(P=0.004)。Spearman相关性分析显示，SII与BD疾病活动(ρ=0.303，P < 0.001)呈正相关，SIRI与BD疾病活动无相关性(ρ=0.049，P=0.500)；SII与BU发病风险(ρ=0.442, P < 0.001)、炎症活动(ρ=0.392, P=0.005)、炎症标志物C反应蛋白(ρ=0.272, P < 0.001)、红细胞沉降率(ρ=0.285, P < 0.001)呈正相关；SIRI仅与BU发病风险呈正相关(ρ=0.301, P=0.006)。Logistic回归分析显示，高SII是BU发病风险的独立危险因素(OR=1.003，95%CI：1.001~1.004，P＜0.001)。ROC曲线分析表明，SII预测BU发病风险的阈值为711.800 [ROC曲线下的面积(area under curve, AUC)= 0.752]，预测BU炎症活动的阈值为1 622.300(AUC=0.741)，预测BU预后不良的阈值为1 634.200(AUC=0.726)；SIRI预测BU发病风险的阈值为1.260(AUC=0.709)，预测BU炎症活动的阈值为1.390(AUC=0.704)，预测BU预后不良的阈值为2.790(AUC=0.678)。Kaplan-Meier曲线分析发现高SII水平是预后不良事件的独立预测因素(HR=3.440, 95%CI: 1.040~11.410, P=0.043)。结论: SII和SIRI可作为BD合并BU患者风险预测、疾病活动度及预后评估的潜在临床指标，为临床早期识别高风险BU患者及干预决策提供了依据。

关键词: 白塞病葡萄膜炎, 全身免疫炎症指数, 全身炎症反应指数, 预后评估

Abstract:

Objective: To evaluate the association of systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) with Behçet disease uveitis (BU), and to assess their predictive value for inflammatory activity and clinical prognosis in BU patients. Methods: There were 194 patients diagnosed with Behçet disease (BD) and 122 healthy controls. The BD patients were classified into two subgroups based on disease activity: An active phase cohort (n=90) and a stable phase cohort (n=104). Furthermore, the patients were categorized according to the presence or absence of uveitis into two cohorts: BU (n=49) and non-BU (n=145). Among the BU cohort, 26 patients were in the active inflammatory stage, while 23 patients were in the quiescent inflammatory stage. SII and SIRI were calculated using routine blood parameters, including platelet, neutrophil, lymphocyte, and monocyte counts. Spearman correlation analysis was performed to assess the associations of SII and SIRI with BU onset, inflammatory activity, and inflammatory markers. Receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal thresholds and predictive accuracy of SII and SIRI for BU onset and inflammatory activity. Results: SII and SIRI levels were significantly elevated in BD patients with ocular and vascular manifestations compared to those with stable disease (P < 0.05). No significant differences were observed in SII or SIRI levels among the patients with other clinical manifestations of BD. In the patients with BU, both SII and SIRI were significantly higher than in the non-BU and healthy control the groups (P < 0.001). Moreover, SII and SIRI levels were higher during the active inflamma-tory stage than in the inactive stage of BU (P=0.004). Spearman correlation analysis revealed that SII was positively associated with BD disease activity (ρ=0.303, P < 0.001), BU onset (ρ=0.442, P < 0.001), inflammatory activity (ρ=0.392, P=0.005), C-reactive protein (CRP, ρ=0.272, P < 0.001), and erythrocyte sedimentation rate (ESR, ρ=0.285, P < 0.001). SIRI was only positively correlated with BU onset (ρ=0.301, P=0.006). Logistic regression analysis demonstrated that eleva-ted SII was an independent risk factor for BU onset (OR=1.003, 95% CI: 1.001-1.004, P < 0.001). ROC curve analysis indicated that the optimal thresholds for SII were 711.800 [area under curve (AUC)=0.752] for predicting BU onset, 1 622.300 (AUC=0.741) for predicting inflammatory activity, and 1 634.200 (AUC=0.726) for predicting poor prognosis. The corresponding thresholds for SIRI were 1.260 (AUC=0.709), 1.390 (AUC=0.704), and 2.790 (AUC=0.678), respectively. Kaplan-Meier analysis indicated that elevated SII independently predicted adverse prognostic events (HR=3.440, 95%CI: 1.040-11.410, P=0.043). Conclusion: SII and SIRI may serve as potential clinical indicators for predicting inflammatory activity and prognosis in BD patients with uveitis. SII, in particular, demonstrates superior predictive performance for BU onset and disease activity, providing a basis for early identification of high-risk patients and clinical decision-making.

