脂蛋白的变化与全身炎症反应综合征加剧的相关性分析

Analysis of the correlation between the changes of serum lipoproteins and the exacerbation of systemic inflammatory response syndrome

目的分析全身炎症反应综合征（SIRS）患者体内存在脂蛋白代谢紊乱的特点及脂蛋白水平与SIRS病情加剧的相关性。方法选择2006—06—2007—10入住急诊ICU的SIRS患者45例作为试验组，将同期健康体检者50例作为对照组，比较两组的脂蛋白水平；根据SIRS患者急性生理学及慢性健康状况评分Ⅱ（APACHEⅡ）将试验组分为APACHEⅡ评分≥20分和APACHEⅡ评分〈20分两组，比较两组的脂蛋白水平和死亡率。结果SIRS组总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、脂蛋白（a）[LP（a）]水平降低（P〈0．01），甘油三酯（TG）、极低密度脂蛋白（VLDL）水平与对照组相近（P〉0．05）。APACHEⅡ评分t〉20分组TC、HDL水平更低（P〈0．05，P〈0．01），LDL、LP（a）水平也较低（P〉0．05），多脏器功能障碍综合征（MODS）评分及死亡率更高（P〈0．01），而TG、VLDL水平则较APACHEⅡ评分〈20分组高（P〈0．05，P〈0．01）；HDL与APACHEⅡ评分呈负相关（P〈0．01），TG、VLDL与APACHEⅡ评分呈正相关（P〈0．05，P〈0．01），TC、LDL、LP（a）与APACHEⅡ评分无相关性（P〉0．05）。结论SIRS患者血清HDL、TG及VLDL水平与病情加剧相关，脂蛋白代谢紊乱可能是SIRS病情加剧而最终导致多器官功能障碍综合征（MODS）的一个重要因素。

Objective To analyze the characteristics of the lipoproteins metabolic disorder in systemic inflammatory response syndrome （ SIRS）and the correlation between the changes of serum lipoproteins and the exacerbation of SIRS. Methods From June 2006 to October 2007, 45 patients with SIRS admitted to EICU were selected as experimental group and 50 healthy people undergoing medical examination as control group in the corresponding period of time. The serum level of lipoproteins in two groups were compared. Furthermore, according to the acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ） scores, 45 patients with SIRS were divided into two groups ： one was APACHE Ⅱ scores ≥ 20 group, the other was APACHE Ⅱ scores 〈 20 group. The serum level of lipoproteins and mortality were compared in two groups. Results Compared with the control group, the patients with SIRS had significantly lower levels of total cholesterol （TC）, highdensity lipoprotein （HDL）, low- density lipoprotein （ LDL ）, lipoprotein （ a ） （ P 〈 0.01 ）. Triglyceride （ TG ） and very - low - density lipoprotein （ VLDL ） levels in both groups were similar to each other（ P 〉0.05）. Compared with the APACHE II scores 〈 20 group, the patients with APACHE Ⅱ scores≥20 had lower TC （ P 〈 0.05 ） and HDL （ P 〈 0.01 ）, but had higher levels of TG （ P 〈 0. 05 ） , VLDL （ P 〈 0.01 ） , LDL and LP （ a ） levels were close in two groups （ P 〉 0. 05 ）. APACHE Ⅱ scores ≥ 20 group also had higher multiple organ dysfunction syndrome （MODS） scores and mortality （P 〈 0.01 ）. HDL levels correlated negatively with APACHE Ⅱ scores （ P 〈 0.01 ）. TG （ P 〈 0. 05 ） and VLDL（ P 〈 0 . 01 ） levels positively correlated with APACHE Ⅱ scores. Conclusion The serum HDL,TG and VLDL levels of the patients with SIRS are related to the exacerbation of SIRS, which is caused by lipoprotein metabolic disorder and eventually results in MODS.