血脂水平对老年脓毒症患者预后的影响及关联因素分析  

Characteristics of serum cholesterol in sepsis patients and its correlation with prognosis

作　　者：许青宗[1] 郭力鹏[1] 王向杰[1] 宋金玲[1] Xu Qingzong;Guo Lipeng;Wang Xiangjie;Song Jinling(Department of Emergency General Ward/General Practice,the Third People′s Hospital of Dalian,Dalian 116033,China)

机构地区：[1]大连市第三人民医院急诊综合病房/全科医学科,116033

出　　处：《中国医师进修杂志》2020年第2期122-125,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨血脂各项指标在脓毒症患者中变化特征以及其与预后的关联性。方法回顾性分析2015年2月至2019年2月大连市第三人民医院收治的206例脓毒症患者(观察组)的临床资料,并选择同期住院200例非脓毒症患者作为对照组,对比两组患者一般临床资料、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)以及其他生化指标;进一步把观察组分成存活组、死亡组,再以多因素Logistic回归分析影响预后的相关因素。结果观察组TC、HDL-C均较对照组显著下降[(2.49±1.14)mmol/L比(3.40±1.26)mmol/L、(1.66±0.89)mmol/L比(2.49±0.81)mmol/L](t=6.240、5.532,P<0.05),而两组LDL-C比较差异无统计学意义(P>0.05)。观察组按预后不同分为死亡组(85例)和存活组(121例),死亡组年龄较存活组增大[(75.6±8.6)岁比(62.5±6.0)岁,t=4.565]、血肌酐(SCr)较存活组升高[(246.2±34.6)μmol/L比(165.4±35.6)μmol/L,t=5.420],而TC[(2.15±0.59)mmol/L比(2.89±1.02)mmol/L,t=5.475]、HDL-C[(1.40±0.42)mmol/L比(1.94±0.52)mmol/L,t=4.856]、LDL-C[(1.73±0.56)mmol/L比(1.97±0.72)mmol/L,t=4.261]均较存活组显著降低,差异均有统计学意义(P<0.05)。Logistic回归分析显示,年龄是影响脓毒症患者预后的危险因素(OR=1.256,95%CI 1.006~1.056,P=0.012),而TC则是保护因素(OR=-0.758,95%CI 0.579~0.867,P=0.014)。结论脓毒症患者TC、HDL-C呈下降特征,而死亡者较存活者TC、HDL-C、LDL-C均进一步下降,其中TC作为保护因素可对脓毒症患者的预后进行评估。Objective To analyze the characteristics of changes in serum cholesterol level in sepsis patients,and to explore its correlation with prognosis.Methods A retrospective analysis was conducted.Two hundred and six patients with sepsis admitted in the Third People′s Hospital of Dalian from February 2015 to February 2019 were enrolled(observation group),and 206 patients without sepsis hospitalized in the same period were served as control group.The basic clinical data of the two groups were collected,and the results of total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and biochemical parameters were compared.The patients with sepsis were divided into death group and survival group,and risk factors influencing the prognosis of patients with sepsis were analyzed with Logistic regression analysis.Results Compared with control group,the levels of serum TC[(2.49±1.14)mmol/L vs.(3.40±1.26)mmol/L,t=6.240]and HDL-C[(1.66±0.89)mmol/L vs.(2.49±0.81)mmol/L,t=5.532]in observation group were significantly lower(P<0.05),and that of LDL-C showed no statistically significant difference[(1.96±0.91)mmol/L vs.(2.10±0.72)mmo/L,t=0.940,P>0.05].In observation group,the patients in death group(85 cases)were older than those of the survival group(121 cases)[(75.6±8.6)years vs.(62.5±6.0)years,t=4.565],serum creatinine(SCr)was higher than that of survival group[(246.2±34.6)μmol/L vs.(165.4±35.6)μmol/L,t=5.420],and the levels of serum TC[(2.15±0.59)mmol/L vs.(2.89±1.02)mmol/L,t=5.475],HDL-C[(1.40±0.42)mmol/L vs.(1.94±0.52)mmol/L,t=4.856]and LDL-C[(1.73±0.56)mmol/L vs.(1.97±0.72)mmol/L,t=4.261]were significantly lower than those of survival group(P<0.05).Logistic regression analysis showed that age was the risk factor of death in sepsis patients(OR=1.256,95%CI 1.006-1.056,P=0.012),and TC was the protective factor for the prognosis of sepsispatients(OR=-0.758,95%CI 0.579-0.867,P=0.014).Conclusions The levels of TC,HDL-C in sepsis patients are significantly lowered,and t

关 键 词：脓毒症 老年 胆固醇 预后 

分 类 号：R45[医药卫生—治疗学]