【目的】 探究炎症指标中性粒细胞与淋巴细胞比值（NLR）、系统性免疫炎症指数（SII）、系统性炎症反应指数（SIRI）、系 统性炎症聚集指数（AISI）在慢性肾脏病（CKD）合并心力衰竭中西医诊疗中的临床意义。【方法】 共纳入 190 例 2022 年 1 月 ~ 2024年12月在温岭市中医院门诊及住院部接受治疗的CKD合并心力衰竭患者（病例组）以及30例CKD非心力衰竭患者（对照 组），对比2组患者间的NLR、SII、SIRI、AISI水平差异，并分析CKD合并心力衰竭患者不同中医证型与这些炎症指标的关 系；通过Logistic回归分析和受试者工作特征（ROC）曲线，评估了NLR、SII、SIRI、AISI在预测CKD合并心力衰竭病情程度 方面的效能。【结果】（1）病例组CKD合并心力衰竭患者的NLR、SII、SIRI、AISI水平均显著高于对照组的CKD非心力衰竭患 者（P＜0.01）。（2）在 CKD 合并心力衰竭患者中，NLR、SII、SIRI、AISI与 N末端 B型利钠肽前体（NT-ProBNP）水平呈正相关 （P＜0.01）。（3）本虚证中，脾肾阳虚证患者占比最高，其他依次为脾肾气阴两虚证、脾肾气虚证和阴阳两虚证；标实证中， 血瘀证患者占比最高，其他依次为湿热证、溺毒证和水湿证。（4）CKD合并心力衰竭患者的 NLR、SII、SIRI、AISI水平在本 虚证中从高到低依次为阴阳两虚证、脾肾阳虚证、脾肾气阴两虚证、脾肾气虚证；在标实证中从高到低依次为溺毒证、湿 热证、血瘀证、水湿证（P＜0.05）。（5）多因素Logistic回归分析结果显示，NLR、SII、SIRI、AISI是CKD合并心力衰竭病情程 度的独立危险因素（P＜0.01）。（6）ROC曲线分析表明，NLR、SII、SIRI、AISI在鉴别CKD合并心力衰竭病情程度方面具有较 高价值（P＜0.01）。【结论】 炎症指标NLR、SII、SIRI、AISI与CKD合并心力衰竭的病情程度存在显著相关性，这些指标有望 成为CKD合并心力衰竭中医微观辨证及其病情程度的潜在生物学标志物。

Objective To investigate the clinical significance of neutrophil-to-lymphocyte ratio （NLR），systemic immune-inflammatory index （SII）， systemic inflammation response index （SIRI）， and aggregate index of systemic inflammation （AISI） in chronic kidney disease （CKD） patients complicated with heart failure. Methods This study enrolled 190 CKD patients complicated with heart failure （case group） and 30 CKD patients without heart failure （control group） who treated in the outpatient and inpatient departments of Wenling Hospital of Traditional Chinese Medicine from January 2022 to December 2024. Differences in NLR，SII，SIRI，and AISI between the two groups were compared，and the relationship between these inflammatory markers and traditional Chinese medicine （TCM） syndrome types in CKD patients complicated with heart failure was analyzed. Logistic regression analysis and receiver operating characteristic （ROC） curve were used for evaluating the predictive efficacy of NLR，SII，SIRI，and AISI for illness severity of CKD complicated with heart failure. Results （1） The levels of NLR，SII，SIRI，and AISI in the case group were significantly higher than those in the control group （P＜0.01）.（2） In CKD patients complicated with heart failure， NLR， SII， SIRI， and AISI were positively correlated with N-terminal pro-brain natriuretic peptide （NT-proBNP） levels （P＜0.01）.（3） Among the CKD patients complicated with heart failure of fundamentally deficiency syndromes， spleen-kidney yang deficiency syndrome was the most prevalent， followed by spleen-kidney qi-yin deficiency syndrome， spleen-kidney qi deficiency syndrome，and yin-yang deficiency syndrome. Among the CKD patients complicated with heart failure of incidentally excess syndromes，blood stasis syndrome was the most common，followed by damp-heat syndrome， urinary toxin retention syndrome，and water-damp syndrome.（4） In CKD patients complicated with heart failure of fundamentally deficiency syndromes，NLR，SII，SIRI，and AISI levels ranked in the decreasing sequence in the syndromes of yin-yang deficiency， spleen-kidney yang deficiency， spleen-kidney qi-yin deficiency， and spleen-kidney qi deficiency； in the patients with incidentally excess syndromes， the levels ranked in the decreasing sequence in urinary toxin retention，damp-heat syndrome，blood stasis syndrome，and water-damp syndrome （P＜0.05）.（5） Multivariate logistic regression identified NLR，SII，SIRI，and AISI as independent risk factors for illness severity of CKD complicated with heart failure （P＜0.01）. （6）ROC curve analysis demonstrated high values of NLR，SII，SIRI，and AISI in differentiating illness severity of CKD complicated with heart failure （P＜0.01）. Conclusion Inflammatory markers of NLR， SII， SIRI， and AISI exhibit significant correlation with illness severity of CKD complicated with heart failure，suggesting their potentiality as biological markers for TCM syndrome differentiation and disease progression assessment in this population.

R269.92；R259.416

浙江省自然科学基金资助项目（编号：2024J011612）