SII、SIRI、NPAR对维持性血液透析患者营养不良的预测价值研究

Study on the Predictive Value of SII, SIRI, and NPAR for Malnutrition in Patients Undergoing Maintenance Hemodialysis

摘要: 目的：本研究旨在评估免疫炎症指数(SII)、系统炎症反应指数(SIRI)及中性粒细胞与白蛋白比值(NPAR)在预测维持性血液透析(MHD)患者营养不良预测中的应用价值。方法：选取2024年10月至2025年5月于我院接受维持性血液透析治疗的患者共106例，根据是否存在蛋白质能量消耗(PEW)分为PEW组(n = 40)与非PEW组(n = 66)，比较两组患者间SII、SIRI、NPAR与红细胞分布宽度、白细胞计数、C反应蛋白、白蛋白、前白蛋白、血肌酐、血清尿素氮等指标的差异，并对差异具有统计学意义的变量进行二元Logistic回归分析营养不良的独立影响因素，同时绘制ROC曲线评估三项指标及其联合预测指标对PEW的预测效能并确定最佳截断值。结果：相较于非PEW组，PEW组SII、SIRI、NPAR水平均显著升高(P < 0.05)。其中，SIRI、NPAR在多因素Logistic回归分析中仍为MHD患者蛋白质能量消耗的独立预测因子(P < 0.05)。三项指标预测PEW发生的曲线下面积分别为0.754、0.753、0.738。而多指标联合诊断时，SII + SIRI + NPAR和SII + SIRI + NPAR + CRP + WBC的曲线下面积分别为0.768、0.777。结论：SII、SIRI及NPAR是MHD患者蛋白质能量消耗的独立影响因素。三者单独、多指标联合预测可提高营养不良的预测准确性，对MHD患者预测PEW发生均有一定的临床参考价值。

Abstract: Objective: This study aims to evaluate the application value of immune-inflammation index (SII), systemic inflammation response index (SIRI), and neutrophil-to-albumin ratio (NPAR) in predicting malnutrition in maintenance hemodialysis (MHD) patients. Methods: A total of 106 patients who received maintenance hemodialysis treatment in our hospital from October 2024 to May 2025 were selected and divided into the PEW group (n = 40) and the non-PEW group (n = 66) based on the presence or absence of protein-energy wasting (PEW). The differences in SII, SIRI, NPAR and various indicators such as red blood cell distribution width, white blood cell count, C-reactive protein, albumin, prealbumin, serum creatinine, and serum urea nitrogen between the two groups of patients were compared. And for the variables with statistically significant differences in the above indicators, a binary Logistic regression analysis was conducted to identify the independent influencing factors of malnutrition. At the same time, a ROC curve was drawn to evaluate the predictive efficacy of the three indicators and their combined predictive indicators for PEW, and the optimal cut-off value was determined. Results: Compared with the non-PEW group, the levels of SII, SIRI and NPAR in the PEW group were significantly higher (P < 0.05). Among them, SIRI and NPAR remained independent predictors of protein-energy expenditure in MHD patients in the multivariate Logistic regression analysis (P < 0.05). The areas under the curve for the three indicators used to predict the occurrence of PEW were 0.754, 0.753, and 0.738, respectively. When using multiple indicators for combined diagnosis, the areas under the curves for SII + SIRI + NPAR and SII + SIRI + NPAR + CRP + WBC were 0.768 and 0.777, respectively. Conclusion: SII, SIRI and NPAR are independent factors influencing protein-energy wasting in MHD patients. Predictive accuracy for malnutrition can be enhanced through the use of these indices individually or in combination, and they hold clinical reference value for forecasting the onset of PEW in MHD patients.