脓毒症患者血胆固醇的变化及其与预后的关系

Changes characteristics of serum cholesterol indicators in sepsis patients and its correlation with prognosis

目的探讨脓毒症患者血胆固醇的变化及其与预后的关系。方法回顾性分析2014年2月至2018年12月南京医科大学附属南京医院收治236例脓毒症患者(观察组)的临床资料,并与同期住院的236例非脓毒症患者作为对照组,比较两组患者一般临床资料、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)以及其他生化指标;将脓毒症患者按预后分成存活组和死亡组,以多因素Logistic回归分析影响预后的相关因素。结果脓毒症患者存活率为60.6%(143/236),病死率为39.4%(93/236),生存组为143例,死亡组为93例。观察组和对照组患者TC[(2.51±1.20)mmo/L与(3.42±1.33)mmo/L,t=6.385、P<0.05]、HDL-C[(1.62±0.91)mmo/L与(2.53±0.79)mmo/L,t=5.526、P<0.05]比较差异均有统计学意义,而两组患者LDL-C[(1.95±0.93)mmo/L与(2.11±0.84)mmo/L,t=0.958、P>0.05]比较差异无统计学意义。脓毒症患者死亡组年龄较存活组增大[(75.4±10.3)岁与(64.3±16.0)岁,t=4.984、P<0.05]、血肌酐较存活组升高[(252.3±65.2)μmol/L与(168.3±47.8)μmol/L,t=5.604、P<0.05],而死亡组与存活组TC[(2.20±1.46)mmo/L与(2.91±1.12)mmo/L,t=6.157、P<0.05]、HDL-C[(1.41±0.51)mmo/L与(1.95±0.65)mmo/L,t=5.090、P<0.05]、LDL-C[(1.71±0.67)mmo/L与(2.02±0.84)mmo/L,t=4.525、P<0.05]比较差异均有统计学意义。经Logistic回归分析显示,年龄是影响脓毒症患者预后的独立危险因素(OR=1.035,95%CI 1.012~1.049,P=0.008),而TC则是保护因素(OR=0.748,95%CI 0.693~0.822,P=0.015)。结论TC、HDL-C在脓毒症患者中呈显著下降特征,而死亡者较存活者TC、HDL-C、LDL-C均进一步下降;其中TC作为保护因素可以成为评估脓毒症患者预后的有效生化指标。

Objective To explore the relationship between the change of blood cholesterol and prognosis in patients with sepsis.Methods The clinical data of 236 patients with sepsis(observation group)admitted to Nanjing Hospital Affiliated to Nanjing Medical University from February 2014 to December 2018 were analyzed retrospectively.The general clinical data,total cholesterol(TC),low density lipoprotein cholesterol(LDL-C)of the two groups were compared with 236 patients without sepsis in the same period as the control group,high density lipoprotein cholesterol(HDL-C)and other biochemical indexes;sepsis patients were divided into survival group and death group according to the prognosis,and the related factors affecting the prognosis were analyzed by multi factor Logistic regression.Results The survival rate of sepsis patients was 60.6%(143/236),the mortality rate was 39.4%(93/236),143 cases in survival group and 93 cases in death group.Compared with control group,the levels of serum TC((2.51±1.20)mmo/L vs.(3.42±1.33)mmo/L,t=6.385)and HDL-C((1.62±0.91)mmo/L vs.(2.53±0.79)mmo/L,t=5.526)in observation group were significantly lower(all P<0.05),and that of LDL-C showed no statistically significant difference((1.95±0.93)mmo/L vs.(2.11±0.84)mmo/L,t=0.958,P>0.05).In observation group,the patients in death group were older than those of the survival group((75.4±10.3)years vs.(64.3±16.0)years,t=4.984,P<0.05),serum creatinine(SCr)was higher than that of survival group((252.3±65.2)μmol/L vs.(168.3±47.8)μmol/L,t=5.604,P<0.05),the levels of serum TC((2.20±1.46)mmo/L vs.(2.91±1.12)mmo/L,t=6.157,P<0.05),HDL-C((1.41±0.51)mmo/L vs.(1.95±0.65)mmo/L,t=5.090,P<0.05)and LDL-C((1.71±0.67)mmo/L vs.(2.02±0.84)mmo/L,t=4.525,P<0.05)were significantly lower than those of survival group.Logistic regression analysis showed that age was the risk factor of death in sepsis patients(OR=1.035,95%CI 1.012-1.049,P=0.008),and TC was the protective factor on the prognosis of sepsis patients(OR=0.748,95%CI 0.693-0.822,P=0.015).Conclusion TC and HDL-C were significantly decreased in sepsis patients,while those who died were further decreased than those who survived.As a protective factor TC can be an effective biochemical index to evaluate the prognosis of patients with sepsis.