Objective To analyze the correlation of inflammatory markers of peripheral blood cells with sex hormone levels and insulin resistance in patients with polycystic ovary syndrome (PCOS).Methods A total of 200 PCOS patients who visited Guilin Women's and Children's Health Hospital from August 2021 to August 2022 were included in the PCOS group, and other age-matched healthy women who underwent physical examination during the same period were included in the control group. The peripheral blood neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), monocyte lymphocyte ratio (MLR), derived neutrophil lymphocyte ratio (dNLR), systemic immune inflammation index (SII), luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), homeostatic model insulin resistance index (HOMA-IR), and insulin sensitivity index (ISI) were compared between the two groups. After Pearson correlation analysis of the relationship of inflammatory markers of peripheral blood cells with sex hormones and insulin resistance, the working curve of the subject (ROC) was drawn to evaluate the value of inflammatory markers of peripheral blood cells in the prediction of PCOS, and a binary logistic regression model was established to analyze the correlation between inflammatory markers of peripheral blood cells and PCOS.Results The levels of white blood cell count, lymphocyte count, neutrophil count, monocyte count, and platelet count were higher in the PCOS group than in the control group (P < 0.05); the levels of NLR, dNLR, PLR, LMR, and SII were higher in the PCOS group than in the control group (P < 0.05); the levels of LH, T, and HOMA-IR were higher in the PCOS group than in the control group, and the levels of FSH and ISI levels were all lower than those in the control group (P < 0.05); Pearson correlations showed that peripheral blood NLR, dNLR, PLR, LMR, and SII were all positively correlated with LH (r = 0.385, 0.425, 0.483, 0.231 and 0.494), T (r = 0.435, 0.479, 0.539, 0.349 and 0.501), HOMA-IR (r = 0.452, 0.561, 0.580, 0.361 and 0.632) (P < 0.05), and negatively correlated with FSH (r = -0.340, -0.463, -0.621, -0.378 and -0.533), ISI (r = -0.512, -0.546, -0.732, -0.462 and -0.638) (all P < 0.05); ROC curves showed that the sensitivities of NLR, dNLR, PLR, LMR, SII, and combined to predict the occurrence of PCOS were 0.689 (95% CI: 0.593, 0.782), 0.726 (95% CI: 0.652, 0.796), 0.751 (95% CI: 0.683, 0.818), 0.642 (95% CI: 0.528, 0.721), 0.762 (95% CI: 0.699, 0.842), and 0.821 (95% CI: 0.782, 0.896), respectively; the specificities were 0.762 (95% CI: 0.693, 0.832), 0.843 (95% CI: 0.793, 0.902), 0.879 (95% CI: 0.816, 0.921), 0.753 (95% CI: 0.673, 0.828), 0.902 (95% CI: 0.834, 0.953), and 0.967 (95% CI: 0.893, 0.986) , respectively; multi-factor logistic regression analysis showed that NLR [O^R = 3.632, (95% CI: 1.325, 17.652) ], dNLR [O^R = 4.351, (95% CI: 1.574, 19.364)], PLR [O^R = 1.165, (95% CI: 1.069, 1.269) ], LMR [O^R = 8.023, (95% CI: 2.421, 28.963) ], and SII [O^R = 1.136, (95% CI: 1.066, 1.210) ] were all risk factors for the development of PCOS (P < 0.05).Conclusion The high levels of NLR, dNLR, PLR, LMR, and SII in peripheral blood of PCOS patients are closely related to sex hormone levels and insulin resistance, and the combination can effectively predict the occurrence of PCOS.