高龄重症肺炎患者氧疗前后脂代谢指标动态变化及临床意义  

Dynamic changes and clinical significance of lipid metabolism in elderly patients with severe pneumonia before and after oxygen therapy

作　　者：张悦华[1] 杜娟[2] 李影[3] ZHANG Yuehua;DU Juan;LI Ying(Department of Laboratory,Beijing Second Hospital,Beijing,100031,China;Department of Laboratory,Beijing Anzhen Hospital Affiliated to Capital Medical University;Department of Laboratory,Liangxiang Hospital in Fangshan District)

机构地区：[1]北京市第二医院检验科,北京100031 [2]首都医科大学附属北京安贞医院检验科 [3]北京市房山区良乡医院检验科

出　　处：《临床血液学杂志》2023年第12期855-859,共5页Journal of Clinical Hematology

摘　　要：目的:探讨高龄重症肺炎(SP)患者氧疗前后脂代谢指标动态变化及临床意义,为SP临床治疗及预后改善提供经验指导。方法:回顾性分析医院2019年1月—2022年9月收治的150例高龄SP氧疗患者的临床资料,依据入院28 d预后情况分为存活组(n=98)与病死组(n=52),收集2组患者临床资料,统计氧疗前(T0)、氧疗1 d(T1)、氧疗3 d(T2)时的脂代谢指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)]检测参数并计算高龄SP患者氧疗前后脂代谢指标波动情况。结果:病死组T0、T1、T2时血清TC、TG、LDL-C水平均高于存活组,HDL-C、ApoA1水平低于存活组,差异有统计学意义(P<0.05)。病死组血清TC、TG、HDL-C、LDL-C、ApoA1波动指标均高于存活组,差异有统计学意义(P<0.05)。经Pearson相关性检验,TC、TG、HDL-C、LDL-C、ApoA1指标之间呈正相关(r>0,P<0.05)。多因素Cox回归分析结果显示,血清TG波动大是高龄SP患者氧疗期间病死的危险因素(HR>1,P<0.05);绘制ROC曲线图,血清TC、TG、HDL-C、LDL-C、ApoA1波动指标对高龄SP患者氧疗期间病死评估的AUC均>0.7,评估价值较好。结论:高龄SP患者病死风险与氧疗前后脂代谢指标波动情况有关,氧疗前后脂代谢指标波动较大的患者病死风险更高,且氧疗前后脂代谢波动情况对高龄SP患者病死风险的评估价值较好,可作为临床评估及改善高龄SP患者预后的生物学指标。Objective:To investigate the dynamic changes and clinical significance of lipid metabolism in elderly patients with severe pneumonia(SP)before and after oxygen therapy,and provide experience guidance for clinical treatment and prognosis improvement of SP.Methods:The clinical data of 150 elderly patients treated with SP oxygen therapy in our hospital from January 2019 to September 2022 were retrospectively analyzed.They were divided into survival group(n=98)and death group(n=52)according to the 28 day prognosis after admission.The clinical data of patients in the two groups were collected,and the lipid metabolism indexes(total cholesterol[TC],triglyceride[TG],high-density lipoprotein cholesterol[HDL-C],low-density lipoprotein cholesterol[LDL-C],apolipoprotein A1[ApoA1])before oxygen therapy(T0),oxygen therapy 1 d(T1),and oxygen therapy 3 d(T2)were counted,and the fluctuation of lipid metabolism indexes before and after oxygen therapy in elderly SP patients was calculated.Results:The levels of serum TC,TG and LDL-C at T0,T1 and T2 in the death group were higher than those in the survival group,and the level of HDL-C,ApoA1 was lower than that in the survival group,with a statistical significant difference(P<0.05).The fluctuation indexes of serum TC,TG,HDL-C,LDL-C,ApoA1 in the death group were higher than those in the survival group,with a statistical significant difference(P<0.05).Pearson correlation test showed that TC,TG,HDL-C,LDL-C and ApoA1 were positively correlated(r>0,P<0.05).Multivariate Cox regression analysis showed that large fluctuation of serum TG was a risk factor for death of elderly SP patients during oxygen therapy(HR>1,P<0.05).The ROC curve was drawn,and the AUC of serum TC,TG,HDL-C,LDL-C,ApoA1 fluctuation indicators for the assessment of mortality of elderly SP patients during oxygen therapy was greater than 0.7,with a good evaluation value.Conclusion:The risk of death of elderly SP patients might be related to the fluctuation of lipid metabolism indexes before and after oxygen therapy.Patients wi

关 键 词：重症肺炎 高龄 氧疗 脂代谢指标 

分 类 号：R563.1[医药卫生—呼吸系统]