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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 blood lipid levels in patients with sepsis and its impact on prognosis. Methods Sixty-seven sepsis patients (sepsis group) admitted to the ICU of the First Affiliated Hospital of Wenzhou Medical University and 30 patients (control group) with neurology outpatients in the same period were enrolled in this study. Blood lipid, blood glucose and blood Lactic acid, patients were recorded APACHE Ⅱ score and age. The sepsis group was divided into survival group and death group according to prognosis. The relationship between serum lipids, APACHEⅡscore, age and prognosis was analyzed by multivariate logistic regression and ROC curve. Results The levels of TC, HDL-C and LDL-C in sepsis group were significantly lower than those in control group (P <0.05). The levels of TC, HDL-C and LDL-C in death group were significantly lower than those in survivor group Blood lactate levels and age were significantly higher than those in survivors (P <0.05). Multivariate logistic regression analysis showed that plasma HDL-C level, APACHEⅡscore and age were the three risk factors influencing the prognosis of sepsis. The regression coefficients were -5.207,0.168 and 0.074, respectively. The ROC curve showed that the area under the ROC curve of patients with sepsis using HDL-C, APACHEⅡscore and age were 0.724 ± 0.067 (P = 0.003), 0.749 ± 0.064 (P = 0.001) and 0.648 ± 0.069 (P = 0.054). Conclusions There is lipid disorder, lipoprotein decline and serum HDL-C level in sepsis patients. It is an independent risk factor for sepsis prognosis evaluation. Combined with APACHEⅡscore and age factor, the assessment is better.