脓毒血症患儿血脂、乳酸水平变化与预后关系的探讨

Study on relationship between changes of blood lipid and lactic acid level with prognosis in children patients with septicopyemia

目的探讨脓毒血症患儿血脂四项和乳酸水平的变化及预后关系。方法选取2013年1月至2014年12月符合脓毒血症诊断的患儿95例,其中死亡30例(死亡组),存活65例(非死亡组),对照组为同期年龄、性别与患儿相匹配的健康儿童60例。测定血清胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及动脉全血乳酸(LAC)的水平,并进行比较。结果非死亡组和死亡组患儿TC、HDL-C水平均低于对照组(P<0.05),死亡组患儿LDL-C水平低于对照组和非死亡组(P<0.05),而非死亡组和死亡组患儿TG水平均高于对照组(P<0.05),死亡组TG水平明显升高(P<0.01)。机体过度炎性反应时,TC,HDL-C、LDL-C水平下降,随病情的发展而下降;TG则随病情的发展而升高。死亡组患儿LAC水平高于对照组和非死亡组,非死亡组随病情的好转而恢复正常,死亡组随病情的发展而升高,并从第3天开始与第1天比较差异均有统计学意义(P<0.05)。结论血脂和乳酸水平的监测对脓毒血症患儿的病情和预后有重要意义。

Objective To investigate the relationship between the changes of blood lipid 4 indexes and lactic acid level with prog‐nosis in children patients with septicopyemia .Methods Ninety‐five children patients with septicopyemia in our hospital from Janu‐ary 2013 to December 2014 were selected ,including 30 death cases（death group and） and 65 survival cases（non‐death group） .To‐tally 60 age‐and gender‐matched healthy children were enrolled as control group .The levels of serum cholesterol （TC） ,triglyceride （TG） ,high density lipoprotein cholesterol （HDL‐C） ,low density lipoprotein cholesterol（LDL‐C） and arterial blood lactate acid （LAC） were measured ,and the results were compared among the three groups .Results The TC and HDL‐C levels in the death group and the non‐death group were lower than those in the control group （P〈0 .05） ,the LDL‐C level of the death group was lower than that the control group and survival group（P〈0 .05） ,while the TG level in the death group and the non‐death group was higher than that in the control group（P〈0 .05） ,moreover the TG level in the death group was increased significantly （P〈0 .01） . In the excessive inflammation reaction ,the levels of TC ,HDL‐C and LDL‐C were dropped ,which were also decreased with the disase development ,but the TG level was increased .The LAC level in the death group was higher than that in the control group and the non‐death group ,which in the non‐death group was recovered to the normal level with the disease condition improvement ,while which in the death group was increased with the disease condition progression ,moreover the difference between on 1 d and 3 d had statistical difference（P〈0 .05） .Conclusion Monitoring the levels of the blood lipid and lactic acid has an important significance to judge the severity and prognosis in children patients with septicopyemia .