血脂水平预测脓毒症患者预后的研究  

Study of the blood lipid level in predicting the prognosis of septic patients

作　　者：黄雨晴[1] 龙春艺 陈翔 韦凌云 黄高[1] 尧国胜[1] 陆亿[1] 李军[1] 廖品琥[1] Huang Yuqing;Long Chunyi;Chen Xiang;Wei Lingyun;Huang Gao;Yao Guosheng;Lu Yi;Li Jun;Liao Pinhu(Department of Intensive Care Unit,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,Guangxi,China　)

机构地区：[1]右江民族医学院附属医院重症医学科,广西百色533000

出　　处：《右江民族医学院学报》2018年第1期1-4,共4页Journal of Youjiang Medical University for Nationalities

基　　金：国家自然科学基金资助项目(81560321);2014年广西医学高层次骨干人才培养"139"计划培养人选项目;广西高校急重症分子免疫研究重点实验室项目(kfkt20160058)

摘　　要：目的研究血脂水平对脓毒症患者预后的影响。方法收集2016年1月—2017年3月期间,右江民族医学院附属医院重症医学科收治的80例脓毒症患者(脓毒症组)资料,根据患者的预后情况,又分为存活组(n=57)和死亡组(n=23)两个亚组。回顾性分析脓毒症患者存活组和死亡组的血脂及其他临床资料,进行Logistic回归及ROC曲线分析,并与同期100例健康体检者(对照组)的血脂水平对比,研究影响脓毒症患者预后的血脂水平及其它相关因素。结果脓毒症组患者血清总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、脂蛋白a[LP(a)]水平均明显低于对照组(P<0.05);甘油三酯(TG)、极低密度脂蛋白(VLDL)、载脂蛋白AⅠ(Apo A-Ⅰ)、载脂蛋白B(Apo-B)两组比较差异均无统计学意义(P均>0.05)。脓毒症死亡组患者血清TC、HDL和LDL水平较存活组低,序贯器官衰竭评分(SOFA评分)、血乳酸(Lac)较存活组高(P<0.05);但两组间年龄、男性比例、ICU住院时间、VLDL、TG、Apo A-Ⅰ、Apo-B、LP(a)、血糖(Glu)、降钙素原(PCT)、C反应蛋白(CRP)、急性生理与慢性健康评分(APACHEⅡ)比较差异无统计学意义(P>0.05)。Logistic回归分析提示血清TC、HDL、Lac是影响脓毒症患者预后的三个独立危险因素;且用ROC曲线下面积(AUC)评价TC、HDL、Lac的预测价值,分别是0.706±0.064(P=0.004)、0.731±0.066(P=0.001)、0.709±0.062(P=0.004),HDL在预测脓毒症患者预后方面优于TC和Lac。结论脓毒症患者存在脂质代谢紊乱,血清TC、HDL和Lac可能作为预测脓毒症患者预后的标志物,脓毒症患者的TC和HDL越低、Lac越高,则预后越差。Objective To study the effects of blood lipid level on the prognosis of patients with sepsis. Methods Records of 80 patients with sepsis(sepsis group)cared at the Department of Intensive Care Unit of Affiliated Hospital of Youjiang Medical University for Nationalities from January 2016 to March 2017 were collected.According to the patient’s prognosis,the sepsis group was divided into two subgroups:the survival group(n=57)and the death group(n=23).Retrospective analysis of the serum lipids and other clinical data of septic patients in the survival and the death groups was performed,meanwhile the Logistic regression and ROC curve analyseis was performed.The blood lipid level was compared between the septic patients and 100 healthy individuals(control group)who received physical examination in the same period so as to study the level of blood lipid and other related factors affecting the prognosis of septic patients. Results The levels of serum total cholesterol(TC),high density lipoprotein(HDL),low density lipoprotein(LDL),lipoprotein a[LP(a)]in the sepsis group were significantly lower than those in the control group(P<0.05).Comparing the triglyceride(TG),very low density lipoprotein(VLDL),apolipoprotein AⅠ(Apo A-Ⅰ)and apolipoprotein B(Apo-B)between the two groups showed that there were no significant differences(all P>0.05).The levels of serum TC,HDL and LDL in the death group were lower than those in the survival group,but the sequential organ failure assessment(SOFA)score and the serum lactate(Lac)level were higher than those in the survival group(P<0.05).However,comparing the age,proportion of male,ICU hospital duration,VLDL,TG,Apo A-Ⅰ,Apo-B,LP(a),glucose(Glu),procalcitonin(PCT),C-reaction protein(CRP),and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score between the two groups yielded that there were no significant differences(P>0.05).The results of Logistic regression analysis showed that serum TC,HDL and Lac were three independent risk factors for the prognosis of septic patients.Mor

关 键 词：脓毒症 血脂 乳酸 预后 

分 类 号：R631[医药卫生—外科学]