脓毒症患儿血浆胆固醇、白细胞介素-6水平变化与病情危重度的关系

Relationship between the Changes of Plasma Cholesterol and Interleukin-6 Levels and the Disease Severity of Sepsis in Children

目的探讨脓毒症患儿血浆胆固醇、IL-6水平变化及其与病情危重程度的关系。方法脓毒症患儿(脓毒症组)60例,未达全身炎性反应综合征(SIRS)诊断标准的一般感染患儿40例(对照组),二组均于确诊次日晨取外周血2 mL,采用全自动生化分析仪测定患儿血浆总胆固醇(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,ELISA法测定其IL-6水平。并于确诊后即刻测心率、血压、呼吸、pa(O2)、pH、电解质、肾功能、血红蛋白等指标,进行危重症评分。危重症评分≤80分为危重症组,>80分为非危重症组。结果脓毒症患儿HDL-C、LDL-C及TC水平均明显低于对照组(Pa<0.01),IL-6水平明显高于对照组(P<0.01)。危重症组脓毒症患儿HDL-C、LDL-C及TC水平均显著低于非危重症患儿(Pa<0.01),IL-6水平明显高于非危重症组(P<0.01)。HDL-C与危重症评分呈正相关(r=0.74 P<0.01),与IL-6呈负相关(r=-0.66 P<0.01)。结论胆固醇代谢紊乱参与脓毒症的发病过程,监测血浆胆固醇尤其HDL-C水平有助于判断病情的严重度及预后。

Objective To explore the relationship between the changes of blood plasma IL - 6 and cholesterol levels and the disease severity of sepsis in children. Methods Sixty septic children were included in this study, and 40 children with mild infection and not attaining to systemic inflammatory response syndrome （SIRS） standards were selected as control group. Blood samples were drawn in the following day after diagnosis to detect high density lipoprotein cholesterol （ HDL - C ） , low density lipoprotein cholesterol （ LDL - C ） and total cholesterol （TC） by automatic biochemical analyzer and IL -6 level by ELISA. In addition, critical illness scores were conducted for all children at the time of diagnosis by evaluating those items of heart rate, blood pressure, respiratory rate ,Pa （ O2 ） , pH, electrolyte, blood urea nitrogen, creatinine and hemoglobin. Results Blood plasma HDL - C, LDL - C and TC levels were significantly lower and IL - 6 levels was significantly higher in children with sepsis than those in control group （ Pa 〈 0.01 ）. Critical illness score lower than or equal to 80 group and had decreased levels of LDL, HDL and TC and a heighten IL - 6 level compared to those with a critical illness score higher than 80 （ P 〈 0.01 ）. The levels of HDL - C had a highly positive correlation with critical illness scores and a moderated negative correlation with IL - 6 level （ r = 0. 74, - 0.66 P 〈 0.01 ）. Conclusion The metabolic disturbance of cholesterol can be implicated in pathology process of sepsis survelillance of plasma cholesterol, especially HDL - C can help to judge the degree of this disorder and prognosis.