γ-谷氨酰转移酶/血小板比值对脓毒症相关肝损伤患者预后的预测价值

摘要/Abstract

摘要： 目的探讨γ-谷氨酰转移酶(GGT)/血小板(PLT)比值(GPR)对脓毒症相关肝损伤(SRLI)患者预后的预测价值。方法选取2022年6月至2024年7月上海健康医学院附属崇明医院收治的102例SRLI患者作为研究对象,根据患者入院第28 d预后将其分为预后良好组(n=68)和预后不良组(n=34)。酶联免疫吸附法检测GGT水平,全自动血细胞分析仪检测PLT,并计算GPR。采用受试者工作特征(ROC)曲线分析GPR对SRLI患者预后的预测价值;采用多因素logistic逐步回归分析探讨SRLI患者预后的影响因素。结果预后不良组患者GGT、GPR分别为(76.84±10.23)U/L、(0.82±0.13),高于预后良好组的[(51.60±12.19)U/L、(0.43±0.10)],预后不良组患者PLT为(94.17±15.98)×10⁹/L,低于预后良好组的[(121.29±17.24)×10⁹/L](P<0.05)。GPR预测SRLI患者预后的AUC为0.925,明显高于GGT、PLT单独预测的0.832、0.778(Z=9.475、11.824,P<0.001)。预后不良组合并急性肾损伤占比、重度肝损伤程度占比、APACHE-Ⅱ评分、SOFA评分、CRP分别为52.94%、41.18%、(27.14±7.08)分、(15.03±3.01)分、(25.83±4.37)mg/L, 高于预后良好组的[32.25%、14.70%、(18.29±5.76)分、(11.52±2.18)分、(20.17±4.05)mg/L](P<0.05)。多因素回归分析显示:肝损伤程度(OR=2.396,95%CI: 1.308~4.391)、 APACHE-Ⅱ 评分(OR=2.130,95%CI: 1.328~3.416)、 SOFA评分(OR=2.522,95%CI: 1.303~4.882)、 GPR(OR=2.998,95%CI: 1.695~5.303)是SRLI患者预后的独立影响因素(P<0.05)。结论 GPR是SRLI患者预后的独立影响因素,且GPR对SRLI患者预后具有较好的预测价值。

关键词: γ-谷氨酰转移酶/血小板比值, 脓毒症, 肝损伤, 预后, 预测价值

Abstract: Objective To explore the predictive value of the γ-glutamyl transferase (GGT)/platelet (PLT) ratio (GPR) for the prognosis of cases with sepsis-related liver injury (SRLI). Methods A total of 102 patients with SRLI from June 2022 to July 2024 in Chongming Hospital Affiliated to Shanghai Health Medical College were selected. They were divided into a good prognosis group (n=68) and a poor prognosis group (n=34) according to their 28-day prognosis after admission. GGT levels were detected by enzyme-linked immunosorbent assay, and PLT was detected by an automatic blood cell analyzer. GPR was calculated. The predictive value of GPR for the prognosis of SRLI patients was analyzed by receiver operating characteristic(ROC)curve. The influencing factors of the prognosis of SRLI cases were explored by multivariate logistic stepwise regression analysis. Results The GGT and GPR of the poor prognosis group were (76.84±10.23) U/L and (0.82±0.13), respectively, which were higher than those of the good prognosis group [(51.60±12.19) U/L and (0.43±0.10)]. The PLT of the poor prognosis group was (94.17±15.98) × 10⁹/L, which was lower than that of the good prognosis group [(121.29±17.24) × 10⁹/L] (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of GPR for predicting the prognosis of SRLI patients was 0.925, which was greater than that of GGT and PLT alone (0.832 and 0.778, respectively) (Z=9.475, 11.824, P<0.001). The proportion of patients with acute kidney injury, the proportion of patients with severe liver injury, APACHE Ⅱ score, SOFA score, and CRP in the poor prognosis group were 52.94%, 41.18%, (27.14±7.08) points, (15.03±3.01) points, and (25.83±4.37) mg/L, respectively, which were higher than those in the good prognosis group [32.25%, 14.70%, (18.29±5.76) points, (11.52±2.18) points, and (20.17±4.05) mg/L] (P<0.05). The severity of liver injury (OR=2.396, 95%CI: 1.308~4.391), APACHE Ⅱ score (OR=2.130, 95%CI: 1.328~3.416), SOFA score (OR=2.522, 95%CI: 1.303~4.882), and GPR (OR=2.998, 95%CI: 1.695~5.303) were independent factors associated with poor prognosis for the prognosis of SRLI patients (P<0.05). Conclusion GPR is an independent influencing factor for the prognosis of SRLI patients, and GPR showed good predictive value for the prognosis of SRLI patients.

Key words: γ-glutamyl transferase/platelet ratio, Sepsis, Liver injury, Prognosis, Predictive value

荣进, 成熙芸, 殷洪敏. γ-谷氨酰转移酶/血小板比值对脓毒症相关肝损伤患者预后的预测价值[J]. 肝脏, 2026, 31(5): 724-728.

