中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
7期
1-4
,共4页
刘志鹏%崔书章%柴艳芬%丁宁
劉誌鵬%崔書章%柴豔芬%丁寧
류지붕%최서장%시염분%정저
脓毒症%预后%急性病生理学和长期健康评价%血脂
膿毒癥%預後%急性病生理學和長期健康評價%血脂
농독증%예후%급성병생이학화장기건강평개%혈지
Sepsis%Prognosis%APACHE%Blood lipid
目的 观察脓毒症患者血脂水平变化,揭示血脂水平对判断脓毒症患者预后的临床意义.方法 记录40例脓毒症患者(脓毒症组)入院后血脂水平及急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分,与25例健康体检者(对照组)血脂水平进行比较,分析血脂水平与APACHEⅡ评分及脓毒症预后的关系.结果 脓毒症组血浆总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白B(ApoB)水平分别为(3.92±0.96) mmol/L、( 1.10±0.39) mmol/L、(2.44±0.81)mmol/L、( 1.03±0.27)g/L,均明显低于对照组的(4.40±0.55) mmol/L、( 1.61±0.42) mmol/L、(2.79±0.47) mmol/L、(1.13±0.12) g/L,差异有统计学意义(P＜0.05).脓毒症组死亡14例(死亡组),存活26例(存活组),死亡组血浆TC、三酰甘油(TG)、HDL、LDL、载脂蛋白A Ⅰ(ApoA Ⅰ)、ApoB、血小板计数和白蛋白水平分别为(3.33±0.92) mmol/L、(0.81±0.39) mmol/L、( 1.03±0.27) mmol/L、( 1.83±0.68)mmol/L、( 1.03±0.27)g/L、(0.86±0.27) g/L、( 140.0±82.3)×109/L、( 32.00±5.52) g/L,均明显低于存活组的(4.24±0.84) mmol/L、( 1.21±0.44) mmol/L、( 1.25±0.30) mmol/、(2.77±0.68) mmol/L、(1.25±0.13) g/L、(1.13±0.23) g/L、(215.9±101.0)×109/L、(36.12±6.30) g/L,差异有统计学意义(P＜0.05)；死亡组APACHEⅡ评分(20.5±4.2)分,明显高于存活组的(13.8±4.8)分,差异有统计学意义(P＜0.05).多因素Logistic回归提示血浆HDL水平与APACHEⅡ评分是影响预后的两个危险因素,标准回归系数分别为-6.222和0.337.结论 脓毒症患者存在脂代谢紊乱,血浆HDL水平是评估脓毒症患者预后的较好指标,与APACHEⅡ评分一起评估效果更佳.
目的 觀察膿毒癥患者血脂水平變化,揭示血脂水平對判斷膿毒癥患者預後的臨床意義.方法 記錄40例膿毒癥患者(膿毒癥組)入院後血脂水平及急性生理學與慢性健康狀況Ⅱ(APACHEⅡ)評分,與25例健康體檢者(對照組)血脂水平進行比較,分析血脂水平與APACHEⅡ評分及膿毒癥預後的關繫.結果 膿毒癥組血漿總膽固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、載脂蛋白B(ApoB)水平分彆為(3.92±0.96) mmol/L、( 1.10±0.39) mmol/L、(2.44±0.81)mmol/L、( 1.03±0.27)g/L,均明顯低于對照組的(4.40±0.55) mmol/L、( 1.61±0.42) mmol/L、(2.79±0.47) mmol/L、(1.13±0.12) g/L,差異有統計學意義(P＜0.05).膿毒癥組死亡14例(死亡組),存活26例(存活組),死亡組血漿TC、三酰甘油(TG)、HDL、LDL、載脂蛋白A Ⅰ(ApoA Ⅰ)、ApoB、血小闆計數和白蛋白水平分彆為(3.33±0.92) mmol/L、(0.81±0.39) mmol/L、( 1.03±0.27) mmol/L、( 1.83±0.68)mmol/L、( 1.03±0.27)g/L、(0.86±0.27) g/L、( 140.0±82.3)×109/L、( 32.00±5.52) g/L,均明顯低于存活組的(4.24±0.84) mmol/L、( 1.21±0.44) mmol/L、( 1.25±0.30) mmol/、(2.77±0.68) mmol/L、(1.25±0.13) g/L、(1.13±0.23) g/L、(215.9±101.0)×109/L、(36.12±6.30) g/L,差異有統計學意義(P＜0.05)；死亡組APACHEⅡ評分(20.5±4.2)分,明顯高于存活組的(13.8±4.8)分,差異有統計學意義(P＜0.05).多因素Logistic迴歸提示血漿HDL水平與APACHEⅡ評分是影響預後的兩箇危險因素,標準迴歸繫數分彆為-6.222和0.337.結論 膿毒癥患者存在脂代謝紊亂,血漿HDL水平是評估膿毒癥患者預後的較好指標,與APACHEⅡ評分一起評估效果更佳.
