摘要目的:探讨全身免疫炎症指数(SII)对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者预后的评估价值。方法:回顾性分析2016年1月至2021年8月复旦大学附属华山医院诊治的HBV-ACLF患者的年龄、性别、并发症、入院后实验室检查结果和SII、终末期肝病模型(MELD)评分、MELD-Na评分和蔡尔德-皮尤改良评分(CTP评分)等临床资料。根据随访90 d时患者疾病转归分为生存组和死亡组。统计学分析采用配对样本 t检验、曼-惠特尼 U检验和 χ2检验。采用Pearson相关分析SII与HBV-ACLF预后预测模型的相关性。采用受试者操作特征曲线下面积(AUC)分析SII、MELD评分、MELD-Na评分和CTP评分对HBV-ACLF患者预后预测的临床效能，计算SII预测HBV-ACLF预后的最佳截断值，采用Kaplan-Meier法进行生存分析。 结果:共纳入140例HBV-ACLF患者，生存组88例，其中男65例，女23例，年龄为(47.69±11.96)岁；死亡组52例，其中男40例，女12例，年龄为(52.73±12.22)岁。死亡组年龄、天冬氨酸转氨酶、总胆红素、血肌酐、国际标准化比值、中性粒细胞计数/淋巴细胞计数比值、单核细胞计数/淋巴细胞计数比值、SII、MELD评分、MELD-Na评分、CTP评分和感染率高于生存组，死亡组白蛋白、淋巴细胞计数、血小板计数、预后营养指数低于生存组，差异均有统计学意义( t＝－2.39， Z＝－2.84， t＝－4.81， Z＝－2.15， Z＝－4.91， Z＝－3.47， Z＝－3.36， Z＝－3.83， Z＝－4.69， Z＝－4.56， Z＝－6.31， χ2＝24.96， t＝3.06， t＝3.03， Z＝－7.57， t＝4.12，均 P<0.05)。SII与CTP评分( r＝0.272 7， P＝0.001)、MELD评分( r＝0.365 8， P<0.001)和MELD-Na评分( r＝0.381 1， P<0.001)均呈正相关。SII的AUC最大，为0.80，MELD评分为0.76，MELD-Na评分为0.74，CTP评分为0.73。SII的最佳截断值为447.49, SII≥447.49患者的90 d生存率[38.60%(22/57)]低于SII<447.49患者[79.52%(66/83)]，两组间差异有统计学意义( χ2＝23.80， P<0.001)。 结论:SII可用于评估HBV-ACLF患者病情严重程度和预后，SII≥447.49提示预后不佳。

abstractsObjective:To investigate the prognostic value of systemic immune-inflammation index (SII) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods:The clinical data, including age, gender, complications, laboratory examination results post-admission, SII, model for end-stage liver disease (MELD) score, MELD-Na score, Child-Turcotte Pugh (CTP) score of HBV-ACLF patients treated in Huashan Hospital, Fudan University from January 2016 to August 2021 were retrospectively analyzed. The patients were divided into survival group and death group according to the outcome at 90 days of follow-up.Paired sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis.Pearson correlation was used to analyze the correlation between SII and the prognosis prediction model of HBV-ACLF. The area under the curve (AUC) was used to analyze the clinical efficacies of SII, MELD score, MELD-Na score and CTP score in predicting the prognosis of HBV-ACLF patients, and the optimal cut-off value of SII for predicting the prognosis of HBV-ACLF was calculated. Kaplan-Meier method was used for survival analysis. Results:A total of 140 patients with HBV-ACLF were included. There were 88 patients in the survival group, including 65 males and 23 females, with the age of (47.69±11.96) years. There were 52 cases in the death group, including 40 males and 12 females, with the age of (52.73±12.22) years. The age, aspartate aminotransferase, total bilirubin, serum creatinine, international normalized ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, SII, MELD score, MELD-Na score, CTP score and the incidence of infection in the death group were all significantly higher than those in the survival group, and albumin, lymphocyte count, platelet count, prognostic nutritional index in the death group were all significantly lower than those in the survival group, and the differences were all statistically significant ( t=-2.39, Z=-2.84, t=-4.81, Z=-2.15, Z=-4.91, Z=-3.47, Z=-3.36, Z=-3.83, Z=-4.69, Z=-4.56, Z=-6.31, χ2=24.96, t=3.06, t=3.03, Z=-7.57 and t=4.12, respectively, all P<0.05). Pearson correlation analysis showed that SII was positively correlated with CTP score ( r=0.272 7, P=0.001), MELD score ( r=0.365 8, P<0.001) and MELD-Na score ( r=0.381 1, P<0.001). The AUC of SII was the largest of 0.80, and 0.76 for MELD score, 0.74 for MELD-Na score and 0.73 for CTP score. The optimal cut-off value of SII was 447.49. Kaplan-Meier analysis showed that the 90 days survival rate of patients with SII≥447.49(38.60%(22/57)) was lower than that of SII<447.49 group (79.52%(66/83)), and the difference between the two groups was significant ( χ2=23.80, P<0.001). Conclusions:SII can be used to assess the severity and prognosis of HBV-ACLF patients. SII ≥447.49 indicates poor prognosis.