Key words: Behçet disease uveitis, Systemic immune inflammation index, Systemic inflammatory response index, Prognostic assessment

中图分类号: 

  • R593.22

表1

BD患者的基线临床特征"

Items BD (n=194)
Age/years 37.5 (30, 48)
BD disease course/years 5 (1, 10)
WBC/ (×109/L) 6.83 (5.05, 8.45)
RBC/ (×1012/L) 4.54 (4.16, 4.99)
PLT/ (×109/L) 245 (211.25, 308.00)
NEUT/ (×109/L) 4.05 (2.81, 5.58)
LYMPH/ (×109/L) 1.84 (1.38, 2.35)
MONO/ (×109/L) 0.46 (0.34, 0.63)
CRP/ (mg/L) 2.55 (1.20, 8.54)
ESR/ (mm/h) 17 (10, 30)
SII 510.55 (337.16, 849.29)
SIRI 0.98 (0.59, 1.79)

表2

BD疾病活动期与稳定期患者的实验室炎症指标比较"

Items Active BD (n=90) Stable BD (n=104) P value
WBC/ (×109/L) 7.57 (5.54, 9.75) 6.45 (4.93, 7.76) 0.002
PLT/ (×109/L) 251.50 (213.00, 325.25) 241.00 (210.00, 293.75) 0.269
NEUT/ (×109/L) 4.98 (3.17, 6.65) 3.58 (2.66, 4.73) < 0.001
LYMPH/ (×109/L) 1.74 (1.28, 2.39) 1.92 (1.53, 2.42) 0.078
MONO/ (×109/L) 0.51 (0.37, 0.66) 0.45 (0.33, 0.62) 0.193
CRP/ (mg/L) 4.08 (1.30, 18.46) 2.50 (1.20, 5.25) 0.017
ESR/ (mm/h) 21.50 (10.75, 45.50) 15.50 (8.25, 24.00) 0.001
SII 638.36 (367.84, 1 375.35) 469.78 (227.87, 680.42) 0.001
SIRI 1.19 (0.70, 2.58) 0.82 (0.53, 1.30) 0.002

表3

比较不同临床表现BD患者的SII和SIRI水平"

Manifestations Cases, n(%) SII，M(P25，P75) P value SIRI, M(P25，P75) P value
Oral aphthae 0.772 0.894
    Yes 192 (98.96) 510.55 (335.94, 858.82) 0.98 (0.59, 1.79)
    No 2 (1.04) 487.93 (335.75, 487.93) 1.24 (0.69, 1.24)
Genital aphthae 0.499 0.525
    Yes 153 (78.87) 508.22 (331.06, 808.88) 1.03 (0.60, 1.70)
    No 41 (21.13) 524.90 (351.78, 1 259.78)) 0.81 (0.51, 1.93)
Dermal 0.575 0.710
    Yes 81 (41.75) 504.20 (326.68, 724.67) 0.99 (0.57, 1.66)
    No 113 (58.25) 524.90 (341.59, 890.59) 0.97 (0.59, 1.81)
Uveitis < 0.001 < 0.001
    Yes 49 (25.26) 823.73 (498.34, 1 622.28) 1.61 (0.94, 2.90)
    No 145 (74.74) 453.16 (296.94, 684.78) 0.82 (0.54, 1.38)
Gastrointestinal 0.110 0.640
    Yes 25 (12.89) 704.76 (351.36, 1 441.90) 1.15 (0.57, 2.07)
    No 169 (87.11) 504.20 (332.88, 791.37) 0.97 (0.59, 1.71)
Vascular 0.040 0.038
    Yes 22 (11.34) 1 107.40 (422.73, 1 457.9) 1.56 (0.73, 1.72)
    No 172 (88.66) 671.45 (328.92, 772.03) 0.98 (0.57, 1.63)
Cardiovascular 0.363 0.340
    Yes 4 (2.06) 1 086.72 (349.43, 1 369.11) 1.93 (0.74, 2.72)
    No 190 (79.94) 506.85 (335.34, 813.91) 0.97 (0.59, 1.70)
Nervous system 0.435 0.856
    Yes 15 (7.73) 504.20 (335.75, 887.92) 1.07 (0.37, 2.55)
    No 179 (92.27) 512.89 (248.41, 707.32) 0.97 (0.60, 1.72)

图1

BU组、非BU组及健康对照组的SII和SIRI分布水平"

表4

BU发病风险的多因素二元Logistic回归分析"

Items β SE t P OR OR 95%CI
SII 0.003 0.001 19.702 < 0.001 1.003 1.001-1.004
SIRI 0.041 0.141 0.083 0.773 0.960 0.729-1.265

表5

活动期与稳定期BU患者的实验室炎症指标比较"

Items Active BU (n=26) Stable BU (n=23) P value
WBC/ (×109/L) 9.36 (7.32, 11.49) 6.74 (5.08, 9.71) 0.002
PLT/ (×109/L) 308.50 (232.00, 366.00) 258.00 (213.00, 304.00) 0.113
NEUT/ (×109/L) 6.85 (4.81, 8.95) 4.39 (3.05, 5.74) 0.001
LYMPH/ (×109/L) 1.51 (1.06, 2.50) 1.54 (1.31, 2.09) 0.113
MONO/ (×109/L) 0.56 (0.40, 0.69) 0.51 (0.36, 0.75) 0.440
CRP/ (mg/L) 2.53 (1.18, 7.82) 2.50 (1.00, 6.56) 0.920
ESR/ (mm/h) 19.00 (11.00, 38.75) 18.00 (9.00, 33.00) 0.865
SII 1 471.74 (639.23, 1 970.36) 683.47 (347.29, 1 309.66) 0.004
SIRI 1.86 (1.36, 3.21) 1.11 (0.64, 2.26) 0.015

图2

SII和SIRI预测BU的ROC曲线"

图3

不同SII组BU患者Kaplan-Meier曲线"

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