APRI和简化JSTH评分对脓毒症肝损伤的早期诊断价值

The Value of APRI and Simplified JSTH Score in the Early Diagnosis of Septic Liver Injury

摘要: 目的：探讨成人外周血天冬氨酸转移酶与血小板比值指数(APRI)和简化JSTH评分对脓毒症肝损伤(SRLI)的早期诊断价值。方法：收集青岛市市立医院2019年1月至2020年12月180例住院脓毒症患者的基本资料，根据是否合并肝损伤分为SRLI组(55例)和非SRLI组(125例)，比较两组患者基本资料、APRI和简化JSTH评分，采用Logistic回归模型分析SRLI发生的危险因素，绘制ROC受试者工作曲线评估APRI和简化JSTH评分对SRLI发生的诊断价值。结果：SRLI组患者D-Dimer、Lac、ALT、APRI、DBil、TBil、PT、SOFA评分、简化JSTH评分均高于非SRLI组，差异有统计学意义(P < 0.05)。外周血ALT、TBil是SRLI的危险因素(ALT: P < 0.05, OR = 1.198, 95% CI: 1.016~1.413; TBil: P < 0.05, OR = 1.358, 95% CI: 1.06~1.74)。ROC曲线分析表示ALT、TBil、APRI、简化JSTH评分诊断SRLI的AUC分别为0.912 (95% CI: 0.858~0.966)、0.865 (95% CI: 0.802~0.928)、0.895 (0.845~0.946)、0.727 (0.647~0.807)，其中ALT、TBil诊断SRLI的特异度高，而APRI和简化JSTH评分诊断SRLI的敏感度高。结论：APRI对SRLI早期诊断价值次于ALT，但优于TBil，简化JSTH评分诊断效能最差，APRI和简化JSTH可作为早期诊断SRLI的辅助方法。

Abstract: Objective: To explore the value of adult peripheral blood aspartate transferase to platelet ratio index (APRI) and simplified JSTH score in the early diagnosis of septic liver injury (SRLI). Method: The basic data of 180 hospitalized sepsis patients in Qingdao Municipal Hospital from January 2019 to December 2020 were collected, and the two groups were compared according to whether liver damage was combined with SRLI group (55 cases) and non-SRLI group (125 cases). The basic data, APRI and simplified JSTH scores of the two groups of patients were compared, and the logistic regression model was used to analyze the risk factors of SRLI, and the ROC receiver operating curve was drawn to evaluate the diagnostic value of APRI and simplified JSTH scores for the occurrence of SRLI. Results: The scores of D-Dimer, Lac, ALT, APRI, DBil, TBil, PT, SOFA, and simplified JSTH in the SRLI group were higher than those in the non-SRLI group, and the difference was statistically significant (P < 0.05). Peripheral blood ALT and TBil are risk factors for SRLI (ALT: P < 0.05, OR = 1.198, 95% CI: 1.016~1.413; TBil: P < 0.05, OR = 1.358, 95% CI: 1.06~1.74). The ROC curve indicates that the AUC of ALT, TBil, APRI, and simplified JSTH scores to diagnose SRLI are 0.912 (95% CI: 0.858~0.966), 0.865 (95% CI: 0.802~0.928), 0.895 (0.845~0.946), 0.727 (0.647~0.807). ALT and TBil are highly specific, and APRI and simplified JSTH scores are highly sensitive. Conclusion: The value of APRI in the early diagnosis of SRLI is inferior to that of ALT, better than TBil. The simplified JSTH score has the worst diagnostic value. APRI and simplified JSTH can be used as auxiliary methods for the early diagnosis of SRLI.