목적 관찰농독증환자혈지수평변화,게시혈지수평대판단농독증환자예후적림상의의.방법 기록40례농독증환자(농독증조)입원후혈지수평급급성생이학여만성건강상황Ⅱ(APACHEⅡ)평분,여25례건강체검자(대조조)혈지수평진행비교,분석혈지수평여APACHEⅡ평분급농독증예후적관계.결과 농독증조혈장총담고순(TC)、고밀도지단백(HDL)、저밀도지단백(LDL)、재지단백B(ApoB)수평분별위(3.92±0.96) mmol/L、( 1.10±0.39) mmol/L、(2.44±0.81)mmol/L、( 1.03±0.27)g/L,균명현저우대조조적(4.40±0.55) mmol/L、( 1.61±0.42) mmol/L、(2.79±0.47) mmol/L、(1.13±0.12) g/L,차이유통계학의의(P＜0.05).농독증조사망14례(사망조),존활26례(존활조),사망조혈장TC、삼선감유(TG)、HDL、LDL、재지단백A Ⅰ(ApoA Ⅰ)、ApoB、혈소판계수화백단백수평분별위(3.33±0.92) mmol/L、(0.81±0.39) mmol/L、( 1.03±0.27) mmol/L、( 1.83±0.68)mmol/L、( 1.03±0.27)g/L、(0.86±0.27) g/L、( 140.0±82.3)×109/L、( 32.00±5.52) g/L,균명현저우존활조적(4.24±0.84) mmol/L、( 1.21±0.44) mmol/L、( 1.25±0.30) mmol/、(2.77±0.68) mmol/L、(1.25±0.13) g/L、(1.13±0.23) g/L、(215.9±101.0)×109/L、(36.12±6.30) g/L,차이유통계학의의(P＜0.05)；사망조APACHEⅡ평분(20.5±4.2)분,명현고우존활조적(13.8±4.8)분,차이유통계학의의(P＜0.05).다인소Logistic회귀제시혈장HDL수평여APACHEⅡ평분시영향예후적량개위험인소,표준회귀계수분별위-6.222화0.337.결론 농독증환자존재지대사문란,혈장HDL수평시평고농독증환자예후적교호지표,여APACHEⅡ평분일기평고효과경가.
Objective To observe the changes of the blood lipid levels in patients with sepsis,and reveal the clinical significance of the blood lipid level in the prognosis of patients with sepsis.Methods The blood lipid levels and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) of 40 patients with sepsis (sepsis group) were recorded.The blood lipid levels were compared with those of 25 healthy people (control group).The correlation of the blood lipid level with APACHE Ⅱ score and prognosis of sepsis was analyzed.Results In sepsis group,plasma total cholesterol (TC),high density lipoprotein (HDL),low density lipoprotein (LDL),apolipoprotein B (ApoB) was (3.92 ±0.96) mmol/L,(1.10 ±0.39) mmol/L,(2.44 ± 0.81 ) mmol/L and ( 1.03 ± 0.27) g/L respectively,which were significantly decreased compared with those in control group [ ( 4.40 ± 0.55 ) mmol/L,( 1.61 ± 0.42) mmol/L,(2.79 ± 0.47 ) mmol/L,( 1.13 ± 0.12 ) g/L] (P ＜0.05).In sepsis group,26 cases survived and 14 cases died.TC,triacylglycerol (TG),HDL,LDL,apolipoprotein A Ⅰ (ApoA Ⅰ ),ApoB,platelet count and albumin level of death patients was (3.33 ±0.92) mmol/L,(0.81 ±0.39) mmol/L,(1.03 ±0.27) mmol/L,(1.83 ±0.68) g/L,(1.03 ±0.27) g/L,(0.86 ±0.27) g/L,(140.0 ±82.3) × 109/L,and (32.00 ±5.52) g/L,respectively,which were significantly decreased compared with those of survival patients [ (4.24 ± 0.84) mmol/L,( 1.21 ± 0.44) mmol/L,( 1.25 ±0.30) mmol/L,(2.77 ±0.68) mmol/L,(1.25 ±0.13) g/L,(1.13 ±0.23) g/L,(215.9 ± 101.0) × 109/L,(36.12 ±6.30) g/L](P＜0.05).APACHEM Ⅱ score of death patients was (20.5 ±4.2) scores,which was increased compared with that of survival patients [ ( 13.8 ± 4.8) scores ] ( P ＜ 0.05 ).Multivarisble Logistic regression analysis showed plasma HDL and APACHE Ⅱ score was independent risk factor (standard regression coefficient,HDL =-6.222,APACHE Ⅱ score =0.337).Conclusions Disorders of lipid metabolism exist in patients with sepsis.Plasma HDL level is a good indicator in assessment of prognosis in patients with sepsis and it shows better results combined with APACHE Ⅱ score.
