【摘要】 目的 构建单核细胞分布宽度(MDW)、白细胞介素-6(IL-6)及淋巴细胞/单核细胞比值(LMR)联合模型，评估其对脓毒症早期诊断及28 d预后的预测效能。方法 选取2024年6月至2025年12月西安交通大学第一附属医院榆林医院260例疑似脓毒症感染患者，依据Sepsis-3标准分为非脓毒症组(n=101)、普通脓毒症组(n=98)和脓毒症休克组(n=61)。比较各组间MDW、IL-6、LMR表达差异，通过Spearman法分析各指标与序贯器官衰竭(SOFA)评分及急性生理与慢性健康(APACHE Ⅱ)评分的关联性，利用受试者工作特征(ROC)曲线探讨联合模型对诊断及预后的评估价值。结果 脓毒症休克组MDW、IL-6水平高于普通脓毒症组与非脓毒症组，LMR呈递减趋势(P<0.05)。相关性分析提示，MDW、IL-6与SOFA、APACHE Ⅱ评分呈正相关，LMR则与之呈负相关。联合模型诊断脓毒症的曲线下面积(AUC)达0.971(95%CI 0.955～0.987)，灵敏度为91.20%，特异度为94.10%。在28 d预后评估中，死亡组MDW、IL-6水平高于存活组，LMR则较低，联合模型预测死亡的AUC为0.872(95%CI0.830～0.914)。结论 MDW、IL-6与LMR联合检测可为脓毒症早期识别提供高精度依据，且三者构建的联合模型对近期预后分层具有一定指导意义。更多还原

【Abstract】 Objective To construct a combined model of monocyte distribution width(MDW), interleukin-6(IL-6), and lymphocyte/monocyte ratio(LMR), and evaluate its predictive efficacy for early diagnosis of sepsis and 28-day prognosis. Methods From June 2024 to December 2025, 260 suspected sepsis-infected patients were selected from Yulin Hospital, the First Affiliated Hospital of Xi’an Jiaotong University. They were divided into non-sepsis group(n=101), common sepsis group(n=98), and septic shock group(n=61) according to the Sepsis-3 criteria. The differences in MDW, IL-6, and LMR expression among the groups were compared. The correlations between each index and sequential organ failure assessment(SOFA) score and acute physiology and chronic health(APACHE Ⅱ) score were analyzed using the Spearman method. The receiver operating characteristic(ROC) curve was used to explore the evaluation value of the combined model for diagnosis and prognosis. Results The MDW and IL-6 levels in the septic shock group were higher than those in the common sepsis group and the non-sepsis group, and LMR showed a decreasing trend(P<0.05). Correlation analysis showed that MDW, IL-6 were positively correlated with SOFA and APACHE Ⅱ scores, while LMR was negatively correlated with them. The area under the curve(AUC) of the combined model for diagnosing sepsis was 0.971(95%CI 0.955 to 0.987), with a sensitivity of 91.20% and a specificity of 94.10%. In the 28-day prognosis assessment, the MDW and IL-6 levels in the death group were higher than those in the survival group, while LMR was lower. The AUC of the combined model for predicting death was 0.872(95%CI 0.830 to 0.914). Conclusions The combined detection of MDW, IL-6, and LMR can provide a high-precision basis for the early identification of sepsis, and the combined model constructed by these three indicators has certain guiding significance for the recent prognosis stratification.更多还原