预后营养指数联合血清指标对急性脑梗死患者预后的预测价值

doi:10.11958/20253177

天津医药 ›› 2026, Vol. 54 ›› Issue (4): 423-428.doi: 10.11958/20253177

预后营养指数联合血清指标对急性脑梗死患者预后的预测价值

项亚娟(), 陈长春, 张璐^△()

安徽省第二人民医院神经内科（邮编230000）

收稿日期:2025-10-16 修回日期:2025-11-24 出版日期:2026-04-15 发布日期:2026-04-14
通讯作者: ^△E-mail：hidide@163.com
作者简介:项亚娟（1981），女，副主任医师，主要从事神经病学方面研究。E-mail：suspqe456781@163.com
基金资助:
安徽省高校自然科学研究项目(KJ2021A0350);安徽省高校科研项目(2024AH050551)

The predictive value of prognostic nutritional index combined with urea nitrogen/creatinine and DFR levels for poor prognosis in patients with acute cerebral infarction

XIANG Yajuan(), CHEN Changchun, ZHANG Lu^△()

Department of Neurology, Anhui Second People's Hospital, Hefei 230000, China

Received:2025-10-16 Revised:2025-11-24 Published:2026-04-15 Online:2026-04-14
Contact: ^△E-mail：hidide@163.com

项亚娟, 陈长春, 张璐. 预后营养指数联合血清指标对急性脑梗死患者预后的预测价值[J]. 天津医药, 2026, 54(4): 423-428.

XIANG Yajuan, CHEN Changchun, ZHANG Lu. The predictive value of prognostic nutritional index combined with urea nitrogen/creatinine and DFR levels for poor prognosis in patients with acute cerebral infarction[J]. Tianjin Medical Journal, 2026, 54(4): 423-428.

摘要/Abstract

摘要：

目的探究预后营养指数（PNI）联合尿素氮/肌酐、D-二聚体/纤维蛋白原（DFR）、红细胞分布宽度（RDW）对急性脑梗死患者预后不良的预测价值。方法采用便利抽样法抽取280例急性脑梗死患者作为研究对象，依据改良Rankin量表，将其分为预后良好组（177例）和预后不良组（103例）。收集患者年龄、性别、体质量指数（BMI）、基础疾病史；血清同型半胱氨酸（Hcy）、淋巴细胞总数（TLC）、血清白蛋白（ALB）、血红蛋白（Hb）、总胆固醇（TC）、血清总蛋白（TP）、C反应蛋白（CRP）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、尿酸（UA）、尿素氮、肌酐、D-二聚体、纤维蛋白原、RDW等指标。计算PNI、DFR。采用Spearman法分析PNI、尿素氮/肌酐、DFR、RDW与预后不良的相关性，单、多因素Logistic回归分析急性脑梗死患者预后不良的影响因素，绘制受试者工作特征（ROC）曲线，比较其曲线下面积（AUC）。结果预后不良组RDW、尿素氮/肌酐、DFR高于预后良好组，PNI低于预后良好组（均P<0.05）。单因素Logistic回归分析结果显示，PNI升高是急性脑梗死患者预后不良的保护因素，尿素氮/肌酐升高、DFR升高、RDW增大是危险因素（均P<0.05）。急性脑梗死患者的PNI与预后不良呈负相关，尿素氮/肌酐、DFR及RDW与预后不良均呈正相关（均P<0.01）。多因素Logistic回归分析结果显示，PNI升高是急性脑梗死患者预后不良的保护因素，尿素氮/肌酐升高、DFR升高、RDW增大是危险因素。ROC曲线分析结果显示，四者联合的AUC为0.986（95%CI：0.974~0.999），敏感度和特异度分别为84.50%、99.40%，均优于单独检测。结论急性脑梗死预后不良患者相比预后良好患者，前者的PNI低，而尿素氮/肌酐、DFR和RDW比后者高，四指标联合检测对急性脑梗死患者的预后具有较高的预测价值。

关键词: 脑梗死, 预后, 预后营养指数, 尿素氮/肌酐, D-二聚体与纤维蛋白原比值

Abstract:

