Lower extremity arteriosclerotic obliteration (ASO) is a chronic disease characterized by the formation of atherosclerotic plaques in the lower extremity arteries, leading to arterial stenosis, occlusion, and subsequently chronic ischemia of the limbs, manifesting as pain, claudication, and even ischemic necrosis of the limbs. Inflammation and lipid infiltration play pivotal roles in the development of lower extremity atherosclerosis. However, there is currently a lack of relevant indices for its diagnosis and analysis.

To explore the correlation between multiple inflammatory and oxidative stress indices and ASO, and to evaluate their diagnostic value by collecting case data from ASO patients.

A retrospective study was conducted involving 600 ASO patients who visited the Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from October 2014 to January 2024. Patients were divided into mild (n=200), moderate (n=200), and severe (n=200) groups based on the Rutherford classification. Additionally, 200 healthy individuals who underwent physical examinations at the outpatient clinic of the same hospital were randomly selected as controls. Baseline data were collected, and inflammatory and oxidative stress indices were calculated, including the pan-immune inflammation value (PIV), systemic immune-inflammation index (SIRI), systemic immune-inflammatory index (SII), monocyte-to-hdl cholesterol ratio (MHR), neutrophil-to-lymphocyte ratio (NLR), SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C. Spearman's rank correlation analysis was used to explore the correlation between these indices and ASO severity. Multivariate Logistic regression analysis was conducted to investigate the influencing factors of ASO. Receiver operating characteristic (ROC) curves were plotted to assess the diagnostic efficacy of the indices for ASO, and the area under the ROC curve (AUC) was calculated.

ASO patients had higher levels of monocyte count (MONO), platelet count (PLT), neutrophil count (NEUT), LDL-C, PIV, SIRI, SII, MHR, NLR, SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C, as well as lower HDL-C levels compared to healthy controls (P<0.05). Comparison of ASO patients across different Rutherford stages showed that the severe group had a higher proportion of males, hypertension, smoking rates, MONO, NEUT, PIV, SIRI, SII, MHR, NLR, SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C than the mild and moderate groups (P<0.05). The severe group also had lower lymphocyte count (LYMP) and HDL-C levels (P<0.05), higher age than the moderate group (P<0.05), and lower LDL-C than the mild group (P<0.05). The moderate group had a higher proportion of hypertension, MONO, NEUT, PIV, SIRI, SII, MHR, NLR, SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C than the mild group (P<0.05), as well as lower HDL-C levels (P<0.05). The mild group had a lower proportion of alcohol consumption than the moderate and severe groups (P<0.05), and lower PLT than the moderate and severe groups (P<0.05). Correlation analysis results indicated that PIV, SIRI, SII, MHR, NLR, SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C were positively correlated with ASO severity (P<0.05). Multivariate Logistic regression analysis revealed that SIRI was a protective factor for ASO (OR=0.009, 95%CI=0.000-0.181, P=0.009), while SIRI×LDL-C (OR=1.665, 95%CI=1.260-2.201, P=0.001) and PIV/HDL-C (OR=1.014, 95%CI=1.003-1.024, P=0.005) were risk factors for ASO. The AUC for predicting ASO using SIRI×LDL-C was 0.710, with a sensitivity of 0.442 and a specificity of 0.890. The AUC for predicting ASO using PIV/HDL-C was 0.761, with a sensitivity of 0.505 and a specificity of 0.975.

The comprehensive indices included in this study, namely PIV, SIRI, SII, MHR, NLR, SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C, are correlated with ASO severity. SIRI is a protective factor for ASO, while SIRI×LDL-C and PIV/HDL-C are independent risk factors for ASO and have predictive value for its occurrence.

