目的 探讨全血细胞衍生的炎症指标对维持性血液透析(maintenance hemodialysis,MHD)患者全因死亡的预测价值。 方法 纳入2022年01月─2022年12月在贵州中医药大学第二附属医院MHD患者335例。根据随访期内是否死亡分为死亡组(53例)和存活组(282例)。比较2组全血细胞衍生的炎症指标水平，应用限制性立方样条(restricted cubic splines,RCS)和Logistic回归分析炎症指标与MHD死亡风险之间的关系，采用受试者工作特征(ROC)分析其对MHD患者全因死亡的预测价值。 结果 死亡组中性粒细胞与淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、单核细胞与淋巴细胞比值(monocyte/lymphocyte ratio,MLR)、中性粒细胞-单核细胞与淋巴细胞比值(neutrophil-monocyte to lymphocyte ratio,NMLR)、全身免疫炎症指数(systemic immune inflammatory index,SII)、全身炎症反应指数(systemic inflammatory response index,SIRI)和血小板与淋巴细胞比值(platelet/lymphocyte ratio，PLR)高于存活组(Z=-5.746、-5.275、-5.784、-4.446、-6.087、-2.222，均P＜0.05)。RCS分析表明SIRI、NLR、MLR、NMLR、PLR与MHD患者全因死亡风险间表现为非线性关系(χ2=11.480、20.440、17.500、18.830、13.540、10.750，P=0.003、＜0.001、＜0.001、＜0.001、0.001、0.005)。Logistic回归显示在充分调整混杂因素后，NLR(OR=2.324,95% CI:1.461～3.698，P＜0.001)、SII(OR=2.047,95% CI:1.365～3.070,P＜0.001)、SIRI(OR=1.623,95% CI:1.080～2.437,P=0.017)及NMLR(OR=2.302,95% CI:1.457～3.636,P＜0.001)是MHD患者全因死亡的独立危险因素。NLR、NMLR、SII及SIRI预测MHD全因死亡风险的曲线下面积(AUC)分别为0.822(95% CI:0.756～0.888)、0.822(95% CI:0.756～0.888)、0.817(95%CI:0.750～0.885)和0.814(95% CI:0.747～0.881)。 结论 NLR、NMLR、SII及SIRI与MHD患者全因死亡风险显著相关，能有效预测死亡风险。
Objective To investigate the predictive value of whole blood cell-derived inflammatory indicators for all-cause mortality in maintenance hemodialysis (MHD) patients. Methods A total of 335 MHD patients from January 2022 to December 2022 at Guizhou University of Traditional Chinese Medicine Second Affiliated Hospital were included. They were divided into a deceased group (n=53) and a survival group (n=282) based on follow-up outcomes. Levels of inflammatory indicators were compared between groups. Restricted cubic splines (RCS) and logistic regression analyzed associations between inflammatory indicators and mortality risk. Receiver operating characteristic (ROC) curves assessed predictive value. Results Patients in the deceased group had higher neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), neutrophil-monocyte to lymphocyte ratio (NMLR), systemic immune inflammatory index (SII), systemic inflammatory response index (SIRI), and platelet/lymphocyte ratio (PLR) than those in the survival group (Z=-5.746, -5.275, -5.784, -4.446, -6.087, -2.222; all P＜0.05). RCS showed nonlinear relationships between SIRI, NLR, MLR, NMLR, PLR, and all-cause mortality (χ²=11.480, 20.440, 17.500, 18.830, 13.540, 10.750; P =0.003, ＜0.001, ＜0.001, ＜0.001, 0.001, 0.005). After adjusting for confounders, logistic regression identified NLR (OR=2.324, 95% CI :1.461～3.698, P＜0.001), SII (OR=2.047, 95% CI :1.365～3.070, P＜0.001), SIRI (OR=1.623, 95% CI :1.080～2.437, P=0.017), and NMLR (OR=2.302, 95% CI :1.457～3.636, P＜0.001) as independent risk factors. AUCs for predicting mortality were: NLR 0.822(95% CI :0.756～0.888), NMLR 0.822(95% CI :0.756～0.888), SII 0.817(95% CI :0.750～0885), and SIRI 0.814s (95% CI :0.747～0881). Conclusion NLR, NMLR, SII, and SIRI are significantly associated with the risk of all-cause mortality in MHD patients and can effectively predict mortality risk.
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