血小板计数、D-二聚体及APRI水平与脓毒症相关肝损伤患者预后的相关性  

The correlation between platelet count,D-dimer and APRI levels and the prognosis of sepsis related liver injury patients

作　　者：唐开放 刘贝珠 李金慧 刘志豪[2] 李有强 TANG Kaifang;LIU Beizhu;LI Jinhui;LIU Zhihao;LI Youqiang(Department of Emergency Medicine,Guangzhou Panyu District Maternal and Child Health Care Hospital,Guangzhou,Guangdong 511400,China;Department of Emergency Medicine,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong 510080,China;Department of Laboratory Medicine,Guangzhou Panyu District Maternal and Child Health Care Hospital,Guangzhou,Guangdong 511400,China)

机构地区：[1]广州市番禺区妇幼保健院急诊医学科,广东广州511400 [2]中山大学附属第一医院急诊医学科,广东广州510080 [3]广州市番禺区妇幼保健院检验科,广东广州511400

出　　处：《热带医学杂志》2024年第10期1453-1456,共4页Journal of Tropical Medicine

基　　金：广东省基础与应用基础研究基金(2022A1515012255)。

摘　　要：目的探讨血小板计数(PLT)、D-二聚体(D-D)及天门冬氨酸氨基转移酶/血小板比值指数(APRI)与脓毒症肝损伤患者预后结局的关系。方法分析2019年1月-2021年12月中山大学附属第一医院急诊重症监护室及急诊病房收治的112例脓毒症肝损伤患者临床资料,根据患者治疗结局将其分为死亡组(n=38)和存活组(n=74)。对比两组PLT、D-D、APRI、序贯器官功能衰竭(SOFA)评分、急性生理学和慢性健康评估Ⅱ(APACHEⅡ)评分、肝功能等指标,绘制受试者工作特征(ROC)曲线计算PLT、D-D、APRI预测脓毒症肝损伤患者预后结局的临床价值。结果死亡组PLT、白蛋白水平低于存活组,D-D、APRI、血乳酸、总胆红素水平高于存活组,差异均有统计学意义(t=-4.937、-4.343、6.218、7.641、8.552、3.471,P均<0.05)。死亡组SOFA评分、APACHEⅡ评分、合并急性肾损伤患者占比高于存活组,差异均有统计学意义(t=5.057、11.735,χ^(2)=4.588,P均<0.05)。经ROC曲线分析,PLT、D-D、APRI预测脓毒症肝损伤患者预后结局的AUC分别为0.743、0.844、0.871。结论预后结局不良的脓毒症肝损伤患者PLT明显更低,D-D、APRI测定值更高,PLT、D-D、APRI与脓毒症肝损伤患者预后结局具有密切的关系,并且对患者预后有较高的预测价值。Objective To investigate the relationship between platelet count(PLT),D-dimer(D-D),and aspartate aminotransferase/platelet ratio index(APRI)and the prognosis of patients with sepsis-induced liver injury.Methods A retrospective analysis was performed on 112 patients with sepsis-induced liver injury admitted to the EICU and emergency ward of the First Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2021.According to the treatment outcome of patients,they were divided into death group(n=38)and survival group(n=74).The two groups were compared with each other in terms of PLT,D-D,APRI,sequential organ failure evaluation(SOFA)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,liver function and other indicators.The receiver operating characteristic(ROC)curve was drawn to calculate the clinical value of PLT,D-D and APRI in predicting the prognosis of patients with septic liver injury.Results The PLT and albumin levels were lower in the death group than in the survival group;D-D,APRI,blood lactate,and total bilirubin levels were higher than those in the survival group(t=-4.937,-4.343,6.218,7.641,8.552,3.471;all P<0.05);SOFA score and APACHEⅡscore were higher in patients who deceased and died than in the survival group,the proportion of patients with acute kidney injury was higher than the survival group(t=5.057,11.735,χ^(2)=4.588;All P<0.05).Area under the cure values of PLT,D-D and APRI for predicting the outcome of patients with septic liver injury were 0.743,0.844 and 0.871,respectively.Conclusions Patients with sepsis-induced liver injury who had poor prognosis outcomes had significantly lower levels of PLT,higher level of D-D,and higher APRI values.PLT,D-D,and APRI levels were closely related to the prognosis outcomes of patients with sepsisinduced liver injury and had a high predictive value for patient prognosis.

关 键 词：血小板 D-二聚体 天门冬氨酸氨基转移酶 脓毒症 肝损伤 预后 

分 类 号：R459.7[医药卫生—急诊医学]