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·204 · 南 京 医 科 大 学 学 报 2025年2月

In the current study，patients with a poor prognosis had kylosing spondylitis patients，an SII critical value of
elevated NEU，decreased LYC，and consequently ele⁃ 513.20 yielded a sensitivity of 86.84% and specificity
vated NLR，consistent with previous studies ［44- 48，50- 51］ . of 83.33% for diagnosing disease activity ［27］ . In the cur⁃
The development of ILD is associated with the over⁃ rent study，the mean SII value for surviving patients
activation of alveolar macrophages，which triggers was 694.55，while for deceased patients，it was 1 278.43
neutrophil activation and the release of lymphocyte （P=0.001）. SII was significantly associated with mor⁃
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chemotactic factors ［52-53］ ，further leading to an increase tality in anti⁃MDA5 DM patients，with a cut⁃off value
in NLR. For instance，in patients with systemic sclerosis， above 895.79 indicating an increased risk of death.
［50］
an NLR value higher than 2.59 helps predict ILD ；in Additionally，the current study showed that age was an
polymyositis and dermatomyositis，NLR is significantly independent risk factor for predicting mortality in anti⁃
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correlated with the presence of ILD and serves as an MDA5 DM，consistent with previous findings，which
［54］
independent predictor of its occurrence . Therefore， may be due to older patients having more comorbidi⁃
［50］ ［56-57］
NLR is closely associated with ILD . In the current ties and overall poorer health .
study，the mean NLR value was 3.92 in non⁃RPILD In summary，NLR and SII are valuable tools for
patients and 6.74 in RPILD patients（P=0.003）. After clinicians in assessing disease severity，monitoring in⁃
conducting an ROC curve analysis，the best cut ⁃ off flammation，and predicting poor prognosis in anti ⁃
+ ［54］
value for NLR in predicting RPILD was consistent with MDA5 DM patients . These parameters offer greater
that of mortality，which was 6.12，indicating a strong diagnostic and predictive accuracy than single indica⁃
association with a fatal outcome，especially when com⁃ tors because they provide a more comprehensive as⁃
bined with RPILD. Compared with recent studies，NLR sessment of the inflammatory response. Although the
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higher than 4.86 was used as an independent predictor exact cause of anti⁃MDA5 DM remains unknown，re⁃
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of mortality in patients with anti⁃MDA5 DM ［14］ . It is cent studies have correlated disease prognosis with sev⁃
worth noting that the optimal cut⁃off value may differ in eral factors，including anti⁃MDA5 antibody titers，high
other studies because of factors such as sample size ferritin levels，serum KL⁃6，serum LDH levels，and the
+ + ［3，58-59］
and analysis methods. Therefore，further research with proportion of CD4 CXCR4 T cells . Besides，stu⁃
larger sample sizes and multi⁃center studies is neces⁃ dies have shown that peripheral LYC is correlated with
sary to determine a more definitive prediction. RPILD and is an applicable prognostic predictor for an⁃
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SII is a newly developed index that measures in⁃ ti⁃MDA5 DM ［60］ . Compared with these indicators，both
flammation by combining peripheral lymphocytes，neu⁃ NLR and SII are simpler，faster，and more cost⁃effec⁃
trophils，and platelets，providing a more comprehen⁃ tive，making them particularly useful for dynamic moni⁃
sive assessment of inflammation and immune balance toring in clinical practice.
in the body. SII can be used to evaluate disease activity However，the current study has several limitations.
and predict adverse outcomes. From a pathophysiologi⁃ Firstly，the follow⁃up period for recently enrolled pa⁃
cal perspective，inflammation leads to an increase in tients was relatively short，which may introduce some
neutrophil and platelet counts as well as a decrease in bias. Secondly，because of the rarity of the disease，the
lymphocyte counts，which results in higher SII values sample size was relatively small. Thirdly，the study was
that indicate stronger inflammatory responses and limited to a single center，and future multicenter stud⁃
［55］
weaker immune responses . In the assessment of can⁃ ies are needed to validate the results. Lastly，lympho⁃
cer，an elevated SII is significantly associated with lower cyte，neutrophil，and platelet counts may be influenced
survival rates，and the median critical value for SII was by treatment regimens；however，most cases in the
572 ［37］ ，with a value above 600 serving as a clinical study had received steroid treatment，making it diffi⁃
［50］
marker of inflammation . Studies have shown that cult to exclude this factor. Prospective studies are nec⁃
when the critical value exceeds 578.25，there is a sig⁃ essary to evaluate changes in NLR and SII at different
［25］
nificant increase in the risk of developing RA . In an⁃ disease stages. Future efforts should focus on design⁃