2026 年第 8 期 第 21 卷

天冬氨酸转氨酶与血小板比值指数和脓毒症相关肝损伤发生的相关性及预测价值

Correlation and predictive value of aspartate aminotransferase to platelet ratio index in the occurrence of sepsis-associated liver injury

作者：周海银1陈玉坤1陈艳瑛1罗兰2刘萍萍1颜海鹏2姚震亚3

英文作者：Zhou Haiyin1 Chen Yukun1 Chen Yanying1 Luo Lan2 Liu Pingping1 Yan Haipeng2 Yao Zhenya3

单位：1中南大学湘雅医学院附属儿童医院湖南省儿童医院急救中心急诊综合科，长沙410007；2中南大学湘雅医学院附属儿童医院湖南省儿童医院国际病房，长沙410007；3中南大学湘雅医学院附属儿童医院湖南省儿童医院重症医学科，长沙410007

英文单位：1Department of Emergency General Emergency Center Hunan Children′s Hospital Children′s Hospital Affiliated to Xiangya School of Medicine Central South University Changsha 410007 China; 2International Ward Hunan Children′s Hospital Children′s Hospital Affiliated to Xiangya School of Medicine Central South University Changsha 410007 China; 3Department of Critical Care Medicine Hunan Children′s Hospital Children′s Hospital Affiliated to Xiangya School of Medicine Central South University Changsha 410007 China

关键词：脓毒症；肝损伤；脓毒症相关肝损伤；天冬氨酸转氨酶与血小板比值指数

英文关键词：Sepsis;Liverinjury;Sepsis-associatedliverinjury;Aspartateaminotransferasetoplateletratioindex

• 摘要：

• 目的 探讨天冬氨酸转氨酶（AST）与血小板比值指数（APRI）和脓毒症相关肝损伤（SALI）发生的关系，并评价其对SALI的预测价值。方法 回顾性分析湖南省儿童医院2018年1月至2025年9月收治的脓毒症或脓毒性休克患者789例。根据入院后28 d内是否发生SALI分为SALI组和非SALI组。收集患者入院首次血常规、生化及凝血功能等实验室指标，计算APRI值。采用单因素和多因素Logistic回归分析SALI发生的独立影响因素。绘制受试者工作特征（ROC）曲线评价APRI、AST及血小板计数（PLT）对SALI的预测效能。结果 789例脓毒症患者中SALI发生率为7.2%(57/789)。SALI组γ-谷氨酰转移酶（GGT）、红细胞体积分布宽度变异系数（RDW-CV）、APRI水平显著高于非SALI组，二氧化碳结合力（CO2CP）、抗凝血酶Ⅲ（ATⅢ）水平显著低于非SALI组(均P＜0.05)。多因素Logistic回归分析显示，GGT(比值比=1.01)、RDW-CV(比值比=2.62)、APRI(比值比=1.72)为SALI的独立危险因素，CO2CP(比值比=0.74)、ATⅢ(比值比=0.89)为独立保护因素(均P＜0.001)。ROC曲线分析显示，APRI预测SALI的曲线下面积为0.784，高于AST(0.735)和PLT(0.702)。APRI截断值1.2时，敏感度为71.93%，特异度为80.46%。结论 APRI是SALI的独立危险因素，对SALI具有较好的预测价值，优于单一AST或PLT，可作为脓毒症住院患者早期识别肝损伤高危人群和进行风险分层的简便指标。

• Objective To explore the correlation between aspartate aminotransferase to platelet ratio index (APRI) and the occurrence of sepsis-associated liver injury (SALI), and to evaluate its predictive value for SALI. Methods A retrospective analysis was conducted on 789 patients with sepsis or septic shock admitted to Hunan Children′s Hospital from January 2018 to September 2025. Patients were divided into SALI group and non-SALI group according to whether SALI occurred within 28 days after admission. Initial laboratory indicators including routine blood test, biochemistry and coagulation function were collected, and APRI was calculated. Univariate and multivariate Logistic regression analyses were used to identify independent influencing factors for SALI. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive efficacy of APRI, AST and platelet count (PLT) for SALI. Results The incidence of SALI among 789 sepsis patients was 7.2% (57/789). The levels of gamma-glutamyl transferase (GGT), red cell distribution width-coefficient of variation (RDW-CV) and APRI in the SALI group were significantly higher than those in the non-SALI group, while carbon dioxide combining power (CO2CP) and antithrombin Ⅲ (ATⅢ) levels were significantly lower (all P＜0.05). Multivariate Logistic regression analysis showed that GGT (odds ratio=1.01), RDW-CV (odds ratio=2.62) and APRI (odds ratio=1.72) were independent risk factors for SALI, while CO2CP (odds ratio=0.74) and ATⅢ (odds ratio=0.89) were independent protective factors (all P＜0.001). ROC curve analysis showed that the area under the curve of APRI for predicting SALI was 0.784, higher than AST (0.735) and PLT (0.702). At the cut-off value of 1.2, APRI had a sensitivity of 71.93% and a specificity of 80.46%. Conclusion APRI is an independent risk factor for SALI and presents good predictive value superior to single AST or PLT. It can be used as a simple indicator for early identification of high-risk populations and risk stratification of liver injury in hospitalized sepsis patients.