全身炎症反应指数联合预后营养指数预测急性失代偿期肝硬化患者短期预后的价值

肝脏 ›› 2026, Vol. 31 ›› Issue (4): 494-498.

全身炎症反应指数联合预后营养指数预测急性失代偿期肝硬化患者短期预后的价值

曾雪丽, 刘佩, 张顺玲, 李心怡, 杨涓, 郑盛

671003 大理州大理大学临床医学院(曾雪丽,刘佩,张顺玲,李心怡);
650021 昆明云南大学附属医院(杨涓);
650011 昆明大理大学第二附属医院(郑盛)

收稿日期:2025-05-30 出版日期:2026-04-30 发布日期:2026-06-04
通讯作者: 郑盛,Email:zheng_sheng523@163.com
基金资助:
云南省教育厅科学研究基金项目(2025Y1181);云南省地方高校(部分)基础研究联合专项面上项目(202301BA070001-029,202301BA070001-044);云南省高层次科技人才及创新团队选拔专项-中青年学术和技术带头人后备人才项目(202405AC350067)

The predictive value of prognostic nutritional index combined with systemic inflammatory response index for the short-term prognosis of patients with acute decompensated cirrhosis

ZENG Xue-li¹, LIU Pei¹, ZHANG Shun-ling¹, LI Xin-yi¹, YANG Juan², ZHENG Sheng³

1. School of Clinical Medicine, Dali University, Dali 671003, China;
2. Yunnan University Affiliated Hospital, Kunming 650021, China;
3. the Second Affiliated Hospital of Dali University, Kunming 650011, China

Received:2025-05-30 Online:2026-04-30 Published:2026-06-04
Contact: ZHENG Sheng,Email:zheng_sheng523@163.com

摘要/Abstract

摘要： 目的探讨预后营养指数(PNI)联合全身炎症反应指数(SIRI)对急性失代偿期肝硬化(ADC)患者短期预后的预测价值。方法收集2020年1月至2024年11月大理大学第二附属医院收治的112例ADC患者为研究对象,随访3个月,观察患者的生存状况,并将其分为生存组(n=82)和死亡组(n=30)。比较生存组与死亡组的基线资料,分析影响ADC患者短期死亡的独立危险因素,并评估PNI联合SIRI对ADC患者短期预后的预测价值。结果死亡组的CTP评分为(10.53±2.01)分、Child-Pugh C级占比为63.3%(19/30)、MELD评分为(17.33±8.76)分、CLIF-C AD评分为(56.75±12.20)分、WBC为6.55(4.01,12.33)×10⁹ /L、ALT为33.15(18.68,59.48)U/L、AST为69.50(37.40,118.68)U/L、TBil为63.85(37.35,137.15)μmol/L、SIRI为31.08±7.15,均高于生存组的(7.80±1.56)分、14.2%(12/82)、(8.19±4.78)分、(46.16±7.62)分、4.33(2.96,6.15)×10⁹ /L、19.35(13.45,32.08)U/L、28.55(21.85,58.20)U/L、24.00(16.08,47.8)μmol/L、37.56±4.13,差异均有统计学意义(P<0.05),死亡组的RBC为(2.82±0.83)×10¹²/L、PNI为31.08±7.15,均低于生存组的(3.20±0.76)×10¹²/L、37.56±4.13,差异均有统计学意义(P<0.05)。单因素logistic回归分析显示,RBC、ALT、TBil、SCr、PNI、SIRI、CTP评分、MELD评分、CLIF-C AD评分是ADC患者短期不良预后的影响因素(P<0.05),多因素logistic回归分析显示SCr、PNI、SIRI、CTP评分仍是ADC患者短期不良预后的独立危险因素(P<0.05)。ROC曲线显示,SIRI、PNI单项与二者联合预测ADC患者短期不良预后的AUC分别为0.652(95%CI:0.522~0.782)、0.782(95%CI: 0.674~0.889)、0.846(95%CI:0.753~0.939),P值均＜0.05。结论 PNI、SIRI为两种简单、易得的血清学指标,二者联合预测ADC患者短期死亡风险的效能更佳。

