脓毒症休克患者血脂水平动态监测对预测短期预后的价值研究  

Research of the Value of Dynamic Monitoring of Blood Lipid Levels in Septic Shock for Predicting Short-Term Prognosis

作　　者：张士跃 张庆[2] 刘春来 齐兴 ZHANG Shiyue;ZHANG Qing;LIU Chunlai;QI Xing(Department of Clinical Laboratory,the Tongzhou District Integrated Traditional Chinese and Western Medicine Hospital,Beijing 101199,China;Department of Intensive Care Unit,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100701,China;Department of Clinical Laboratory,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100701,China)

机构地区：[1]北京通州区中西医结合医院,北京101199 [2]北京中医药大学东直门医院重症监护室,北京100701 [3]北京中医药大学东直门医院检验科,北京100701

出　　处：《现代检验医学杂志》2024年第4期72-75,共4页Journal of Modern Laboratory Medicine

摘　　要：目的探讨血脂水平动态变化对脓毒症休克患者短期预后的预测价值。方法选取2019年3月~2023年7月北京中医药大学东直门医院诊治的脓毒症休克患者107例为研究对象。根据患者28天生存结局分为生存组(n=76)和死亡组(n=31)。检测入院日(Day0),第4±1天和第7±1天的总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、高密度脂蛋白-胆固醇(high density lipoprotein-cholesterol,HDL-C)和低密度脂蛋白-胆固醇(low density lipoprotein-cholesterol,LDL-C)水平。受试者工作特征(ROC)曲线用于分析血脂动态变化对脓毒症休克患者生存结局的预测价值。多因素COX回归分析影响患者预后因素。结果生存组入院日TC和LDL-C水平第4±1天和第7±1天的TC,HDL-C和LDL-C水平均明显高于死亡组患者,差异具有统计学意义(Z=2.241~5.744,均P<0.05)。入院第一周HDL-C和LDL-C变化量[D(7±1)-D0]预测生存结局的曲线下面积[AUC(95%CI)]分别为0.775(0.685~0.850),0.646(0.547~0.736),最佳截断值为0.16mmol/L,0.28mmol/L;敏感度分别为70.97%,64.52%;特异度分别为82.89%,69.74%。多变量回归分析确定HDL-C动态变化与预后不良独立相关(OR=0.141,95%CI:0.044~0.454,P=0.001)。结论监测入院第1周血脂动态变化有助于预测脓毒症休克患者短期预后。Objective To explore the predictive value of blood lipid dynamics of septic shock for the short-term prognosis.Methods A total of 107 patients with septic shock treated in Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine from March 2019 to July 2023 were selected as the study subjects.They were divided into survival group(n=76)and death group(n=31)based on their 28-day outcomes.Total cholesterol(TC),triacylglycerol(TG),high density lipoprotein cholesterol(HDL-C)and LDL cholesterol(LDL-C)concentrations were tested at disease onset(day 0),day 4±1 and day 7±1.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of lipid dynamics on outcomes in patients with septic shock.Multivariate COX regression analysis was used to analyze factors affecting the prognosis of patients with septic shock.Result The levels of TC and HDL-C at disease onset,as well as TC,HDL-C and LDL-C on day(4±1)and day(7±1)in the survival group were higher than those in death group,and the differences were significant(Z=2.241~5.744,all P<0.05).The areas under the curve[AUC(95%)]for the prediction of changes in HDL-C and LDL-C in the first week of admission were 0.775(95%CI:0.685~0.850)and 0.646(95%CI:0.547~0.736),with the best cutoff values of 0.16mmol/L and 0.28mmol/L,sensitivity of 70.97%and 64.52%,and specificity of 82.89%and 69.74%,respectively.Multivariate regression analysis showed that HDL-C dynamics was independently associated with poor prognosis(OR=0.141,95%CI:0.044~0.454,P=0.001).Conclusion Monitoring the dynamic changes of blood lipid at the first week of admission could help in predicting short-term outcomes in patients with septic shock.

关 键 词：脓毒症休克 胆固醇 高密度脂蛋白-胆固醇 

分 类 号：R631[医药卫生—外科学] R446.112[医药卫生—临床医学]