RONG Jin, CHENG Xi-yun, YIN Hong-min. The predictive value of the γ-glutamyl transferase/platelet ratio for the prognosis of patients with sepsis-related liver injury[J]. Chinese Hepatolgy, 2026, 31(5): 724-728.

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参考文献

[1] Jacobi J. The pathophysiology of sepsis-2021 update:part 2,organ dysfunction and assessment[J].Am J Health Syst Pharm, 2022,79(6):424-436.
[2] He Y, Wang C, He W, et al. Analysis of risk factors for sepsis-related liver injury and construction of a prediction model[J]. Front Public Health,2024,12(1):1475292.
[3] Song Y, Maged Abdulsalam Mohammed Ali A M, Yang W, et al. Clinical characteristics and prognosis of patients with early sepsis-related liver injury in Northeast China[J]. J Intensive Care Med, 2025,40(3):253-262.
[4] You G, Zhao X, Liu J, et al. Machine learning-based identification of CYBB and FCAR as potential neutrophil extracellular trap-related treatment targets in sepsis[J]. Front Immunol, 2023, 14(1):1253833.
[5] Liu Z, Yuan X, Huang Y, et al. The role of interferon-induced proteins with tetratricopeptide repeats 1 and 2 in sepsis-induced acute liver injury[J]. Infect Drug Resist, 2024, 17(1):2337-2349.
[6] Neuman M G, Malnick S, Chertin L. Gamma glutamyl transferase-an underestimated marker for cardiovascular disease and the metabolic syndrome[J]. J Pharm Pharm Sci, 2020, 23(1):65-74.
[7] Zhao X, Wu X, Si Y,et al. D-DI/PLT can be a prognostic indicator for sepsis[J]. PeerJ, 2023, 11(1):e15910.
[8] Wang J, Xia J, Yan X, et al. The gamma-glutamyl transpeptidase to platelet ratio predicts liver inflammation in chronic hepatitis B with normal or mildly elevated alanine transaminase[J]. Clin Res Hepatol Gastroenterol, 2020, 44(6):913-922.
[9] 中国医疗保健国际交流促进会急诊医学分会, 中华医学会急诊医学分会, 中国医师协会急诊医师分会, 等.中国脓毒症早期预防与阻断急诊专家共识[J].中国急救医学, 2020, 40(7):577-588.
[10] 徐大洲,张树贤,王坤,等. 血清簇集蛋白、1-磷酸鞘氨醇水平对脓毒症急性肝损伤患者的预后价值[J]. 临床肝胆病杂志, 2023, 39(12):2867-2872.
[11] 雷佳佳, 邓利艳, 王洪锦, 等. ALBI、PALBI评分对脓毒症患者预后的预测价值分析[J]. 保健医学研究与实践, 2024, 21(8):78-83.
[12] Chen Y B, Zhan X J, Xiao J,et al. γ-Gammaglutamyl transferase predicts all-cause mortality within three-year intervals in patients undergoing peritoneal dialysis[J]. Ren Fail, 2024,46(1):2353339.
[13] Bai C, Zhang M, Zhang Y,et al. Gamma-glutamyltransferase activity (GGT) is a long-sought biomarker of redox status in blood circulation:a retrospective clinical study of 44 types of human diseases[J]. Oxid Med Cell Longev, 2022, 2022(1):8494076.
[14] Sun L, Gu M, Cai J, et al. Combining γ-GT, PIVKA-II, and AFP to predict long-term prognosis in patients with hepatocellular carcinoma after hepatectomy[J]. Clin Exp Pharmacol Physiol, 2023, 50(4):287-297.
[15] Repsold L, Joubert A M. Platelet function, role in thrombosis, inflammation, and consequences in chronic myeloproliferative disorders[J]. Cells, 2021, 10(11):3034.
[16] Li L, Chen L, Wang H, et al. Clinical correlation between coagulation disorders and sepsis in patients with liver failure[J]. Clin Hemorheol Microcirc, 2022, 80(3):219-231.
[17] Kim T S, Choi D H. Liver dysfunction in sepsis[J]. Korean J Gastroenterol, 2020, 75(4):182-187.
[18] Avcioğlu U, Eruzun H, Ustaoğlu M. The gamma-glutamyl transferase to platelet ratio for noninvasive evaluation of liver fibrosis in patients with primary biliary cholangitis[J]. Medicine (Baltimore), 2022, 101(40):e30626.
[19] Luo J, Du Z, Liang D,et al. Gamma-glutamyl transpeptidase-to-platelet ratio predicts liver fibrosis in patients with concomitant chronic hepatitis B and nonalcoholic fatty liver disease[J]. J Clin Lab Anal,2022,36(8):e24596.
[20] Zhao Y, Lin Z, Ji Y, et al. Gamma-glutamyl transpeptidase to platelet ratio:a new inflammatory marker associated with outcomes after cardiac arrest[J]. Mediators Inflamm,2021, 2021(1):5537966.