关键词: 预后营养指数, 全身炎症反应指数, 急性失代偿期肝硬化, 影响因素, 预后

Abstract: Objective To investigate the predictive value of prognostic nutritional index (PNI) combined with systemic inflammatory response index (SIRI) for the short-term prognosis of patients with acute decompensated cirrhosis. Methods One hundred and twelve patients with acute decompensated cirrhosis admitted to the Second Affiliated Hospital of Dali University from January 2020 to November 2024 were collected as the study subjects. The patients were followed up for 3 months to observe their survival status and categorized into a survival group (n=82) and a death group (n=30). The baseline data of these two groups of patients were compared and the independent risk factors affecting short-term mortality of patients with acute decompensated cirrhosis and the predictive value of PNI combined with SIRI for the short-term prognosis of patients with acute decompensated cirrhosis were analyzed. Results In the death group, the Child-Turcotte-Pugh (CTP) score, percentage of CTP grade C, Model for end-stage liver disease (MELD) score, CLIF Consortium Acute Decompensation (CLIF-C AD) score, white blood cells count (WBC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), and SIRI were (10.53±2.01) points, 63.3% (19/30), (17.33±8.76)points, (56.75±12.20) points, 6.55 (4.01, 12.33)×10⁹/L, 33.15 (18.68, 59.48) U/L, 69.50 (37.40, 118.68) U/L, 63.85 (37.35, 137.15) μmol/L, and 31.08±7.15, respectively, which were higher than those of (7.80±1.56) points, 14.2% (12/82), (8.19±4.78) points, (46.16±7.62) points, 4.33 (2.96, 6.15)×10⁹/L,19.35 (13.45, 32.08) U/L, 28.55 (21.85, 58.20) U/L, 24.00 (16.08, 47.8) μmol/L, and 37.56±4.13 in the survival group, and the difference was statistically significant (P<0.05). The red blood cells count (RBC) and PNI were (2.82±0.83)×10¹²/L and 31.08±7.15 in the death group, which were lower than those of (3.20±0.76)×10¹²/L and 37.56±4.13 in the survival group, and the differences were statistically significant (P<0.05). By one-way logistic regression analysis it was shown that RBC, ALT, TBil, SCr, PNI, SIRI, CTP score, MELD score, and CLIF-C AD score were the influencing factors of the short-term poor prognosis in patients with acute decompensated cirrhosis (P<0.05). By multifactorial logistic regression analysis it was shown that SCr, PNI, SIRI, and CTP score were still the independent risk factors of short-term poor prognosis in patients with acute decompensated cirrhosis (P<0.05). By ROC curves analysis it was shown that the AUC of SIRI, PNI alone and SIRI combined with PNI for predicting short-term poor prognosis in patients with acute decompensated cirrhosis were 0.652(95%CI=0.522~0.782), 0.782(95% CI=0.674~0.889), and 0.846(95%CI=0.753~0.939), respectively (P<0.05). Conclusion PNI and SIRI, as two simple and readily available serologic indices, have better efficacy in combination for predicting short-term mortality risk in patients with acute decompensated cirrhosis.

Key words: Prognostic nutritional index, Systemic inflammatory response index, Acute decompensated cirrhosis, Influence factor;Prognosis

曾雪丽, 刘佩, 张顺玲, 李心怡, 杨涓, 郑盛. 全身炎症反应指数联合预后营养指数预测急性失代偿期肝硬化患者短期预后的价值[J]. 肝脏, 2026, 31(4): 494-498.

ZENG Xue-li, LIU Pei, ZHANG Shun-ling, LI Xin-yi, YANG Juan, ZHENG Sheng. The predictive value of prognostic nutritional index combined with systemic inflammatory response index for the short-term prognosis of patients with acute decompensated cirrhosis[J]. Chinese Hepatolgy, 2026, 31(4): 494-498.

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