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目的:探讨肝动脉阻力指数（Hepatic artery resistance index，HARI)、miRNA-122a对脓毒症休克合并肝损伤的早期诊断及预后评估的临床价值。方法:选择2016年12月至2019年02月沧州市中心医院EICU收治的176例脓毒症休克患者作为研究对象，根据有无肝损伤分为无肝损伤组（90例）、肝损伤组（86例）。肝损伤组患者再按肝损伤程度分为轻度肝损伤组（20例）、中度肝损伤组（25例）、重度肝损伤组（41例）。脓毒症休克合并肝损伤患者根据28 d转归分为存活组（26例）和死亡组（60例）。选择健康体检者40例作为对照组。分析两组患者的临床资料，采用彩色多普勒超声测定肝动脉阻力指数（HARI)，采用反转录-聚合酶链反应（RT-PCR)测定血清miRNA- 122a表达量。采用受试者工作特征（receiver operating characteristic，ROC）曲线分析HARI、血清miRNA-122a对脓毒症休克合并肝损伤的早期诊断价值。采用二元Logistic回归分析影响脓毒症休克合并肝损伤患者预后的危险因素。结果:①与对照组比较，脓毒症休克无肝损伤组、脓毒症休克合并肝损伤组患者的HARI、血清miRNA-122a呈递增趋势，差异有显著统计学意义(n P 0.05)，而血清miRNA-122a差异有统计学意义(n P <0.01)。随肝损伤严重程度加重，HARI、血清miRNA-122a呈递增趋势，重度肝损伤组显著高于轻度和中度肝损伤组，差异有显著统计学意义( n P <0.01)。③与存活组比较，单因素分析显示，脓毒症休克合并肝损伤28 d死亡组患者的肝损伤严重程度、APACHE Ⅱ评分、SOFA评分、PCT、Lac、miRNA-122a、HARI显著升高，差异有统计学意义( n P<0.01)。④二元Logistic回归分析发现，肝损伤严重程度、APACHE Ⅱ评分、SOFA评分、HARI、miRNA-122a是影响脓毒症休克合并肝损伤患者预后的独立危险因素。n 结论:HARI联合血清miRNA-122a检测对评估脓毒症休克合并肝损伤具有较高的敏感度和特异度，且对预后评估有一定的临床价值。“,”objective:To investigate the clinical value of hepatic arterial resistance index (HARI) and miRNA-122a in the early diagnosis and prognosis of patients with septic shock complicated with liver injury.Methods:A total of 176 septic shock patients admitted to EICU of Cangzhou Central Hospital from December 2016 to February 2019 were selected as the research subjects. According to the occurrence of acute liver injury, they were divided into the liver injury group (86 cases) and the non-liver injury group (90 cases). Patients in the liver injury group were further divided into the mild liver injury group (20 cases), moderate liver injury group (25 cases), and severe liver injury group (41 cases) according to the degree of liver injury. Patients with septic shock complicated with liver injury were divided into the survival group (26 cases) and non-survival group (60 cases) according to the 28-day mortality. Forty healthy individuals were selected as controls. The clinical data of the subjects were collected. The HARI was determined by bedside color Doppler ultrasonography. The expressions of miRNA-122a in serum were determined by reverse transcriptase polymerase chain reaction (RT-PCR). Receiver operating characteristic (ROC) curves were used to analyze the value of HARI and serum miRNA-122a in the early diagnosis of septic shock combined with liver injury. Binary Logistic regression was used to analyze the prognostic risk factors of septic shock patients with liver injury.Results:① Compared with the control group, there was an increasing trend of HARI and serum miRNA-122a in patients with septic shock without liver injury and patients with septic shock complicated with liver injury, with statistically significant differences (n P 0.05), while the difference of serum miRNA-122a was statistically significant (n P <0.01). As the severity of liver injury increased, HARI and miRNA-122a expression in patients with septic shock complicated with liver injury showed an increasing trend, with statistically significant differences ( n P <0.01). ③ Compared with patients with septic shock with liver injury in the survival group, the liver injury severity, APACHE II score, SOFA score, PCT, HARI and serum miRNA-122a expression levels were significantly increased in the death group, with statistically significant differences ( n P <0.01). ④ Binary Logistic regression analysis showed that the severity of liver injury, APACHE II score, SOFA score, HARI and serum miRNA-122a were independent risk factors affecting the prognosis of patients with septic shock with liver injury.n Conclusions:HARI combined with serum miRNA-122a test has high sensitivity and specificity in the evaluation of septic shock with liver injury, and have certain clinical value in the evaluation of prognosis of patients with septic shock with liver injury.