下肢动脉硬化闭塞症（ASO）是由于下肢动脉粥样硬化斑块形成，引起下肢动脉狭窄、闭塞，进而导致肢体慢性缺血而出现疼痛、跛行，甚至肢体缺血坏死的慢性疾病，炎症和脂质浸润在下肢动脉粥样硬化的发展中发挥着关键作用，但目前尚缺乏相关指标对其进行诊断和分析。

通过收集ASO患者的病例资料，探究多种炎症和氧化应激综合指标与ASO的相关性，并评估其诊断价值。

回顾性纳入2014年10月—2024年1月就诊于辽宁中医药大学附属第二医院的600例ASO患者为研究对象，依据Rutherford分期将患者分为轻度组（n=200）、中度组（n=200）和重度组（n=200）并随机筛选200例于辽宁中医药大学附属第二医院门诊体检的健康人群为对照。收集患者基线资料，计算炎症和氧化应激综合指标[泛免疫炎症值（PIV）、系统性炎症反应指数（SIRI）、全身免疫炎症指数（SII）、单核细胞与高密度脂蛋白胆固醇比值（MHR）、中性粒细胞与淋巴细胞比（NLR）、SIRI/高密度脂蛋白胆固醇（HDL-C）、SIRI×低密度脂蛋白胆固醇（LDL-C）、PIV/HDL-C、PIV×LDL-C]。采用Spearman秩相关分析探究综合指标与ASO严重程度的相关性。采用多因素Logistic回归分析探讨ASO发生的影响因素，绘制受试者工作特征（ROC）曲线探讨综合指标对ASO的诊断效能，并计算ROC曲线下面积（AUC）。

ASO患者单核细胞计数（MONO）、血小板计数（PLT）、中性粒细胞计数（NEUT）、LDL-C、PIV、SIRI、SII、MHR、NLR、SIRI/HDL-C、SIRI×LDL-C、PIV/HDL-C、PIV×LDL-C高于正常人群，HDL-C低于正常人群（P<0.05）。不同Rutherford分期分组ASO患者资料比较结果显示，重度组男性占比、高血压、吸烟比例、MONO、NEUT、PIV、SIRI、SII、MHR、NLR、SIRI/HDL-C、SIRI×LDL-C、PIV/HDL-C、PIV×LDL-C高于轻度组、中度组（P<0.05），LYMP、HDL-C低于轻度组、中度组（P<0.05），年龄高于中度组（P<0.05），LDL-C低于轻度组（P<0.05）；中度组高血压比例、MONO、NEUT、PIV、SIRI、SII、MHR、NLR、SIRI/HDL-C、SIRI×LDL-C、PIV/HDL-C、PIV×LDL-C高于轻度组（P<0.05），HDL-C低于轻度组（P<0.05）；轻度组饮酒比例低于中度组和重度组（P<0.05）、轻度组PLT低于中度组、重度组（P<0.05）。相关性分析结果显示，PIV、SIRI、SII、MHR、NLR、SIRI/HDL-C、SIRI×LDL-C、PIV/HDL-C、PIV×LDL-C与ASO严重程度呈正相关（P<0.05）。多因素Logistic回归分析结果显示，SIRI是ASO发生的保护因素（OR=0.009，95%CI=0.000~0.181，P=0.009），SIRI×LDL-C（OR=1.665，95%CI=1.260~2.201，P=0.001）、PIV/HDL-C（OR=1.014，95%CI=1.003~1.024，P=0.005）是ASO发生的危险因素。SIRI×LDL-C预测ASO发生的AUC为0.710，灵敏度为0.442，特异度为0.890，PIV/HDL-C预测ASO发生的AUC为0.761，灵敏度为0.505，特异度为0.975。

本研究纳入的综合指标，包括PIV、SIRI、SII、MHR、NLR、SIRI/HDL-C、SIRI×LDL-C、PIV/HDL-C、PIV×LDL-C和ASO的严重程度存在相关性，SIRI是ASO发生的保护因素，SIRI×LDL-C、PIV/HDL-C是ASO的独立危险因素，对于ASO的发生具有预测作用。