中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (02): 99-103.doi: 10.3969/j.issn.1671-4091.2026.02.003

• 临床研究 • 上一篇    下一篇

预后营养指数联合全身免疫炎症指数对腹膜透析患者全因死亡的预测价值

付晓慧   郭小雨   姜泽仪   刘映红   

  1. 410011 长沙，1 中南大学湘雅二医院肾内科
  • 收稿日期:2025-07-09 修回日期:2025-10-20 出版日期:2026-02-12 发布日期:2026-02-02
  • 通讯作者: 刘映红 E-mail: liuyingh2002@csu.edu.cn
  • 基金资助:
    湖南省自然科学基金项目(2021JJ30942)；长沙市自然科学基金项目(kq2014235)

Predictive value of combined prognostic nutritional index and systemic immune-inflammation index for all-cause mortality in peritoneal dialysis patients

FU Xiao-hui, GUO Xiao-yu, JIANG Ze-yi, LIU Ying hong   

  1. 1 Department of Nephrology, the Second Xiangya Hospital of Central South University, Changsha 410011, China
  • Received:2025-07-09 Revised:2025-10-20 Online:2026-02-12 Published:2026-02-02
  • Contact: 410011 长沙，1中南大学湘雅二医院肾内科 E-mail: liuyingh2002@csu.edu.cn

摘要： 目的 分析预后营养指数(prognostic nutritional index，PNI)与全身免疫炎症指数(systemic immune-inflammation index,SII)联合对腹膜透析(peritoneal dialysis，PD)患者全因死亡的 预测价值。 方法 纳入2014年6月1日—2024年5月31日于中南大学湘雅二医院肾内科诊治的PD患 者进行研究，使用受试者工作特征(receiver operating characteristic,ROC)曲线计算PNI、SII的最 佳截断值并分组(A组：高PNI/低SII；B组：高PNI/高SII；C组：低PNI/低SII；D组：低PNI/高SII)，比较不 同组别患者的基线资料。Kaplan-Meier法分析组间生存率的差异，COX比例回归风险模型评估PNI、SII 及PNI-SII对终点事件的影响，ROC曲线和决策曲线评估预测效能和临床应用价值。 结果 共纳入955 例 患 者。PNI、SII 的 截 断 值 分 别 为 40.875、691.954。A、B、C、D 组 分 别 纳 入 275、282、199、199 例 患 者。 Kaplan-Meier 法提示患者的累积全因死亡风险组间比较存在统计学差异(Log-rank 检验 χ2 =116.000， P＜0.001)，校 正 关 键 混 杂 因 素 后 D 组 的 全 因 死 亡 风 险 较 A 组 增 加 7.6 倍(95% CI:2.08～27.64，P= 0.002)。PNI-SII预测PD患者全因死亡的曲线下面积为0.822(95% CI:0.780～0.864)，高于PNI(0.777， 95% CI:0.732～0.821) (DeLong 检 验 Z=4.755，校 正 后 P＜0.001)和 SII(0.692，95% CI:0.639～0.745) (DeLong检验Z=14.277，校正后P＜0.001)。 结论 PNI联合SII较单一指标能更有效预测PD患者全因 死亡且具有更优的临床获益。

关键词: 预后营养指数, 全身免疫炎症指数, 腹膜透析, 全因死亡

Abstract: Objective This study aimed to evaluate the predictive value of combining the Prognostic Nutritional Index (PNI) and the Systemic Immune-Inflammation Index (SII) for all-cause mortality in patients undergoing peritoneal dialysis (PD). Methods PD patients diagnosed and treated in the Department of Nephrology at the Second Xiangya Hospital of Central South University between June 1, 2014, and May 31, 2024, were enrolled. Receiver operating characteristic (ROC) curve analysis determined optimal cut-off values for PNI and SII. Patients were divided into four groups based on these cut-offs: Group A (High PNI / Low SII), Group B (High PNI / High SII), Group C (Low PNI / Low SII), and Group D (Low PNI / High SII). Baseline characteristics were compared across groups. Kaplan-Meier (K-M) analysis was performed to assess differences in survival rates. Cox proportional hazards regression models evaluated the impact of PNI, SII, and PNI-SII on all-cause mortality. ROC curves and decision curve analysis were used to evaluate predictive performance and clinical utility. Results A total of 955 patients were included. The cut- off values for PNI and SII were 40.875 and 691.954, respectively. Groups A, B, C, and D comprised 275, 282, 199, and 199 patients, respectively. Kaplan-Meier curves demonstrated a statistically significant difference in the cumulative all-cause mortality risk among groups (log-rank test χ2 =116.000, P＜0.001). After adjusting for key confounding factors, Group D had a 7.6- fold increased risk of all-cause mortality compared to Group A (95% Confidence Interval [CI]: 2.08～27.64, P=0.002). The area under the curve (AUC) for PNI- SII in predicting allcause mortality was 0.822 (95% CI: 0.780～0.864), surpassing that of PNI alone (0.777, 95% CI: 0.732～0.821; DeLong test Z= 4.755, corrected P＜0.001) and SII alone (0.692, 95% CI: 0.639～0.745; DeLong test Z=14.277, corrected P＜0.001). Conclusion The combination of PNI and SII offers superior predictive accuracy and greater clinical utility for all-cause mortality risk stratification in PD patients compared to either in dex used alone.

Key words: Prognostic nutritional index, Systemic immune- inflammation index, Peritoneal dialysis, All-cause mortality

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