diff --git a/crates/erp-ai/src/copilot/engine.rs b/crates/erp-ai/src/copilot/engine.rs
index 6c9541e..d7e4d65 100644
--- a/crates/erp-ai/src/copilot/engine.rs
+++ b/crates/erp-ai/src/copilot/engine.rs
@@ -1,4 +1,4 @@
-use crate::copilot::rules::{RuleData, evaluate_rules};
+use crate::copilot::rules::{MatchedRuleData, RuleData, evaluate_rules};
 use crate::copilot::scoring::{RiskScore, calculate_risk};
 use serde_json::Value;
 
@@ -12,3 +12,84 @@ impl CopilotEngine {
         calculate_risk(matched)
     }
 }
+
+/// 根据规则匹配结果生成异常洞察
+/// 仅 warning 和 critical 级别生成告警洞察，info 级别仅在档案内展示
+pub fn generate_anomaly_insights(
+    patient_id: &str,
+    matched: &[MatchedRuleData],
+) -> Vec<serde_json::Value> {
+    matched
+        .iter()
+        .filter(|(_, _, _, severity, _)| severity == "warning" || severity == "critical")
+        .map(|(rule_id, name, score, severity, suggestion)| {
+            serde_json::json!({
+                "patient_id": patient_id,
+                "insight_type": "anomaly",
+                "source": "rule",
+                "severity": severity,
+                "title": name,
+                "content": {
+                    "rule_id": rule_id.to_string(),
+                    "score": score,
+                    "suggestion": suggestion,
+                },
+            })
+        })
+        .collect()
+}
+
+#[cfg(test)]
+mod tests {
+    use super::*;
+
+    #[test]
+    fn test_generate_anomaly_insight_critical() {
+        let matched = vec![(
+            uuid::Uuid::now_v7(),
+            "高钾血症风险".into(),
+            4,
+            "critical".into(),
+            Some("立即通知主治医生".into()),
+        )];
+        let insights = generate_anomaly_insights("patient-123", &matched);
+        assert_eq!(insights.len(), 1);
+        assert_eq!(insights[0]["severity"], "critical");
+        assert_eq!(insights[0]["insight_type"], "anomaly");
+    }
+
+    #[test]
+    fn test_generate_anomaly_insight_filters_info() {
+        let matched = vec![(
+            uuid::Uuid::now_v7(),
+            "体重轻微波动".into(),
+            1,
+            "info".into(),
+            None,
+        )];
+        let insights = generate_anomaly_insights("patient-123", &matched);
+        assert!(insights.is_empty());
+    }
+
+    #[test]
+    fn test_generate_anomaly_insight_warning_and_critical() {
+        let matched = vec![
+            (
+                uuid::Uuid::now_v7(),
+                "eGFR下降".into(),
+                3,
+                "warning".into(),
+                Some("建议调整".into()),
+            ),
+            (
+                uuid::Uuid::now_v7(),
+                "透析质量危急".into(),
+                5,
+                "critical".into(),
+                Some("紧急评估".into()),
+            ),
+        ];
+        let insights = generate_anomaly_insights("patient-123", &matched);
+        assert_eq!(insights.len(), 2);
+    }
+}
diff --git a/crates/erp-ai/src/event/copilot_consumer.rs b/crates/erp-ai/src/event/copilot_consumer.rs
index 8f750e4..fdcc5d5 100644
--- a/crates/erp-ai/src/event/copilot_consumer.rs
+++ b/crates/erp-ai/src/event/copilot_consumer.rs
@@ -58,8 +58,45 @@ async fn process_event(db: &sea_orm::DatabaseConnection, event: &erp_core::event
         },
         None => return,
     };
-    let _ =
-        crate::service::risk_service::RiskService::compute_risk(db, tenant_id, patient_id).await;
+    // 风险评分计算
+    if let Ok(risk) =
+        crate::service::risk_service::RiskService::compute_risk(db, tenant_id, patient_id).await
+    {
+        // 异常检测：告警级规则匹配生成洞察
+        let matched_with_severity: Vec<_> = risk
+            .matched_rules
+            .into_iter()
+            .map(|r| (r.rule_id, r.name, r.score, r.severity, r.suggestion))
+            .collect();
+        let anomaly_insights = crate::copilot::engine::generate_anomaly_insights(
+            &patient_id.to_string(),
+            &matched_with_severity,
+        );
+        for insight_data in anomaly_insights {
+            let severity = insight_data["severity"]
+                .as_str()
+                .unwrap_or("warning")
+                .to_string();
+            let title = insight_data["title"]
+                .as_str()
+                .unwrap_or("异常告警")
+                .to_string();
+            let _ = crate::service::insight_service::InsightService::create_insight(
+                db,
+                tenant_id,
+                patient_id,
+                "anomaly".into(),
+                "rule".into(),
+                Some(severity),
+                title,
+                insight_data,
+                None,
+                168, // 7 天过期
+                None,
+            )
+            .await;
+        }
+    }
     let _ = erp_core::events::mark_event_processed(db, event.id, "copilot_consumer").await;
 }