APRI指数与脓毒症肝损伤发生及预测的临床价值

The aspartate transaminase to platelet ratio index （APRI） as a risk factor and predictor for sepsis-asso- ciated liver injury in children

目的 探讨天冬氨酸转氨酶与血小板比值指数（aspartate transaminase to platelet ratio index,APRI）与脓毒症肝损伤的相关性及预测其发生的临床意义.方法 回顾性分析2015年4月至2017年3月上海交通大学附属儿童医院PICU确诊为脓毒症的256例患儿,根据是否发生肝损伤,分为脓毒症肝损伤组34例和脓毒症组222例.分析两组患儿的临床资料及收入PICU 24 h内首次血生化检测指标,包括天冬氨酸转氨酶与丙氨酸转氨酶比值（aspartate transaminase to alanine transaminase ratio,AAR）和APRI.采用多因素Logistic回归和受试者工作特征（receiver operating characteristic,ROC）曲线,评估APRI与脓毒症肝损伤的关系及其诊断效能.结果 （1）256例脓毒症患儿中,脓毒症肝损伤34例,肝损伤发生率为13.3％.（2）单因素分析显示,两组患儿收入PICU 24 h内,脓毒症肝损伤组的APRI和AAR显著高于脓毒症组[APRI：7.12（1.71,26.96）比0.38（0.21,0.83）,P〈0.001;AAR：1.43（0.94,2.69）比2.17（1.35,2.96）,P〈0.05].（3）多因素Logistic回归分析发现,总胆红素、APRI、AAR和血小板与脓毒症肝损伤发生相关（P〈0.05）.（4）ROC曲线分析显示,APRI预测脓毒症肝损伤发生的ROC曲线下面积（area under curve,AUC）为0.891（95％CI 0.815～0.966,P〈0.001）,cut-off值为1.73,敏感度为80.0％,特异度为92.2％;优于总胆红素（AUC=0.744,95％CI 0.634～0.853,P〈0.001）和血小板（AUC=0.726,95％CI 0.611～0.841,P〈0.001）.结论 APRI异常是脓毒症患儿发生肝损伤的高危因素.

Objective To investigate the association and predictive value of aspartate transaminase to platelet ratio index（APRI） in sepsis-associated liver injury（SALI）. Methods We retrospectively ana-lyzed the medical records of patients with sepsis admitted to PICU in Shanghai Children′s Hospital of Shanghai Jiaotong University from April 2015 to March 2017. According to whether liver injury occurred in the sepsis patients during hospitalization,all the patients were divided into SALI group （n=34） and sepsis group（n=222）. The clinical characteristics,serological indexes within 24 hours in the PICU,and the ratio of aspartate transaminase to alanine transaminase（ AAR） and APRI were collected and analyzed. The receiver operating characteristic（ ROC） curve was used to evaluate the power of APRI for the prediction of SALI. Results （1）A total of 256 patients were enrolled in this study. There were 34 cases with SALI,and there were 222 patients with sepsis only,the incidence of SALI was 13. 3%. （2） The values of APRI and AAR were both higher in the SALI group compared with the sepsis group[APRI：7. 12（1. 71,26. 96） vs. 0. 38 （0. 21,0. 83）,P〈0. 001;AAR：1. 43（0. 94,2. 69） vs. 2. 17（1. 35,2. 96）,P〈0. 05]. （3）The multivariate Logistic regression analysis showed that total bilirubin, APRI, AAR and platelet were the independent risk factors of SALI（P〈0. 05）. （4）In addition,the area under the ROC curve（AUC）for the APRI was 0. 891 （95%CI 0. 815-0. 966,P〈0. 001）,cut-off value was 1. 73,which was superior to total bilirubin（AUC =0. 744,95%CI 0. 634-0. 853,P〈0. 001） and platelet（AUC=0. 726,95%CI 0. 611-0. 841,P〈0. 001）. The clinical sensitivity and specificity of the APRI for identification of SALI from sepsis was 80. 0% and 92. 2%, respectively. Conclusion APRI is an independently risk factor for the occurrence of SALI and is a precursory marker for SALI.