脓毒症患者血脂与炎症因子水平的相关性研究  

The relationship between the lipid profiles and inflammation in patients with sepsis

作　　者：徐亚楠 王栋[1] 刘欢[1] 丁显飞 张晓娟[1] 刘韶华[1] 孙同文[1] Xu Ya'nan;Wang Dong;Liu Huan;Ding Xianfei;Zhang Xiaojuan;Liu Shaohua;Sun Tongwen(Department of General ICU,the First Affiliated Hospital of Zhengzhou University,Henan Key Laboratory of Critical Care Medicine,Zhengzhou Key Laboratory of Sepsis,Henan Engineering Research Center for Critical Care Medicine,Zhengzhou 450052,Henan,China)

机构地区：[1]郑州大学第一附属医院综合ICU,河南省重症医学重点实验室,郑州市脓毒症重点实验室,河南省重症医学工程研究中心,郑州450052

出　　处：《中华危重病急救医学》2022年第2期127-132,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金联合项目(U2004110);国家自然科学基金面上项目(82172129)。

摘　　要：目的探讨脓毒症患者血脂水平与炎症反应强度及病情严重程度的关系,以期寻找一种可以快速评估脓毒症病情及预后的生物标志物。方法回顾性选择2019年10月至2021年5月郑州大学第一附属医院综合重症监护病房(ICU)收治的449例脓毒症患者及同期住院的355例非脓毒症患者为研究对象。收集两组患者的人口学资料及入院24 h内的血脂及其他临床指标并进行比较;采用双变量相关性研究方法分析脓毒症患者血脂水平与炎症指标及病情严重程度的关系;绘制受试者工作特征曲线(ROC曲线),评估各血脂成分对脓毒症患者28 d病死率的预测价值。根据ROC曲线分析结果,将血脂分为不同水平两组,并采用Kaplan-Meier生存曲线,比较两组无终点事件发生(以28 d病死率为终点事件)的累积存活率。结果与非脓毒症患者比较,脓毒症患者血浆总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平均显著降低〔TC(mmol/L):2.93±1.33比4.01±1.14,HDL-C(mmol/L):0.78±0.47比1.16±0.40,LDL-C(mmol/L):1.53±1.00比2.71±0.98,均P<0.05〕。在脓毒症患者中,血浆胆固醇水平与炎症程度指标及病情严重程度评分均有不同程度的相关性,其中以HDL-C与白细胞介素-6(IL-6;r=-0.551,P=0.000)、降钙素原(PCT;r=-0.598,P=0.000)、序贯器官衰竭评分(SOFA;r=-0.285,P=0.000)的相关性最强。ROC曲线分析显示,在所有血脂成分中,以HDL-C对脓毒症患者28 d病死率预测价值最高,ROC曲线下面积(AUC)为0.718,当最佳截断值为0.69 mmol/L时,敏感度和特异度分别为67.3%、65.2%,阳性预测值和阴性预测值分别为60.6%、71.5%。Kaplan-Meier生存曲线分析显示,HDL-C≤0.69 mmol/L组脓毒症患者死亡风险较HDL-C>0.69 mmol/L组明显增高,差异有统计学意义(P<0.0001)。而且低HDL-C水平组脓毒症患者28 d病死率〔59.73%(135/226)比28.70%(64/223)〕、多器官功能障碍发生率〔41.15%(93/226)比31.84%(71/2Objective To explore the relationship between the changes in the lipid profiles and the intensity of inflammatory response and disease severity in patients with sepsis,in order to find a biomarker that can quickly evaluate the condition and prognosis of sepsis.Methods A retrospective analysis was performed on 449 patients with sepsis admitted to department of critical care medicine of the First Affiliated Hospital of Zhengzhou University from October 2019 to May 2021,and 355 patients without sepsis hospitalized in the same period served as the control.The general demographic data,blood lipid and other clinical indicators within 24 hours after admission were collected and compared between the two groups.Bivariate correlation study was used to analyze the relationship between blood lipid levels and inflammation indicators and severity of illness in patients with sepsis.The receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each blood lipid component on the 28-day mortality of patients with sepsis.According to the results of ROC curve analysis,the blood lipids were divided into two groups with different levels,and the Kaplan-Meier survival curve was used to compare the cumulative survival rates of the two groups without end-point event(the 28-day mortality was the end-point event).Results Compared with non-septic patients,the levels of plasma total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)were significantly lower in patients with sepsis[TC(mmol/L):2.93±1.33 vs.4.01±1.14,HDL-C(mmol/L):0.78±0.47 vs.1.16±0.40,LDL-C(mmol/L):1.53±1.00 vs.2.71±0.98,all P<0.05].In patients with sepsis,plasma cholesterol levels were correlated with the degree of inflammation and severity of the disease to varying degrees,but the HDL-C had the strongest correlation with interleukin-6(IL-6;r=-0.551,P=0.000),procalcitonin(PCT,r=-0.598,P=0.000),sequential organ failure assessment(SOFA;r=-0.285,P=0.000).The ROC curve analysis showed

关 键 词：脓毒症 血脂 炎症因子 预后 

分 类 号：R459.7[医药卫生—急诊医学]