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第45卷第2期 蔡清清，尤含笑，王 磊，等. NLR和SII对抗MDA5抗体阳性皮肌炎伴快速进展型肺炎的预后价值［J］.
2025年2月 南京医科大学学报（自然科学版），2025，45（2）：196-207 ·199 ·

12.57）years vs.（50.16±13.36）years，P=0.03］，had low⁃ （i.e.，age，NLR，LMR，SII，SIRI，AISI，and myasthenia）
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er LYC levels（median：0.73×10 /L vs. 0.98×10 /L，P= were included in the multivariate model. The multivari⁃
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0.003），lower PLT levels（median：168.00 × 10 /L vs. ate Cox regression analysis indicated that a high SII
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179.00×10 /L，P=0.023），higher NLR levels（6.74 vs. was an independent risk factor for mortality（HR=1.00，
3.92，P=0.003），higher SII levels（1 206.81 vs. 716.83， 95% CI：1.00-1.00，P < 0.05）. Increasing age was also
P=0.014），higher AST levels（median：62.40 U/L vs. a significant determinant of mortality risk（Table 3）.
48.60 U/L，P=0.005），higher LDH levels（median： 2.3 Analysis of the value of NLR and SII on the

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344.00 U/L vs. 288.00 U/L，P=0.012），higher CRP prognosis of anti⁃MDA5 DM
levels（median：9.15 mg/L vs. 3.96 mg/L，P=0.001）， NLR and SII were identified as independent risk
and higher SF levels（median：977.70 mg/mL vs. factors for poor prognosis，specifically for the develop⁃
547.20 mg/mL，P=0.001）（Table 1）. ment of RPILD and overall survival，respectively. The
Furthermore，we observed a significant difference ROC curve analysis was used to determine the optimal
in myositis⁃associated antibodies，with a higher rate of cut⁃off values for predicting RPILD and survival（Fig⁃
anti⁃Ro52 antibody positivity in the RPILD group than ure 1A，B）. The AUC for NLR in predicting RPILD
in the non ⁃ RPILD group（86.49% vs. 67.82% ，P= was 0.67，with a cut⁃off value of 6.12. This cut⁃off value
0.044）. Baseline data of glucocorticoid（GC）usage also indicated a sensitivity of 56.76% and a specificity of
differed significantly between the two groups（P= 77.01%，suggesting moderate accuracy. Similarly，the
0.014）. In the non⁃RPILD group，27 cases（31.03%） AUC for NLR in predicting survival was 0.73，with the
used no GC at baseline，26 cases（29.89%）used high⁃ same cut ⁃ off value of 6.12，reflecting a sensitivity of
dose GC，and only 1 case（1.15%）used mega⁃dose GC. 62.16% and a specificity of 79.31%，indicating a good
In contrast，in the RPILD group，17 cases（45.95%） accuracy. Regarding SII，the AUC for predicting
used no GC at baseline，16 cases（43.24%）used high⁃ RPILD was 0.64，with a cut⁃off value of 1 200.82，dem⁃
dose GC，and none used mega⁃dose GC. There were no onstrating a sensitivity of 51.35% and a specificity of
statistically significant differences between the two 78.16%. The AUC for SII predicting survival was 0.69，
groups regarding the percentage of males as well as with the cut⁃off value of 875.79，reflecting a sensitivity
the levels of WBC，NEU，MON，ALT，CK，ESR，FIB， of 72.97% and a specificity of 62.07%，indicating that
D⁃D，baseline average dose of GC and anti⁃MDA5 anti⁃ SII was a moderately accurate predictor（Table 4）.
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bodies（Table 1）. 2.4 Survival analysis of anti⁃MDA5 DM
2.2 Risk factor analysis for RPILD and mortality Among patients with anti⁃MDA5 DM，there was a
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in anti⁃MDA5 DM significant association between SII，NLR and RPILD
In the current study，we analyzed the risk factors （P=0.001 and P < 0.001）. When stratified by the opti⁃
for developing RPILD and mortality in patients with anti mal cut ⁃ off value of SII，the Kaplan ⁃ Meier survival
⁃ MDA5 + DM，respectively. Univariate analysis re⁃ curve revealed that patients with SII>1 200.82 had a
vealed that age and serum biomarkers（i.e.，NLR，PLR， significantly lower incidence of non⁃RPILD within one

SII，SIRI，and AISI）were positively correlated with the year，compared to those with SII≤1 200.82（P=0.001，
risk of developing RPILD［hazard ratio（HR）>1，P < Figure 2A）. Figure 2B showed that patients with an
0.05，respectively］. A higher LMR was identified as a NLR≤6.12 had a significantly lower incidence of non⁃
protective factor against RPILD（Table 2）. In the multi⁃ RPILD than those with an NLR>6.12（P < 0.001）.
variate Cox regression analysis，a high NLR remained Furthermore，SII and NLR were found to be signifi⁃
the strongest independent risk factor for RPILD［HR= cantly associated with mortality（P < 0.001）. Patients
1.11，95% confidence interval（CI）：1.03- 1.18，P= with SII>875.79 had a significantly lower survival rate
0.003］（Table 2）. within one year，compared to those with SII≤875.79
To assess the risk of mortality，variables that （Figure 3A）. While，patients with NLR>6.12 had a
showed significant differences in the univariate analysis lower survival rate than those with NLR<6.12（Figure