血脂水平在脓毒症患者预后判断中的意义

Clinical value of the blood lipid level in the evaluation of prognosis in septic patients

目的探讨脓毒症患者血脂水平变化及其对预后判断的影响。方法选取温州医科大学附属第一医院ICU收治的脓毒症患者67例(脓毒症组),另选同期该院神经内科门诊患者30例(对照组),测定2组患者血脂、血糖和血乳酸,记录患者APACHEⅡ评分和年龄。再将脓毒症组按预后分为存活组和死亡组,通过多因素Logistic回归和ROC曲线分析脓毒症患者血脂、APACHEⅡ评分、年龄与预后间的关系。结果脓毒症组患者血TC、HDL-C和LDL-C均明显低于对照组(P<0.05),死亡组患者血TC、HDL-C和LDL-C明显低于存活组,而APACHEⅡ、血乳酸水平和年龄明显高于存活组(P<0.05)。多因素Logistic回归分析提示血浆HDL-C水平、APACHEⅡ评分和年龄是影响脓毒症预后的三个危险因素,回归系数分别为-5.207、0.168和0.074。ROC曲线显示,应用HDL-C、APACHEⅡ评分和年龄判断脓毒症患者预后的ROC曲线下面积分别为0.724±0.067(P=0.003)、0.749±0.064(P=0.001)和0.648±0.069(P=0.054)。结论脓毒症患者存在脂质代谢紊乱,脂蛋白下降,血HDL-C水平是脓毒症患者预后评估的独立危险因素,联合APACHEⅡ评分和年龄因素,则评估效果更好。

Objective To investigate the changes of serum lipid levels in patients with sepsis and its influence on progno- sis. Methods 67 patients with sepsis admitted to ICU,the First Affiliated Hospital of Wenzhou Medical University,were studied（ sepsis group）. In addition to 30 patients from neurology clinic in our hospital over the same period were selected （ control group）. The blood lipid level, blood glucose and blood lactic acid were measured in patients of sepsis group and control group, APACHE II score and age were also recorded. Then sepsis group according to the prognosis were divided in- to survival group and death group. The relationship between the blood lipid, APACHE II score, age and the prognosis in patients with sepsis ,were studied by multivariate Logistic regression and ROC curve analysis. Results In sepsis group, plasma total cholesterol （TC）, high lipoprotein cholesterol （HDL-C） and low lipoprotein cholesterol were significantly de- creased compared with control group （ P 〈 0.05 ）. In death group, plasma TC, HDL-C and LDL-C were significantly de- creased compared with survival group, but APACHE Ⅱ score, lactic acid and age were significantly increased （P 〈 0.05）. Muhivariable Logistic regression analysis showed the level of plasma HDL-C, APACHE Ⅱscore and age were in- dependent risk factor （ standard regression coefficient, HDL-C = - 5. 207, APACHE II score = 0. 168, age = 0. 074）. The area under receiver operating characteristic （ROC） was 0. 724 ±0. 067 （ P = 0. 003 ）, 0. 749 ＋ 0. 064 （ P = 0. 001 ） and 0.648 ＋ 0.069 （P = 0. 054） by HDL-C, APACHE II score and age to assess the prognosis of patients with sepsis. Con- clusion Patients with sepsis had the disorder of lipid metabolism, and lipoprotein decreased. The blood HDL-C level was an independent risk factor for mortality in patients with sepsis, and it would be better in predicting septic mortality if com- bined with APACHE score and age.