2026 年第 5 期 第 21 卷

炎症-营养复合生物标志物与脓毒症相关急性肾损伤患者预后的关系

Relationship between inflammatory-nutritional composite biomarkers and prognosis in patients with sepsis-associated acute kidney injury

作者：曾涌1王舒2赵金川1

英文作者：Zeng Yong1 Wang Shu2 Zhao Jinchuan1

单位：1重庆市急救医疗中心（重庆市第四人民医院）院前急救部，重庆400010；2重庆市急救医疗中心（重庆市第四人民医院）重症监护室，重庆400010

英文单位：1Department of Pre-hospital Emergency Chongqing Emergency Medical Center (the Fourth People′s Hospital of Chongqing) Chongqing 400010 China; 2Department of Intensive Care Unit Chongqing Emergency Medical Center (the Fourth People′s Hospital of Chongqing) Chongqing 400010 China

关键词：脓毒症相关急性肾损伤；血红蛋白、白蛋白、淋巴细胞和血小板指数；乳酸脱氢酶与血清白蛋白比值；单核细胞与高密度脂蛋白胆固醇比值

英文关键词：Sepsis-associatedacutekidneyinjury;Hemoglobin,albumin,lymphocyteandplateletindex;Lactatedehydrogenasetoalbuminratio;Monocytetohigh-densitylipoproteincholesterolratio

• 摘要：

• 目的 探讨血红蛋白、白蛋白、淋巴细胞和血小板（HALP）指数、乳酸脱氢酶与血清白蛋白比值（LAR）、单核细胞与高密度脂蛋白胆固醇比值（MHR）与脓毒症相关急性肾损伤（S-AKI）患者预后的关系。方法 回顾性选取2023年5月至2025年5月重庆市急救医疗中心收治的100例S-AKI患者，根据住院28 d内存活情况将患者分为存活组（52例）和死亡组（48例）。收集2组患者临床资料和实验室数据，计算HALP指数、LAR、MHR，分析S-AKI患者住院28 d内死亡的相关因素以及HALP指数、LAR、MHR预测住院28 d内死亡的价值。结果 死亡组患者AKI分期3期、急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、序贯器官衰竭评估（SOFA）评分、血管活性药物、机械通气比例均高于存活组（均P＜0.05）。死亡组HALP指数低于存活组［（23.0±2.5）比（27.6±3.1）］（t=-8.112，P＜0.001），LAR、MHR均高于存活组［（12.0±2.2）比（7.3±1.6）、（14.3±3.7）比（9.3±2.3）］（t=12.283、8.188，均P＜0.001）。多因素Logistic回归分析显示高SOFA评分、AKI分期3期、高LAR、高MHR均是S-AKI患者住院28 d内死亡的危险因素（均P＜0.05），高HALP指数是保护因素（P＜0.05）。HALP指数、LAR、MHR预测S-AKI患者住院28 d内死亡的曲线下面积分别为0.746、0.729、0.750，联合预测为0.883，高于各指标单独预测（均P＜0.05）。结论 联合HALP指数、LAR、MHR可有效预测S-AKI患者不良结局风险。

• Objective To investigate the relationship between hemoglobin, albumin, lymphocyte and platelet (HALP) index, lactate dehydrogenase to albumin ratio (LAR), monocyte to high-density lipoprotein cholesterol ratio (MHR) and prognosis in patients with sepsis-associated acute kidney injury (S-AKI). Methods A total of 100 patients with S-AKI admitted to Chongqing Emergency Medical Center from May 2023 to May 2025 were retrospectively enrolled. According to 28 d survival status during hospitalization, patients were divided into survival group (52 cases) and death group (48 cases). Clinical data and laboratory data of the two groups were collected, HALP index, LAR and MHR were calculated. The factors associated with 28 d in-hospital mortality and the predictive value of HALP index, LAR and MHR for 28 d in-hospital mortality were analyzed. Results The proportion of stage 3 AKI, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, vasoactive drugs and mechanical ventilation in death group were higher than those in survival group (all P<0.05). HALP index in death group was lower than that in survival group ［(23.0±2.5) vs (27.6±3.1)］(t=-8.112, P<0.001), while LAR and MHR were higher than those in survival group ［(12.0±2.2) vs (7.3±1.6), (14.3±3.7) vs (9.3±2.3)］(t=12.283, 8.188, both P<0.001). Multivariate Logistic regression analysis showed that high SOFA score, stage 3 AKI, high LAR and high MHR were independent risk factors for 28 d in-hospital mortality in S-AKI patients (all P<0.05), while high HALP index was a protective factor (P<0.05). The area under the curve of HALP index, LAR and MHR for predicting 28 d in-hospital mortality in S-AKI patients was 0.746, 0.729 and 0.750, respectively, and the combined prediction was 0.883, which was higher than that of each single indicator (all P<0.05). Conclusion The combination of HALP index, LAR and MHR can effectively predict the risk of adverse outcomes in patients with S-AKI.