系统性免疫炎症指数与microRNA-145对肺癌根治术患者发生肺部感染的预测价值

Predictive value of the systemic immune-inflammation index and microRNA-145 for pulmonary infection following radical surgery for lung cancer

摘要:

目的 探讨系统性免疫炎症指数（SII）联合microRNA-145（miR-145）对肺癌根治术患者发生肺部感染的预测价值。方法 选取2020年1月—2023年1月在陕西省人民医院接受肺癌根治术患者（244例），根据患者是否发生肺部感染分为感染组（43例）和非感染组（201例）。收集患者的临床资料，比较两组患者术前的炎症因子水平［C反应蛋白（CRP）、白细胞介素-6（IL-6）］、营养指标（白蛋白、血红蛋白）、SII，并通过实时荧光定量聚合酶链反应检测血清miR-145表达。采用多因素逐步Logistic回归模型分析肺癌根治术患者发生肺部感染的风险因素，并绘制受试者工作特征（ROC）曲线评估SII、miR-145对肺部感染的预测效能。结果 感染组患者糖尿病患病率、吸烟率、年龄、手术时间、白细胞计数、炎症因子和SII水平均高于非感染组（P <0.05），白蛋白和miR-145相对表达量均低于非感染组（P <0.05）；多因素逐步Logistic回归分析结果显示，年龄大［O^R=1.520（95% CI：1.137，2.031）］、手术时间长［O^R=9.803（95% CI：1.865，51.528）］、吸烟史［O^R=118.515（95% CI：1.781，7 884.700）］、糖尿病史［O^R=133.243（95% CI：2.960，5 997.049）］、白蛋白低［O^R=0.525（95% CI：0.329，0.836）］、SII水平高［O^R=1.007（95% CI：1.002，1.011）］和miR-145相对表达量低［O^R=0.011（95% CI：0.000，0.675）］均是肺癌根治术患者发生肺部感染的危险因素（P <0.05）；ROC曲线结果显示，SII联合miR-145预测肺癌根治术患者发生肺部感染的曲线下面积为0.956（95% CI：0.927，0.985），敏感性为81.4%（95% CI：0.666，0.916），特异性为96.0%（95% CI：0.923，0.983）。结论 SII越高、miR-145相对表达量越低的患者发生肺部感染的风险增加，可为患者病情评估提供指导。

Abstract:

Objective To explore the predictive value of the systemic immune-inflammation index (SII) combined with microRNA-145 (miR-145) for pulmonary infections in patients undergoing radical surgery for lung cancer.Methods The study included 244 patients who underwent radical surgery for lung cancer at the Shaanxi Provincial People's Hospital from January 2020 to January 2023. The patients were divided into the infection group (n = 43) and the non-infection group (n = 201) based on the occurrence of pulmonary infection. Clinical data of patients were collected, and preoperative levels of inflammatory markers [C-reactive protein (CRP), interleukin-6 (IL-6) ], nutritional indicators (albumin, hemoglobin), and SII were compared between the two groups. The serum expression of miR-145 was measured using real-time quantitative polymerase chain reaction. The multivariable stepwise logistic regression model was applied to investigate the risk factors for pulmonary infection in patients undergoing radical surgery for lung cancer. The diagnostic efficacy of SII and miR-145 for pulmonary infection was assessed via receiver operating characteristic (ROC) curves.Results The infection group exhibited significantly higher prevalence of diabetes mellitus, higher smoking rate, older age, longer duration of surgery, and higher white blood cell count, inflammatory factor levels, and SII compared to the non-infection group (P < 0.05), while albumin levels and miR-145 expression were significantly lower in the infection group (P < 0.05). Multivariable stepwise logistic regression analysis revealed that advanced age [O^R = 1.520 (95% CI: 1.137, 2.031) ], prolonged surgical duration [O^R = 9.803 (95% CI: 1.865, 51.528) ], smoking [O^R = 118.515 (95% CI: 1.781, 7 884.700) ], diabetes mellitus [O^R = 133.243 (95% CI: 2.960, 5 997.049) ], low albumin [O^R = 0.525 (95% CI: 0.329, 0.836) ], elevated SII [O^R = 1.007 (95% CI: 1.002, 1.011) ], and low miR-145 levels [O^R = 0.011 (95% CI: 0.000, 0.675) ] were all risk factors for pulmonary infection in patients undergoing radical surgery for lung cancer (P < 0.05). The ROC curve analysis indicated that the combination of SII and miR-145 in predicting pulmonary infection in patients undergoing radical surgery for lung cancer yielded an area under the curve of 0.956 (95% CI: 0.927, 0.985), with a sensitivity of 81.4% (95% CI: 0.666, 0.916) and a specificity of 96.0% (95% CI: 0.923, 0.983).Conclusion Patients with higher SII and lower miR-145 expression are at increased risk of pulmonary infection, which may guide clinical assessment.