Objective To explore the predictive value of prognostic nutritional index (PNI) combined with urea nitrogen/creatinine, D-dimer/fibrinogen (DFR) and red blood cell distribution width (RDW) for poor prognosis in patients with acute cerebral infarction. Methods A total of 280 patients with acute cerebral infarction were selected as the research subjects by convenience sampling. According to the modified Rankin scale, they were divided into the good prognosis group (177 cases) and the poor prognosis group (103 cases). Clinical data of patients were collected, including their age, gender, body mass index (BMI) and history of underlying diseases (diabetes, coronary heart disease and hypertension). The fully automatic blood cell analyzer, fully automatic biochemical analyzer, whole blood C-reactive protein analyzer and the corresponding reagents were used to obtain serum homocysteine (Hcy), total lymphocyte count (TLC), serum albumin (ALB), hemoglobin (Hb), total cholesterol (TC), total serum protein (TP) and C-reactive protein (CRP). The levels of indicators such as high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), urea nitrogen, creatinine, D-dimer, fibrinogen and RDW were also collected. PNI and DFR were calculated. Spearman assay was used to analyze the correlation between PNI, urea nitrogen/creatinine, DFR, RDW and prognosis. Univariate and multivariate Logistic regression were used to analyze the influencing factors of poor prognosis in patients with acute cerebral infarction. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was compared. Results The RDW, urea nitrogen/creatinine ratio and DFR were higher in the poor prognosis group than those in the good prognosis group (all P<0.05). The PNI index level was lower in the poor prognosis group than that in the good prognosis group (P<0.05). The results of univariate Logistic regression analysis showed that elevated PNI was a protective factor for poor prognosis in patients with acute cerebral infarction, while elevated urea nitrogen/creatinine ratio, elevated DFR and widened red blood cell distribution (RDW) were risk factors (all P<0.05). The PNI of patients with acute cerebral infarction was negatively correlated with poor prognosis (P<0.01). Urea nitrogen/creatinine, DFR and RDW were positively correlated with poor prognosis (all P<0.01). The results of Logistic multivariate regression analysis showed that elevated PNI was a protective factor for poor prognosis in patients with acute cerebral infarction, while elevated urea nitrogen/creatinine ratio, elevated DFR and widened RDW were risk factors. The results of ROC curve analysis showed that the AUC of the combination of the four was 0.986 (95%CI: 0.974-0.999), and the sensitivity and specificity were 84.50% and 99.40% respectively, both of which were superior to the individual detection. Conclusion Compared with patients with a good prognosis, those with a poor prognosis of acute cerebral infarction have a lower PNI, while levels of urea nitrogen/creatinine, DFR and RDW are higher. The combined detection of the four indicators has a high predictive value for the prognosis of patients with acute cerebral infarction.

Key words: brain infarction, prognosis, prognostic nutritional index, urea nitrogen/creatinine, D-dimer/fibrinogen ratio

中图分类号:

R743.33

图/表 7

参考文献 31

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组别	n				年龄/岁			男性				BMI/（kg/m²）				糖尿病史
预后良好组	177				67.29±13.21			122（68.93）				23.49±1.28				28（15.82）
预后不良组	103				67.90±14.11			63（61.17）				23.66±1.37				25（24.27）
χ²或t					0.363			1.750				1.045				3.031
组别			冠心病史			高血压病史				Hb/（g/L）					TP/（g/L）
预后良好组			29（16.38）			88（46.33）				129.63±18.89					64.32±7.21
预后不良组			15（14.56）			61（59.22）				131.25±17.46					65.46±8.01
χ²或t			0.275			2.363				0.709					1.212
组别		CRP/ （mg/L）					TC/（mmol/L）				HDL-C/（mmol/L）			LDL-C/（mmol/L）
预后良好组		2.78±1.29					4.85±1.32				1.11±0.33			2.96±0.82
预后不良组		3.02±1.32					4.91±1.26				1.04±0.29			3.10±0.87
t		1.494					0.312				1.792			1.444
组别				Hcy/（μmol/L）					UA/（μmol/L）				RDW/%
预后良好组				17.28±9.45					320.01±93.89				14.59±1.92
预后不良组				19.12±11.61					323.24±105.81				15.32±2.01
t				1.445					0.265				3.049^＊＊

