2023 年第 1 期 第 18 卷

脓毒症患者糖脂代谢紊乱与免疫功能和病情及预后的相关性分析

Relationship of glycolipid metabolism disorder with immune function, disease condition and prognosis in patients with sepsis

作者：陈谦1蒋文强2

英文作者：Chen Qian1 Jiang Wenqiang2

单位：1电子科技大学医学院附属绵阳医院四川省绵阳市中心医院急诊医学科，绵阳621000；2电子科技大学医学院附属绵阳医院四川省绵阳市中心医院检验科，绵阳621000

英文单位：1Department of Emergency Medicine Mianyang Hospital Affiliated to School of Medicine University of Electronic Science and Technology of China Mianyang Central Hospital Sichuan Province Mianyang 621000 China; 2Department of Clinical Laboratory Mianyang Hospital Affiliated to School of Medicine University of Electronic Science and Technology of China Mianyang Central Hospital Sichuan Province Mianyang 621000 China

关键词：脓毒症；糖代谢；脂代谢；免疫功能；预后

英文关键词：Sepsis;Glucosemetabolism;Lipidmetabolism;Immunefunction;Prognosis

• 摘要：

• 目的  探讨脓毒症患者糖脂代谢紊乱与免疫功能和病情及预后的相关性。方法 选择2018年1月至2022年1月四川省绵阳市中心医院收治的196例脓毒症患者和同期50例健康志愿者（对照组），根据是否发生脓毒症休克将脓毒症患者分为脓毒症组（127例）和脓毒症休克组（69例），追踪临床结局将患者分为死亡组（53例）和存活组（143例）。检测糖脂代谢指标以及细胞免疫指标。Pearson相关系数描述脓毒症患者糖脂代谢指标与细胞免疫指标的相关性，多因素Logistic回归方法 分析脓毒症患者死亡的危险因素。结果 脓毒症休克组、脓毒症组与对照组比较，死亡组与存活组比较，糖脂代谢指标有不同程度的升高或降低，差异均有统计学意义（均P<0.05）。脓毒症患者三酰甘油、极低密度脂蛋白、空腹血糖、空腹胰岛素、糖化血红蛋白与CD+3细胞、CD+4细胞水平、CD+4/CD+8比值、自然杀伤细胞水平均呈负相关，与CD+8细胞水平均呈正相关（均P＜0.05）；总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B与CD+3细胞、CD+4细胞水平、CD+4/CD+8比值及自然杀伤细胞水平均呈正相关，与CD+8细胞水平均呈负相关（均P＜0.05）。多因素Logistic分析结果显示序贯器官衰竭估计评分、三酰甘油、糖化血红蛋白是脓毒症患者住院28 d内死亡的危险因素，总胆固醇为保护因素（比值比=2.354、1.499、1.667、0.548，95%置信区间：1.468～3.775、1.153～1.950、1.237～2.245、0.380～0.790，均P＜0.001）。结论 糖脂代谢紊乱与脓毒症患者免疫功能失调、病情进展以及预后不良均有关。

• Objective To investigate the relationship of glycolipid metabolism disorder with immune function, disease condition and prognosis in patients with sepsis. Methods From January 2018 to January 2022, 196 sepsis patients and 50 healthy volunteers (control group) admitted to Mianyang Central Hospital, Sichuan Province were selected. According to whether septic shock occurred, sepsis patients were divided into sepsis group(127 cases) and septic shock group(69 cases). Clinical outcomes were followed and patients were divided into death group(53 cases) and survival group(143 cases). Glycolipid metabolism indexes and cellular immunity indexes were detected. Pearson correlation coefficient was used to describe the correlation between glycolipid metabolism indexes and cellular immune indexes in patients with sepsis, and multivariate Logistic analysis was used to analyze the death factors in patients with sepsis. Results The glycolipid metabolism indexes were significant different among sepsis group, septic shock group and control group, and were also different between death group and survival group (all P<0.05). Triacylglycerol, very low-density lipoprotein, fasting plasma glucose, fasting insulin, glycosylated hemoglobin were negatively correlated with of CD+3 cells, CD+4 cells, CD+4/CD+8 ratio and natural killer cells, while were positively correlated with CD+8 cells (all P<0.05). Total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 and apolipoprotein B were positively correlated with CD+3 cells, CD+4 cells, CD+4/CD+8 ratio and natural killer cells, while were negatively correlated with CD+8 cells(all P<0.05). Multivariate Logistic analysis showed that sequential organ failure assessment score, triacylglycerol and glycosylated hemoglobin were risk factors for sepsis patients death within 28 d of hospitalization, while total cholesterol was a protective factor (odds ratios=2.354, 1.499, 1.667, 0.548, 95% confidence intervals: 1.468-3.775, 1.153-1.950, 1.237-2.245, 0.380-0.790, all P<0.001). Conclusion Glucolipid metabolism disorder is related to immune dysfunction, disease progression and poor prognosis of sepsis patients.