目的 探究血小板参数联合中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio，NLR)在糖尿病肾病(diabetic nephropathy,DN)腹膜透析(peritoneal dialysis,PD)患者中的表达及临床意义。 方法 回顾性分析2020年2月—2022年6月于西宁市第一人民医院行PD治疗的DN患者。收集患者入院后的一般资料和实验室指标，根据患者2年内生存结局将患者分为生存组和死亡组。采用ROC曲线分析血小板相关参数、NLR对DN患者PD预后的预测价值，采用多因素Logistic回归分析患者死亡的影响因素。 结果 共纳入83例患者，其中生存组66例，死亡组17例。相较于死亡组，生存组血小板平均体积(MPV)、血小板分布宽度(PDW)、血小板计数(PLT)、NLR、血尿素氮(BUN)、血肌酐(Scr)更低(t=6.071、5.093、3.730、3.604、19.166、23.365，P＜0.001、＜0.001、＜0.001、0.001、＜0.001、＜0.001)。多因素Logistic回归分析提示高水平PLT(OR=1.879，95% CI：1.355～2.607，P＜0.001)、MPV(OR=2.063，95% CI：1.504～2.828，P＜0.001)、PDW(OR=1.998，95% CI：1.449～2.755，P＜0.001)、NLR(OR=1.828，95% CI：1.282～2.606，P=0.001)、Scr(OR=2.924，95% CI：1.712～4.993，P＜0.001)、BUN(OR=2.746，95% CI：1.653～4.561，P＜0.001)为DN患者PD后死亡的危险因素。ROC曲线分析提示PLT(AUC=0.714，P=0.007)、MPV(AUC=0.788，P＜0.001)、PDW(AUC=0.750，P=0.002)、NLR(AUC=0.741，P=0.002)可作为DN患者预后情况的预测指标，四者联合预测(AUC=0.838，P＜0.001)的灵敏度和特异度分别为89.4%、88.2%。 结论  MPV、PDW、PLT、NLR、Scr、BUN水平为DN患者PD后死亡的影响因素。MPV、PDW、PLT、NLR表达水平能有效预测行PD治疗的DN患者生存情况，联合预测效能更高。

Objective  To investigate the expression and clinical significance of platelet parameters and neutrophil-to-lymphocyte ratio (NLR) in diabetic nephropathy (DN) patients under peritoneal dialysis (PD). Methods  A retrospective analysis was conducted on 83 DN patients who underwent PD treatment in our hospital from February 2020 to June 2022. The patients' general information and laboratory indicators after admission were collected, and the patients were divided into survival group and death groups according to their survival outcomes within 2 years. The receiver operating curve (ROC) was used to analyze the predictive value of platelet-related parameters and NLR on the prognosis of PD in patients with DN, and multivariate logistic regression was used to analyze the influencing factors of patient death.  Results  Compared with the death group, the mean platelet volume (MPV), platelet distribution width (PDW), platelet count (PLT), NLR, and blood urea nitrogen (BUN) and serum creatinine (Scr) were lower in the survival group (t=6.071, 5.093, 3.730, 3.604, 19.166, 23.365, P<0.001, <0.001, <0.001, <0.001, <0.001, <0.001). Multivariate logistic regression analysis pointed out that high levels of PLT (OR=1.879, 95% CI:1.355～2.607, P＜0.001), MPV (OR=2.063, 95% CI:1.504～2.828, P＜0.001), PDW (OR=1.998, 95% CI:1.449～2.755, P＜0.001), NLR (OR=1.828, 95% CI:1.282～2.606, P=0.001), Scr (OR=2.924, 95% CI:1.712～4.993, P＜0.001), BUN (OR=2.746, 95% CI:1.653～4.561, P＜0.001) are risk factors for death after PD in DN patients. ROC curve analysis suggested PLT (AUC=0.714, P=0.007), MPV (AUC=0.788, P＜0.001), PDW (AUC=0.750, P=0.002), and NLR (AUC=0.741, P=0.002) as predictors of the outcome of DN patients. The sensitivity and specificity (AUC=0.838, P＜0.001) were 89.4% and 88.2%, respectively.  Conclusion  MPV, PDW, PLT, NLR, Scr, and BUN levels were the contributing factors for death after PD in DN patients. The expression levels of MPV, PDW, PLT and NLR can effectively predict the survival of DN patients treated with PD, and the combined prediction efficacy is higher.