2020 年第 12 期 第 15 卷

代谢综合征及其各组分对脓毒性休克患者预后的影响

Effects of metabolic syndrome and its components on the prognosis of patients with septic shock

作者：王首江邢柏

英文作者：Wang Shoujiang Xing Bo

单位：海南医学院第二附属医院东湖分院急诊科，海口570100

英文单位：Department of Emergency Donghu Branch the Second Affiliated Hospital of Hainan Medical College Haikou 570100 China

关键词：脓毒性休克;代谢综合征;序贯器官功能衰竭评分;预后

英文关键词：Septicshock;Metabolicsyndrome;Sequentialorganfailureassessmentscores;Prognosis

• 摘要：

• 目的 探讨脓毒性休克伴代谢综合征(MS)患者及其各组分对脓毒性休克患者预后的影响。方法 收集2017年8月至2019年8月海南医学院第二附属医院东湖分院收治的脓毒性休克患者113例病历资料，根据是否合并MS分为MS组(37例)和非MS组(76例)，并根据28 d预后分为死亡组(49例)和生存组(64例)。比较MS组与非MS组、死亡组与生存组的一般资料、临床观察指标以及实验室检测指标水平。应用Logistic回归方法分析脓毒性休克患者预后的影响因素。结果 MS组序贯器官功能衰竭（SOFA）评分、28 d病死率、腰围、血清降钙素原、三酰甘油、空腹血糖、去甲肾上腺素用量、血乳酸、日液体平衡量均高于非MS组［(15±3)分比（13±4）分、59.5%(22/37)比35.5%（27/76）、(92±11)cm比（84±15）cm、(26±5)μg/L比（23±8）μg/L、(9.6±0.8)mmol/L比（8.3±0.9）mmol/L、(11.3±2.3)mmol/L比（5.8±1.4）mmol/L、(1.02±0.31)g/(kg·min)比（0.83±0.14）g/(kg·min)、(4.2±0.6)mmol/L比（3.5±1.8）mmol/L、(6 672±559)ml比（5 632±508）ml］，住院时间长于非MS组［(10.7±1.9)d比（9.2±3.1）d］，高密度脂蛋白胆固醇水平低于非MS组［(1.9±0.3)mmol/L比（2.3±0.7）mmol/L］，差异均有统计学意义（均P＜0.05）。死亡组急性生理学与慢性健康状况评分系统Ⅱ评分、SOFA评分、腰围、三酰甘油、空腹血糖及日液体平衡量均高于生存组，住院时间长于生存组，高密度脂蛋白胆固醇水平低于生存组，差异均有统计学意义（均P＜0.05）。Logistic回归分析结果 显示，SOFA评分、住院时间、腰围、三酰甘油和空腹血糖均为脓毒性休克患者预后的危险因素（比值比=1.338、1.599、1.279、1.083、5.698,95%置信区间：1.016~1.784、1.087~2.240、1.029~1.836、1.001~1.198、1.807~9.918，均P＜0.05）。结论 MS存在着诸多影响脓毒性休克病情的危险因素，较高的SOFA评分、腰围、三酰甘油和空腹血糖水平和较长的住院时间均可能加重脓毒性休克患者的病情，导致预后不佳。

• Objective To explore the clinical characteristics of septic shock patients with metabolic syndrome (MS) and the effect of MS on the prognosis of septic shock patients. Methods Clinical data of 113 patients with septic shock in Donghu Branch, the Second Affiliated Hospital of Hainan Medical College from August 2017 to August 2019 were retrospectively analyzed. The patients were divided into MS group (n=37) and non-MS group (n=76) according to whether they were complicated with MS. According to the 28 d prognosis, the patients were divided into death group (n=49) and survival group (n=64). The general data, clinical observation indicators, and laboratory test indicators were compared between the MS group and the non-MS group, the death group and the survival group. Logistic regression was used to analyze the prognostic factors of septic shock patients. Results Sequential organ failure assessment (SOFA) score, 28 d mortality, waist circumference, serum procalcitonin, triacylglycerol, fasting blood glucose, norepinephrine (NE) dosage, blood lactic acid and daily fluid balance in MS group were higher than those in non-MS group ［(15±3) vs (13±4), 59.5%(22/37) vs 35.5%(27/76), (92±11)cm vs (84±15)cm, (26±5)μg/L vs (23±8)μg /L, (9.6±0.8)mmol/L vs (8.3±0.9)mmol/L,(11.3±2.3) mmol/L vs (5.8±1.4) mmol/L, (1.02±0.31)g/(kg· min) vs (0.83±0.14)g/(kg· min), (4.2±0.6)mmol/L vs (3.5±1.8)mmol/L, (6 672±559)ml vs (5 632±508）ml］, the length of hospital stay was longer than that of the non-MS group ［(10.7±1.9)d vs (9.2±3.1)d］, and the level of HDL-C cholesterol was lower than that of the non-MS group ［(1.9±0.3) mmol/L vs (2.3±0.7)mmol/L］, the differences were statistically significant (all P＜0.05). The scores of acute physiology and chronic health score system Ⅱ, SOFA score, waist circumference, triglyceride, fasting blood glucose and daily fluid balance in the death group were higher，the length of hospital stay was longer， the level of HDL cholesterol was lower than those in the survival group, the differences were statistically significant (all P＜0.05). Logistic regression analysis showed that SOFA score, hospital stays, waist circumference, triacylglycerol, and fasting blood glucose were all risk factors for the prognosis in patients with septic shock (odds ratio=1.338, 1.599, 1.279, 1.083, 5.698, 95% confidence interval: 1.016-1.784, 1.087-2.240, 1.029-1.836, 1.001-1.198, 1.807-9.918, all P＜0.05). Conclusion MS may aggravate the condition of patients with septic shock and increase the risk of death.