高密度脂蛋白对链球菌血流感染预后的预测价值  

Prognostic value of high density lipoprotein level in patients with streptococcal bloodstream infection

作　　者：段晓光[1] 石朝阳[1] 孙文举 张晓娟[1] 杜丽娟 王海旭[1] 孙同文[1] Duan Xiaoguang;Shi Zhaoyang;Sun Wenjun;Zhang Xiaojuan;Du Lijuan;WangHaixu;Sun Tongwen(Department of General ICU,the First Affi liated Hospital of Zhengzhou University,Henan Key Laboratory of Critical Care Medicine,Zhengzhou Key Laboratory of Sepsis,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,郑州450052

出　　处：《中华急诊医学杂志》2022年第12期1685-1690,共6页Chinese Journal of Emergency Medicine

基　　金：河南省医学科技攻关计划省部共建重大项目(SBGJ202101015);国家自然科学基金联合基金项目(U2004110);国家自然科学基金面上项目(82172129)。

摘　　要：目的探讨高密度脂蛋白(high density lipoprotein HDL)水平对链球菌血流感染患者预后的预测价值。方法选取2015年1月至2019年12月郑州大学第一附属医院收治的链球菌血流感染患者698例为研究对象。记录患者血培养阳性48 h内血脂水平及其他临床资料。2020年1月至3月电话随访,记录患者终点事件发生情况,终点事件为确诊链球菌血流感染60 d全因死亡。依据HDL水平,将患者分为低HDL组(HDL≤0.84 mmol/L)和高HDL组(HDL>0.84 mmol/L)。采用单因素分析和多因素Cox回归分析影响链球菌血流感染预后的相关因素,绘制患者工作特征曲线(ROC)评估HDL水平对60 d预后的预测价值。Kaplan-Meier生存曲线比较不同HDL水平患者的生存差异。结果(1)根据纳入、排除标准共纳入491例,成功随访461例(随访率93.89%),60 d存活373例,死亡88例,60 d病死率19.09%(88/461)。(2)单因素分析:年龄、总胆固醇(total cholesterol TC)、HDL、低密度脂蛋白(low density lipoprotein LDL)、血小板、白蛋白、纤维蛋白原、甘油三脂(triglyceride TG)、肌酐、谷丙转氨酶、谷草转氨酶、白细胞、PCT、总胆红素、直接胆红素、呼吸衰竭、休克在生存组和死亡组之间的差异均有统计学意义。(3)多因素Cox回归结果显示:HDL(RR=1.922,95%CI:1.186~3.117,P=0.008),谷草转氨酶(RR=1.953,95%CI:1.233~3.094,P=0.004),休克(RR=15.196,95%CI:6.953~33.211,P<0.001),呼吸衰竭(RR=9.509,95%CI:4.232~21.367,P<0.001)为影响链球菌血流感染死亡的独立危险因素。(4)ROC曲线下面积显示:HDL单独预测链球菌血流感染的预后有一定价值,ROC曲线下面积为:0.602,HDL联合谷草转氨酶、休克和呼吸衰竭预测预后的ROC曲线下面积为:0.960,敏感度为92%,特异度为92%。(5)Kaplan-Meier生存曲线分析显示:HDL>0.84 mmol/L组链球菌血流感染患者无终点事件发生的累积存活率高于HDL≤0.84mmol/L组,但差异无统计学意义(Log-Rank检验:χ^(2)=0.843,P<0.358)。�Objective investigate the prognostic value of high density lipoprotein(HDL)level in patients with streptococcal bloodstream infection.Methods A total of 698 patients with streptococcal bloodstream infection admitted to the First Affi liated Hospital of Zhengzhou University from January 2015 to December 2019 were enrolled.Serum lipid and other clinical data of patients with positive blood culture within 48 h were recorded.The patients were followed up by telephone from January to March in 2020,and the end-point events were recorded,which were all-cause death 60 days after the diagnosis of streptococcal bloodstream infection.The patients were divided into two groups according to the levels of HDL:low HDL group(HDL≤0.84 mmol/L)and high HDL group(HDL>0.84 mmol/L).Univariate and multivariate Cox regression analysis were used to analyze the 60-day prognostic factors of patients with streptococcus bloodstream infection.The receiver operating characteristic(ROC)curve was used to explore predictive value of HDL level for 60-day prognosis of patients.Kaplan-Meier survival curve was used to compare the cumulative survival of patients with different HDL levels.Results(1)A total of 491 patients were enrolled according to the inclusion criteria,and 461 patients were followed up successfully,with a follow-up rate of 93.89%.There were 373 survival patients and 88 death patients at 60 days,with a 60-day mortality rate of 19.09%(88/461).(2)There were signifi cant differences in age,total cholesterol(TC),HDL,low density lipoprotein(LDL),platelets,albumin,fi brinogen,triglyceride(TG),creatinine,alanine aminotransferase,aspartate aminotransferase,white blood cell,PCT,total bilirubin,direct bilirubin,and respiratory failure and shock between the survival group and death group.(3)Multivariate Cox regression analysis showed that HDL(RR=1.922,95%CI:1.186-3.117,P=0.008),aspartate aminotransferase(RR=1.953,95%CI:1.233-3.094,P=0.004),shock(RR=15.196,95%CI:6.953-33.211,P<0.001),and respiratory failure(RR=9.509,95%CI:4.232-21.367,P<0.001)we

关 键 词：高密度脂蛋白 链球菌 血流感染 预后 

分 类 号：R515[医药卫生—内科学]