脓毒症患者高密度脂蛋白胆固醇水平的变化及其对患者预后的影响

Impact of change in high-density lipoprotein on prognosis of patients with sepsis

摘要:

目的 探讨脓毒症患者高密度脂蛋白胆固醇(HDL-C)水平的变化及其对患者预后的影响。方法 采用前瞻性研究方法,以2018年12月至2019年5月徐州医科大学附属医院重症监护病房收治的脓毒症患者为研究对象。所有患者均符合2016年发表的《脓毒症和脓毒性休克定义的第三次国际共识(Sepsis-3.0)诊断标准。以同期本院健康体检者为对照组。随访脓毒症患者28d,再根据存活情况将其分为存活组和死亡组。收集对照组基本资料、HDL-C、低密度脂蛋白(LDL-C)、总胆固醇(TC)、甘油三酯(TG)。收集脓毒症组基本资料、入ICU 24h内HDL-C、LDL-C、TC、TG、急性生理学与慢性健康状况评分(APACHEⅡ)和序贯器官衰竭评分(SOFA)、C反应蛋白(CRP)、降钙素原(PCT)、血乳酸、第3天和第5天血HDL-C水平以及28d预后；分析脓毒症患者HDL-C水平与PCT、CRP、APACHEⅡ和SOFA的相关性；采用logistic回归分析影响脓毒症患者死亡的危险因素,再对预后有意义的指标进行受试者工作特征(ROC)曲线分析,分析其对预后的评估价值。结果 共入选65例脓毒症患者和65名健康体检者。脓毒症患者HDL-C、LDL-C、TC水平与对照组比较,差异有统计学意义(P<0.05)；脓毒症患者血HDL-C的表达在生存组和死亡组之间差异有统计学意义(P<0.05)。logistic多因素回归分析显示乳酸为脓毒症死亡的危险因素,而第5天的HDL-C则是保护性因素。进一步ROC曲线分析显示第5天血HDL-C对脓毒症患者28d病死率的预测价值较大,曲线下面积(AUC)为0.833(P＜0.01)；乳酸对脓毒症预后也具有一定的预测价值,AUC为0.708(P＜0.01)。结论 脓毒症患者HDL-C较对照组患者明显下降,且随时间持续下降。脓毒症死亡组HDL-C明显低于存活组,并且可用于评估患者预后。

Abstract:

Objective To investigate the impact of change in high-density lipoprotein cholesterol (HDL-C) on the prognosis among patients diagnosed with sepsis. Methods A prospective study was conducted on the patients with sepsis admitted to the intensive care unit (ICU) of the Affiliated Hospital of Xuzhou Medical University from December 2018 to May 2019. All the patients met the diagnostic criteria for the Third International Consensus Definition for Sepsis and Septic Shock (sepsis-3) published in 2016. Healthy volunteers were enrolled contemporaneously in the same hospital at medical center as control group. The patients with sepsis were followed up for 28 days and were divided into survival group and death group. The basic data were recorded, for the control group, including HDL-C, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TG); for the sepsis group, including HDL-C, LDL-C, TC, TG, acute physiology and chronic health evaluation (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, C-reactive protein (CRP), procalcitonin (PCT), blood lactate, plasma HDL-C levels on days 3 and 5, and 28-day prognosis. Analysis was performed of the correlation between HDL-C levels and PCT, CRP, APACHE Ⅱ, SOFA in the sepsis group. Logistic regression analysis was used to analyze the risk factors of death in the sepsis patients, and the receiver operating characteristic (ROC) curve was drawn to analyze the prognostic value of the meaningful indicators for the sepsis patients. Results A total of 65 patients with sepsis and 65 healthy people were enrolled in the study. HDL-C, LDL-C, and TC in the sepsis patients were significantly different from those in the control group (P<0.05). The HDL-C expression was significantly different between the survival and death groups (P<0.05). Logistic multivariate regression analysis showed that lactic acid was a risk factor for sepsis death, while HDL-C at day 5 was a protective factor. Further ROC analysis showed that HDL-C at day 5 had a greater predictive value for the 28-day mortality rate of the sepsis patients with an area under the curve(AUC) of 0.833 (P<0.01). Lactic acid was also predictive of the prognosis of sepsis with an AUC of 0.708 (P<0.01). Conclusion HDL-C in sepsis patients is significantly lower than that in the control group, and continues to decrease with time. HDL-C is significantly lower in the death group of sepsis patients than in the survival group and could be used to predict prognosis.