组别	n				年龄/岁			男性				BMI/（kg/m²）				糖尿病史
预后良好组	177				67.29±13.21			122（68.93）				23.49±1.28				28（15.82）
预后不良组	103				67.90±14.11			63（61.17）				23.66±1.37				25（24.27）
χ²或t					0.363			1.750				1.045				3.031
组别			冠心病史			高血压病史				Hb/（g/L）					TP/（g/L）
预后良好组			29（16.38）			88（46.33）				129.63±18.89					64.32±7.21
预后不良组			15（14.56）			61（59.22）				131.25±17.46					65.46±8.01
χ²或t			0.275			2.363				0.709					1.212
组别		CRP/ （mg/L）					TC/（mmol/L）				HDL-C/（mmol/L）			LDL-C/（mmol/L）
预后良好组		2.78±1.29					4.85±1.32				1.11±0.33			2.96±0.82
预后不良组		3.02±1.32					4.91±1.26				1.04±0.29			3.10±0.87
t		1.494					0.312				1.792			1.444
组别				Hcy/（μmol/L）					UA/（μmol/L）				RDW/%
预后良好组				17.28±9.45					320.01±93.89				14.59±1.92
预后不良组				19.12±11.61					323.24±105.81				15.32±2.01
t				1.445					0.265				3.049^＊＊

组别	n	PNI	尿素氮/肌酐	DFR（×10^-3）
预后良好组	177	52.06±4.65	13.98±3.46	19.68±3.03
预后不良组	103	44.55±6.12	21.60±4.97	39.06±7.01
t		11.587^＊＊	15.090^＊＊	32.032^＊＊

组别	n	PNI	尿素氮/肌酐	DFR（×10^-3）
预后良好组	177	52.06±4.65	13.98±3.46	19.68±3.03
预后不良组	103	44.55±6.12	21.60±4.97	39.06±7.01
t		11.587^＊＊	15.090^＊＊	32.032^＊＊

变量	β	SE	Wald χ²	P	OR（95%CI）
PNI	-0.276	0.036	59.346	<0.001	0.759（0.708~0.814）
尿素氮/肌酐	0.431	0.050	72.989	<0.001	1.539（1.394~1.698）
DFR	0.350	0.050	49.436	<0.001	1.419（1.287~1.565）
RDW	0.193	0.065	8.795	0.003	1.213（1.068~1.377）

预后营养指数联合血清指标对急性脑梗死患者预后的预测价值

The predictive value of prognostic nutritional index combined with urea nitrogen/creatinine and DFR levels for poor prognosis in patients with acute cerebral infarction

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变量	容差	VIF
PNI	0.774	1.293
尿素氮/肌酐	0.696	1.437
DFR	0.675	1.481
RDW	0.973	1.028

变量	β	SE	Wald χ²	P	OR（95%CI）
PNI	-0.263	0.062	18.194	<0.001	0.769（0.681~0.868）
尿素氮/肌酐	0.400	0.087	21.348	<0.001	1.492（1.259~1.767）
DFR	0.385	0.081	22.690	<0.001	1.469（1.469~1.721）
RDW	0.133	0.158	0.716	0.049	1.142（1.142~1.555）
常数项	-5.977	4.314	1.919	0.166	0.003

指标	AUC（95%CI）	P	敏感度/ %	特异度/ %	约登指数
PNI	0.835（0.784~0.885）	<0.001	70.90	84.20	0.551
尿素氮/肌酐	0.895（0.855~0.935）	<0.001	80.60	84.20	0.648
DFR	0.903（0.863~0.944）	<0.001	73.80	93.80	0.710
RDW	0.613（0.543~0.681）	0.002	58.30	67.20	0.255
四者联合	0.986（0.974~0.999）	<0.001	84.50	99.40	0.839

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