老年脓毒症患者早期蛋白分解代谢规律与炎症反应关系及对预后影响  

Relationship between early protein catabolism and inflammation and its influence on prognosis in elderly patients with sepsis

作　　者：张高泽 陈清 刘爱娣 ZHANG Gao-ze;CHEN Qing;LIU Ai-di(Department of Emergency Medicine,Wenzhou Central Hospital,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州市中心医院急诊医学科,浙江温州325000

出　　处：《环境与健康杂志》2025年第2期102-109,共8页Journal of Environment and Health

基　　金：温州市科研项目(Y2023566)。

摘　　要：目的探讨老年脓毒症患者早期蛋白分解代谢规律与炎症反应的关系及对预后的影响。方法选择2023年1月至2024年5月于温州市中心医院收治的132例老年脓毒症患者为研究对象,根据病情严重程度分为脓毒症组(n=65)、脓毒性休克组(n=67),比较两组患者的一般资料、早期蛋白分解代谢参数及炎症反应指标,采用多元线性回归分析不同严重程度脓毒症患者早期蛋白分解代谢参数与炎症反应指标的关系。另根据患者预后情况分为预后良好组(n=78)与预后不良组(n=54),比较不同预后患者的临床资料,采用广义线性混合效应模型(GLMMs)分析老年脓毒症患者早期蛋白分解代谢参数与预后的关系。采用限制性立方样条分析早期蛋白分解代谢参数与老年脓毒症患者预后的剂量-反应关系。采用广义多因子降维模型分析早期蛋白分解代谢参数与炎症反应指标对老年脓毒症患者预后的作用关系。结果脓毒性休克组患者相较于脓毒症组患者,静息能量消耗(REE)、总氮排出量更高,总氮平衡量更低,差异均有统计学意义(P<0.05);脓毒性休克组患者相较于脓毒症组患者,肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平更高,白细胞介素-10(IL-10)水平更低,差异均有统计学意义(P<0.05)。多元线性回归结果显示,不同严重程度脓毒症下,REE、总氮排出量是TNF-α、CRP的独立正相关因素,总氮平衡量是TNF-α、CRP的独立负相关因素(P<0.05),总氮平衡量是IL-10的独立正相关因素,REE、总氮排出量是IL-10的独立负相关因素(P<0.05)。预后良好与预后不良患者的急性生理和慢性疾病(APACHEⅡ)评分、脓毒症相关器官衰竭(SOFA)评分、血小板(PLT)、D-二聚体(D-D)、白蛋白(Alb)、REE、总氮排出量、总氮平衡量、TNF-α、CRP、IL-10差异均有统计学意义(P<0.05)。GLMMs分析结果显示,REE、总氮排出量越高,总氮平衡量越低,预后不良风险性越大(P<0.0Objective To understand the relationship between early protein catabolism and inflammation in the early stage of senile sepsis and its influence on prognosis.Methods A total of 132 elderly patients with sepsis admitted to our hospital from January 2023 to May 2024 were chosen as the study objects.According to the severity of the disease,they were divided into sepsis group(n=65)and septic shock group(n=67).The general data,early protein catabolic parameters and inflammatory response indexes of the two groups were collected and compared.Multiple linear regression was used to analyze the relationship between early protein catabolic parameters and inflammatory response indexes in patients with sepsis of different severity.The patients were divided into good prognosis group(n=78)and poor prognosis group(n=54)according to the prognosis.The clinical data of patients with different prognosis were compared,and the relationship between early protein catabolic parameters and prognosis of elderly sepsis patients was analyzed by generalized linear mixed effects model(GLMMs).The dose-response relationship between early protein catabolic parameters and prognosis of senile sepsis patients was analyzed with restricted cubic spline.Generalized multifactor dimension reduction model was used to analyze the relationship between early protein catabolic parameters and inflammatory response indexes on the prognosis of elderly patients with sepsis.Results Resting energy expenditure(REE),total nitrogen excretion and total nitrogen balance were higher in septic shock group than in sepsis group,with significant differences(P<0.05).The levels of tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)and interleukin-10(IL-10)in septic shock group were significantly higher than those in sepsis group(P<0.05).Multiple linear regression results showed that REE and total nitrogen output were independent positive correlated factors of TNF-α and CRP,total nitrogen balance was independent negative correlated factors of TNF-α and CRP(P<0.05),and

关 键 词：脓毒症 蛋白质代谢 炎症反应 预后 

分 类 号：R994.6[医药卫生—毒理学]