老年危重症病人血脂水平、IL-6变化与病情程度的关系

Relationship between the lipid,interleukin-6 levels and the disease severity of critical illness in the aged patients

目的探讨老年危重症患者血脂、IL-6水平变化及其与病情危重程度的关系。方法对150例老年危重症患者及120例中青年危重症患者在入院后24 h内抽取静脉血。全自动生化仪检测血脂水平,包括甘油三脂(TG)、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),采用ELISA法对血清IL-6进行测定。同时对老年危重症患者组进行APACHEⅡ评分。根据入院后第1个24 h的APACHEⅡ评分进行分组:分值≥20分的危重症患者共63例为组Ⅰ;分值<20分的87例为组Ⅱ。同时选择健康老年体检者40例(年龄>60岁)作为老年正常对照组。随访2周,分为死亡组(41例)及生存组(109例)。结果组ⅠTC和HDL-C水平比组Ⅱ低(P<0.05或P<0.01),组ⅠIL-6水平比组Ⅱ高(P<0.01)。死亡组APACHEⅡ分值较生存组高(P<0.01),而HDL-C水平则较生存组低(P<0.01),IL-6水平则较生存组高(P<0.01)。老年危重症患者血脂入院第一天最低,入院后各监测点血脂均比老年正常对照组显著降低(P<0.05);老年危重症患者入院后各监测点血脂均低于同时段的中青年危重患者(P<0.05)。150例老年危重症患者血清TC、HDL-C水平与IL-6、APACHEⅡ评分均呈负相关关系(P<0.05),IL-6与APACHEⅡ评分呈正相关关系(P<0.05)。结论老年危重症患者更易出现血脂紊乱,其可能与体内炎症反应有关。血脂水平降低、IL-6水平升高对老年危重症的预后有一定的预测作用。

Objective To explore the relationship between the blood plasma IL-6,lipid levels and the disease severity of critical illness in the elder. Methods Blood samples were drawn from 150 elder and 120 young-middle age patients with critical illness within the first 24 h after hospitalization. An automatic biochemical machine was employed to determine the levels of triglyceride（ TG）,total cholesterol（ TC）,high-density lipoprotein cholesterol（ HDL-C） and low-density lipoprotein cholesterol（ LDL-C）. The IL-6 concentration was determined by ELISA. APACHEⅡ score was introduced to evaluate the disease severity of elder patients. The elder patients were divided into APACHEⅡscore≥20 group（ n = 63） and APACHE Ⅱ score〈 20 group（ n = 87）. At the same time,40 elder health subjects served as elder controls. In addition,the elder patients were divided into death group（ n = 41） and survival group（ n = 109） according to the prognosis during the following two weeks. Results TC and HDL-C levels in APACHEⅡscore≥20 group were lower than those in APACHE Ⅱ score 20 group（ P〈0. 05 or P〈0. 01）. IL-6 level in APACHEⅡscore≥20 group was higher than that in APACHEⅡscore 〈20 group（ P〈0. 01）. The patients had significantly higher APACHEⅡ score and IL-6 levels in death group than in survival group（ P〈0. 01）. HDL-C level in death group was lower than that in survival group（ P〈0. 01）. The level of lipid in elder critical illness patients at the first day in hospital was the lowest. The level of lipids were lower in the elder patients than those of elder normal controls at each time point after hospitalization（ P〈0. 05）. The levels of lipid in the elder critical illness patients were all lower than those of the youngmiddle age patients at the each time point（ P〈0. 05）. A statistically significant negative correlation was found between the levels of TC,HDL-C and IL-6,APACHE Ⅱ score（ P〈0. 05）. A statistically significant positive correlation was found between the level of IL-6and APACHE Ⅱ score（ P〈0. 05）. Conclusion The elder patients with critical illness are prone to develop low serum lipid levels,which may be related to the inflammatory reaction. The low lipid levels and high IL-6 levels may predict the prognosis of elder patients with critical illness.