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目的:探讨脓毒症患者高密度脂蛋白胆固醇（HDL-C）水平的变化及其对该类患者继发急性肾损伤（AKI）的早期预测价值。方法:采用回顾性病例系列研究方法。2019年6月—2021年6月，河北医科大学第二医院收治232例符合入选标准的脓毒症患者，其中男126例、女106例，年龄24~71岁。依据是否继发AKI，将患者分为非AKI组（158例）和AKI组（74例）。对比2组患者入院时性别、年龄、身体质量指数（BMI）、体温、心率、原发感染部位、合并基础疾病情况、急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）评分及脓毒症相关性器官功能衰竭评价（SOFA）评分，确诊脓毒症时检测的血清C反应蛋白（CRP）、降钙素原、肌酐、胱抑素C及HDL-C水平，对数据进行独立样本n t检验n 、χ2检验。对2组比较差异有统计学意义的指标进行多因素logistic回归分析，筛选影响232例脓毒症患者继发AKI的独立危险因素，并以独立危险因素为基础构建联合预测模型。绘制独立危险因素与联合预测模型预测232例脓毒症患者继发AKI的受试者操作特征（ROC）曲线，计算曲线下面积（AUC）及最佳阈值与最佳阈值下的敏感度、特异度。采用Delong检验对前述AUC的质量进行比较，采用n χn 2检验对最佳阈值下的敏感度和特异度进行比较。n 结果:2组患者性别、年龄、BMI、体温、心率、原发感染部位、合并基础疾病以及CRP水平均相近（n P>0.05）；AKI组患者降钙素原、肌酐、胱抑素C、APACHE Ⅱ评分及SOFA评分均明显高于非AKI组（n t值分别为-3.21、-16.14、-12.75、-11.13、-12.88，n P<0.01），HDL-C水平显著低于非AKI组（n t=6.33，n P<0.01）。多因素logistic回归分析显示，肌酐、胱抑素C、HDL-C是232例脓毒症患者继发AKI的独立危险因素（比值比分别为2.45、1.68、2.12，95%置信区间分别为1.38~15.35、1.06~3.86、0.86~2.56n ，P<0.01）。肌酐、胱抑素C、HDL-C、联合预测模型预测232例脓毒症患者继发AKI的ROC的AUC分别为0.69、0.79、0.89、0.93（95%置信区间分别为0.61~0.76、0.72~0.85、0.84~0.92、0.89~0.96n ，P值均<0.01），最佳阈值分别为389.53 μmol/L、1.56 mg/L、0.63 mmol/L、0.48，最佳阈值下的敏感度分别为76.6%、81.4%、89.7%、95.5%，最佳阈值下的特异度分别为78.6%、86.7%、88.6%、96.6%。胱抑素C的AUC质量明显优于肌酐（n z=2.34，n P<0.05），HDL-C的AUC质量及最佳阈值下的敏感度、特异度均明显优于胱抑素C（n z=3.33，n χn 2值分别为6.43、7.87，n P<0.01）与肌酐（n z=5.34，n χn 2值分别为6.32、6.41，n P<0.01），联合预测模型的AUC质量及最佳阈值下的敏感度、特异度均明显优于肌酐、胱抑素C、HDL-C（n z值分别6.18、4.50、2.06，n χn 2值分别5.31、7.23、3.99，6.56、7.34、4.00，n P<0.05或n P0.05). The procalcitonin, creatinine, cystatin C, and scores of APACHE Ⅱ and SOFA of patients in AKI group were all significantly higher than those in non-AKI group (withn t values of -3.21, -16.14, -12.75, -11.13, and -12.88 respectively, n P<0.01), while the HDL-C level of patients in AKI group was significantly lower than that in non-AKI group (n t=6.33, n P<0.01). Multivariate logistic regression analysis showed that creatinine, cystatin C, and HDL-C were the independent risk factors for secondary AKI in 232 sepsis patients (with odds ratios of 2.45, 1.68, and 2.12, respectively, 95% confidence intervals of 1.38-15.35, 1.06-3.86, and 0.86-2.56, respectively,n P<0.01). The AUCs of ROC curves of creatinine, cystatin C, HDL-C, and the joint prediction model for predicting secondary AKI in 232 sepsis patients were 0.69, 0.79, 0.89, and 0.93, respectively (with 95% confidence intervals of 0.61-0.76, 0.72-0.85, 0.84-0.92, and 0.89-0.96, respectively,n P values all below 0.01); the optimal threshold were 389.53 μmol/L, 1.56 mg/L, 0.63 mmol/L, and 0.48, respectively; the sensitivity under the optimal threshold were 76.6%, 81.4%, 89.7%, and 95.5%, respectively; the specificity under the optimal threshold values were 78.6%, 86.7%, 88.6%, and 96.6%, respectively. The AUC quality of cystatin C was significantly better than that of creatinine (n z=2.34, n P<0.05), the AUC quality and sensitivity and specificity under the optimal threshold of HDL-C were all significantly better than those of cystatin C (n z=3.33, with n χn 2 values of 6.43 and 7.87, respectively, n P<0.01) and creatinine (n z=5.34, with n χn 2 values of 6.32 and 6.41, respectively, n P<0.01); the AUC quality and sensitivity and specificity under the optimal threshold of the joint prediction model were all significantly better than those of creatinine, cystatin C, and HDL-C (withn z values of 6.18, 4.50, and 2.06, respectively, n χn 2 values of 5.31, 7.23, 3.99, 6.56, 7.34, and 4.00, respectively, n P<0.05 orn P<0.01).n Conclusions:HDL-C level in sepsis patients with secondary AKI is significantly lower than that in patients without secondary AKI. This is an independent risk factor for secondary AKI in sepsis patients with a diagnostic value being superior to that of creatinine and cystatin C. The combination of the aforementioned three indicators would have higher predicative valuable for secondary AKI in sepsis patients.