肥胖对严重脓毒症患者预后的影响

Impact of Obesity on Prognosis of Severe Sepsis

目的探讨肥胖与严重脓毒症患者预后的关系。方法选取2010年1月—2014年2月于温州医科大学附属第二医院治疗的严重脓毒症患者363例为研究对象,依据体质指数(BMI)将患者分为体质量过轻组(36例)、体质量正常组(160例)和超重及肥胖组(167例);另根据预后将患者分为生存组(287例)和死亡组(76例)。收集患者一般资料,以急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)进行评价,记录入院时降钙素原(PCT)、乳酸水平,脓毒性休克发生率及转归情况。结果糖尿病、慢性阻塞性肺疾病(COPD)检出率随体质量增加而升高(χ2趋势=6.482、6.667,P<0.05)。死亡组年龄、PCT、乳酸、APACHEⅡ评分、脓毒症休克发生率高于生存组(t=4.710、3.030、5.548、5.687,χ2=41.100,P<0.05);死亡组BMI和糖尿病检出率低于生存组(t=2.962,χ2=6.163,P<0.05)。Logistic回归分析显示,年龄〔β=0.130,OR=1.14,95%CI(1.05,1.22),P<0.01〕、BMI〔β=0.030,OR=1.03,95%CI(1.01,1.10),P=0.03〕、糖尿病〔β=-0.630,OR=0.53,95%CI(0.31,0.94),P=0.02〕、PCT〔β=0.095,OR=1.10,95%CI(1.08,1.16),P=0.02〕、乳酸〔β=0.095,OR=1.10,95%CI(1.08,1.16),P<0.01〕、APACHEⅡ评分〔β=0.122,OR=1.13,95%CI(1.10,1.18),P<0.01〕、脓毒性休克〔β=-0.186,OR=0.83,95%CI(0.61,1.14),P=0.02〕进入回归方程。结论肥胖可能是严重脓毒症患者预后的潜在保护因素,其作用的机制可能与胰岛素抵抗相关。

Objective To explore the impact of obesity on the prognosis of severe sepsis patients. Methods A total of 363 patients with severe sepsis treated in the Second Affiliated Hospital of Wenzhou Medical University from January 2010 to February 2014 were divided,according to BMI,into groups A（ whose weight were too light,n = 36）,B（ whose weight were normal,n = 160）,C（ who were overweight and obese,n = 167）,and according to prognosis,into groups survival（ n =287）,death（ n = 76）. The patients＇ general data were collected and evaluated by APACHE Ⅱ,and the levels of procalcitonin（ PCT）,lactic acid（ LA）,the incidence of septic shock（ SS） and its turnover were recorded. Results The detection rates of diabetes,COPD rose with the increase of body weight（ χ2trend= 6. 482,6. 667,P 0. 05）. The age,PCT,LA,APACHE Ⅱscores,incidence of SS were higher in death group than in survival group（ t = 4. 710,3. 030,5. 548,5. 687,χ2= 41. 100,P 0. 05）,and BMI,diabetes detection rate lower（ t = 2. 962,χ2= 6. 163,P 0. 05）. Logistic regression analysis showed that age 〔β = 0. 130,OR = 1. 14,95% CI（ 1. 05,1. 22）,P 0. 01 〕,BMI 〔β = 0. 030, OR = 1. 03,95% CI（ 1. 01,1. 10）,P = 0. 03 〕,diabetes 〔β =- 0. 630,OR = 0. 53,95% CI（ 0. 31,0. 94）,P = 0. 02 〕,PCT 〔β = 0. 095,OR =1. 10,95% CI（ 1. 08,1. 16）,P = 0. 02 〕,LA 〔β = 0. 095,OR = 1. 10,95% CI（ 1. 08,1. 16）,P 0. 01 〕,APACHEⅡ score 〔β = 0. 122,OR = 1. 13,95% CI（ 1. 10,1. 18）,P 0. 01〕,SS 〔β =- 0. 186,OR = 0. 83,95% CI（ 0. 61,1. 14）,P = 0. 02〕entered into the regression equation. Conclusion Obesity may be a potential protective factors of severe sepsis patients＇ prognoses and its acting mechanism may be related to insulin resistance.