重症监护室患者血脂与血清内毒素及炎性因子水平的关系
Relationship between serum lipid and LPS, inflammatory factors in ICU patients

程靖.重症监护室患者血脂与血清内毒素及炎性因子水平的关系[J].内科急危重症杂志,2021,27(2):131-134

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DOI：10.11768/nkjwzzzz20210211

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基金项目:安徽省科技攻关计划项目（No:1604a0802081）

作者	单位	E-mail
程靖	安徽医科大学第一附属医院	Jjhua@yeah.net

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中文摘要:

目的:探讨重症监护室（ICU）患者脂质代谢特点及其与血清内毒素（LPS）、炎性因子水平及预后的关系。方法：选取ICU非脓毒症患者90例为观察组，45例同龄健康体检者作为对照组，2组均剔除原发性高脂血症及近期服用过对血脂代谢有影响的药物患者。观察组在入ICU后24 h内采静脉血检测血脂指标及血清LPS、C反应蛋白（CRP）、白介素-6(IL-6)及肿瘤坏死因子-α（TNF-α）水平，并进行急性生理与慢性健康状况评估(APACHEⅡ)评分。根据观察组患者血脂水平将其分为血脂异常组（63例）及血脂正常组（27例），比较2组患者血清LPS及炎性因子水平。分析观察组患者感染情况、住院天数及病死率。结果：观察组患者血清总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）水平较对照组明显降低，而血清甘油三酯（TG）水平较对照组明显升高(均 P <0.01)。与血脂正常组比较，血脂异常组患者APACHEⅡ评分、血清白细胞计数（WBC）、CRP、IL-6及TNF-α水平明显升高( P <0.05或 P < 0.01)；患者感染率(74.60%)及ICU住院天数\[(19.41±14.82)d\]明显升高(均 P <0.05)。观察组患者血清TC、LDL及HDL水平与APACHEⅡ评分呈负相关（ r=-0.75，-0.462，-0.357，均P <0.01），血清TG水平与WBC、CRP、IL-6及TNF-α呈正相关（ r=0.493，0.590，0.357，0.224，P<0.05或P <0.01）。结论：ICU大部分非脓毒症患者存在明显的脂质代谢紊乱并伴有机体炎性水平的升高，血脂代谢异常与APACHEⅡ评分及炎性因子有一定的相关性并影响患者的预后。

英文摘要:

Objective: To investigate the characteristics of lipid metabolism in ICU patients and its relationship with serum LPS, inflammatory factors and prognosis. Methods: Ninety non-sepsis patients in ICU were selected as the observation group, and 45 healthy persons of the same age group were selected as the control group. The patients with primary hyperlipidemia and those who had recently taken drugs that had effects on lipid metabolism were excluded in both groups. In the observation group, serum samples were taken within 24 h after ICU admission to detect general biochemical indicators, blood lipid indicators, serum LPS, CRP, IL-6 and TNF-alpha levels, and APACHEⅡ score was evaluated. According to the blood lipid level in the observation group, the patients were divided into dyslipidemia group and normal blood lipid group. The differences in serum LPS and inflammatory factors between the two groups were compared. The infection, hospitalization days and death of the patients in the observation group were recorded. Results: The levels of serum TC, LDL, HDL in the observation group were significantly lower than those in the control group, and the levels of serum TG in the observation group were significantly higher than those in the control group (all P <0.01). Compared with the normal blood lipid group, the APACHEII score, number of WBC, levels of CRP, IL-6 and TNF-alpha in the abnormal group increased significantly ( P <0.05 or P <0.01), the infection rate ( 74.60%) and ICU hospitalization days (19.41±14.82days) of the patients with dyslipidemia were significantly increased ( P <0.05). The levels of serum TC, LDL and HDL in the observation group were negatively correlated with APACHEII score ( r =-0.75, -0.462, -0.357), with statistically significant difference (all P <0.01). The serum TG levels in the observation group were positively correlated with WBC count, CRP, IL-6 and TNF-alpha ( r =0.493, 0.590, 0.357, 0.224), and the difference was statistically significant ( P <0.05 or P< 0.01). Conclusion: Most of the non-sepsis patients in ICU have obvious disorder of lipid metabolism with the increase of inflammatory level. Abnormal lipid metabolism is correlated with APACHEII score and inflammatory factors and affects the prognosis of patients.