目的 基于受试者工作特征(receiver operating characteristic，ROC)曲线和决策曲线分析(decision curve analysis，DCA)探讨血清Wnt家庭成员3A(WNT family member 3A，Wnt3A)、血清尿酸与肌酐比值(serum uric acid/creatinine ratio，SUA/Scr)、能量平衡相关蛋白(adropin)对血液透析患者预后的预测价值。 方法 前瞻性选取2022年9月—2024年9月中国人民解放军第三〇五医院血液透析的患者为研究组，根据预后分为预后不良和预后良好组。另选取同期非血液透析慢性肾脏病(chronic kidney disease，CKD)患者为对照组。酶联免疫吸附法检测血清Wnt3A、adropin水平，全自动生化分析仪检测SUA和Scr水平，并计算SUA/Scr。多因素Logistic分析预后的影响因素；ROC曲线分析Wnt3A、SUA/Scr、adropin对预后的预测价值；DCA评估预测模型的临床应用价值。 结果 研究组、对照组分别纳入204例患者，研究组Wnt3A高于对照组，SUA/Scr、adropin低于对照组(t/Z=8.377、14.621、12.759，均P＜0.001)；根据1年随访结果，将研究组患者分为预后良好组(n=141)和预后不良组(n=63)，其中预后不良组患者Wnt3A、SUA/Scr高于预后良好组，adropin水平低于预后良好组(t/Z=8.138、6.934、10.811，均P＜0.001)；多因素Logistic分析结果显示：年龄、透析龄、全段甲状旁腺激素、Wnt3A、SUA/Scr和Adropin是血液透析患者预后不良的影响因素[OR=1.261(95%CI：1.049～1.516)、1.762(95%CI：1.177～2.638)、1.553(95%CI：1.171～2.059)、1.892(95%CI：1.319～2.714)、1.942(95%CI：1.310～2.880)、0.449(95%CI：0.270～0.746)，P=0.014、0.006、0.002、0.001、0.001、0.002]；ROC表明Wnt3A、SUA/Scr、adropin联合预测预后不良的曲线下面积(area under the curve，AUC)为0.953(95%CI：0.928～0.979)，大于单独预测[Wnt3A：AUC=0.803、SUA/Scr：AUC=0.822，SUA/Scr：AUC=0.837(ZWnt3A、SUA/Scr、adropin=4.121、3.693、3.650，均P＜0.001)]，DCA结果提示联合预测预后在高风险阈值为0.04～0.95时，净获益率高于单独预测。 结论 血液透析预后不良患者血清Wnt3A、SUA/Scr水平升高，adropin水平降低，三者联合检测对预后预测价值较高。

Objective  To investigate the predictive value of serum Wnt family member 3A (Wnt3A), serum uric acid/creatinine ratio (SUA/Scr), and adropin for the prognosis of uremic hemodialysis patients based on receiver operating characteristic (ROC) curve and decision curve analysis (DCA).  Methods Patients undergoing hemodialysis at the 305th Hospital of the People's Liberation Army of China from September 2022 to September 2024 were prospectively enrolled as the study group and divided into poor‑prognosis and good‑prognosis subgroups based on 1‑year follow‑up outcomes. Non‑hemodialysis patients with chronic kidney disease (CKD) during the same period were selected as the control group. Serum levels of Wnt3A and adropin were measured by enzyme‑linked immunosorbent assay, and SUA and Scr were determined using an automated biochemical analyzer, with SUA/Scr calculated accordingly. Multivariate logistic regression was used to analyze prognostic factors. ROC curve analysis was performed to evaluate the predictive value of Wnt3A, SUA/Scr, and adropin for prognosis, and DCA was applied to assess the clinical utility of the prediction model.  Results  A total of 204 patients were enrolled in each group. The study group had significantly higher Wnt3A and lower SUA/Scr and adropin levels than the control group (t/Z = 8.377, 14.621, and 12.759, respectively, all P＜0.001). Based on 1-year follow-up, the study group was divided into the good-prognosis (n=141) and poor-prognosis (n=63) subgroups. Patients in the poor-prognosis subgroup had significantly higher Wnt3A and SUA/Scr and lower adropin levels compared with the good-prognosis subgroup (t/Z = 8.138, 6.934, and 10.811, respectively, all P＜0.001). Multivariate logistic regression identified age, dialysis vintage, intact parathyroid hormone, Wnt3A, SUA/Scr, and adropin as factors influencing poor prognosis [OR=1.261 (95% CI: 1.049～1.516), 1.762 (95% CI: 1.177～2.638), 1.553 (95% CI: 1.171～2.059), 1.892 (95% CI: 1.319～2.714), 1.942 (95% CI: 1.310～2.880), and 0.449 (95% CI: 0.270～0.746), with P=0.014, 0.006, 0.002, 0.001, 0.001, and 0.002, respectively]. ROC analysis showed that the area under the curve (AUC) for the combined prediction of poor prognosis using Wnt3A, SUA/Scr, and adropin was 0.953 (95% CI: 0.928～0.979), which was significantly greater than that of each marker alone [Wnt3A: AUC=0.803, SUA/Scr: AUC=0.822, adropin: AUC=0.837; Z values vs. combined model were 4.121, 3.693, and 3.650, respectively, all P＜0.001]. DCA results indicated that the combined prediction model provided a higher net benefit than each individual marker across threshold probabilities ranging from 0.04 to 0.95.  Conclusion  In hemodialysis patients with poor prognosis, serum Wnt3A and SUA/Scr levels are elevated while adropin level is decreased. The combined detection of these three markers offers superior predictive value for prognosis.