目的 了解维持性血液透析（MHD）患者营养状况，探讨分析MHD患者血清铁调素、正五聚蛋白3（PTX3）水平与营养状况的关系。 方法 选自承德医学院附属医院入组符合标准的MHD患者76例，依据主观综合营养评估（SGA）对患者营养状态进行评估，分为SGA-A、SGA-B、SGA-C三个等级。采用酶标抗体法检测血清PTX3、铁调素的水平。应用SPSS 进行统计学分析，采用单因素方差分析比较3个SGA等级组间临床指标差异，影响营养不良的因素分析采用二元logistic回归，其中SGA-B、SGA-C为营养不良（45例），SGA-A为营养良好，血清铁调素、PTX3对营养状况的评估价值分析采用ROC分析。 结果 76例MHD患者中，营养不良者45例患者，占59.2%。对3组间临床资料进行比较显示，营养不良组男性占比更低，年龄更大，血超敏C反应蛋白（hs-CRP）、PTX3、铁调素水平更高（P < 0.05），血白蛋白水平、肌酐、血磷水平更低（P < 0.05）。对SGA等级进行量化分析，Spearman相关性分析显示，hs-CRP、PTX3、铁调素均与SGA等级呈正相关（P < 0.05）。以“营养不良”为因变量进行logistic回归分析提示，血清hs-CRP水平高、PTX3水平高、铁调素水平高、年龄更大是MHD患者营养不良的危险因素，血磷水平高、血肌酐水平高是MHD患者营养不良的保护因素。进一步进行多因素logistic回归分析提示，血清PTX3水平高是MHD患者营养不良的独立危险因素（P = 0.032），血肌酐水平高是MHD患者营养不良呈的独立保护因素（P = 0.047）。ROC分析显示，血肌酐联合PTX3对MHD患者营养不良有较高的评估价值，曲线下面积为0.789（P < 0.001），约登指数0.488，敏感度为77.8%，特异度为71.0%。 结论 高水平的PTX3及铁调素、低水平的血肌酐为MHD患者营养不良的危险因素，其中血清PTX3水平高、血肌酐水平低为MHD患者营养不良的独立危险因素，且对MHD患者营养不良有较好的评估价值。

Objective To investigate the association between nutritional status and serum hepcidin and pentraxin 3 （PTX3） levels in patients undergoing maintenance hemodialysis （MHD）. Methods A total of 76 patients with MHD who met the inclusion criteria were recruited from the hemodialysis center at the Affiliated Hospital of Chengde Medical University. Nutritional status was assessed using the Subjective Global Assessment （SGA）， which categorizes patients into three grades： SGA?A， SGA?B， and SGA?C. Serum levels of PTX3 and hepcidin were measured by enzyme?linked immunosorbent assay （ELISA）. Statistical analyses were conducted using SPSS software. One?way analysis of variance （ANOVA） was applied to compare differences across the three SGA groups. Logistic regression analysis was performed to identify influencing factors， and receiver operating characteristic （ROC） curve analysis was used to evaluate diagnostic value. Among the participants， 45 patients were classified as malnourished based on SGA?B and SGA?C scores， while those with SGA?A constituted the well?nourished control group. Results Among the 76 MHD patients， 59.2% were malnourished. We then compared clinical characteristics across the three groups. The results showed that the malnourished group was older and exhibited significantly higher levels of hs?CRP， PTX3， and hepcidin （P < 0.05）， while serum albumin， creatinine， and phosphorus levels were significantly lower （P < 0.05）. Pearson correlation analysis revealed positive correlations between SGA grades and hs?CRP， PTX3， and hepcidin levels （all P < 0.05）. Logistic regression analysis with “malnutrition” as the dependent variable indicated that elevated hs?CRP， PTX3， and hepcidin levels， along with age and male gender， were associated with increased risk of malnutrition in MHD patients， whereas higher serum phosphorus and creatinine levels were protective factors. Further multivariate logistic regression analysis demonstrated that serum PTX3 level was an independent risk factor for malnutrition （P = 0.032）， while higher creatinine level was an independent protective factor （P = 0.047）. ROC curve analysis showed that the combination of serum PTX3 and creatinine levels had a high diagnostic value for identifying malnutrition in MHD patients， yielding an AUC of 0.789 （P < 0.001）， a Youden index of 0.448， sensitivity of 77.8%， and specificity of 71.0%. Conclusions Elevated levels of PTX3 and hepcidin， along with reduced serum creatinine levels， are associated with an increased risk of malnutrition in patients undergoing MHD. Notably， elevated serum PTX3 and decreased serum creatinine independently predict malnutrition in this population and demonstrate high predictive value.