目的：探讨脓毒症患者血脂水平、超敏C反应蛋白（hs-CRP）与急性生理学及慢性健康状况Ⅱ（APACHEⅡ）评分的变化关系及其对病情程度和预后判断的价值和意义。方法对46例脓毒症患者在入院后24 h内抽取静脉血，检测血脂水平，包括甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C），采用免疫比浊法对血清hs-CRP进行测定。同时进行APACHEⅡ评分。根据入院后第1个24 h的APACHEⅡ评分进行分组：分值≥20分的脓毒症患者共19例为Ⅰ组；分值＜20分的27例为Ⅱ组。随访2周，其中12例死亡，为死亡组；34例存活，为生存组。结果Ⅰ组 TC和 HDL-C水平比Ⅱ组低（ P＜0.05或 P＜0.01），Ⅰ组hs-CRP水平比Ⅱ组低（P＜0.05）。死亡组APACHEⅡ分值较生存组高（P＜0.01），HDL-C水平则较生存组低（P＜0.05），hs-CRP水平则较生存组低（P＜0.01）。相关分析显示：血清 TC和 HDL-C水平与hs-CRP、APACHE Ⅱ评分均呈负相关关系，hs-CRP与APACHE Ⅱ评分均呈正相关关系。结论 APACHEⅡ评分和血脂水平、血清 Hs-CRP之间，血脂水平和血清hs-CRP之间有显著的相关性。脓毒症患者在急性期易出现低脂血症，其可能与体内炎症反应有关。血脂水平降低、hs-CRP水平升高提示脓毒症症患者的病情重、预后差。%Objective To explore the relationship between acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score ,hs-CRP and blood blood lipid levels ,and to study the effect of combination of lipid levels and APACHEⅡ on the clinical judgment of prognosis and condition of the patients with sepsis .Methods Blood sam-ples were drawn from 46 patients with sepsis within the first 24 hours .An automatic biochemical machine was em-ployed to determine triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholestero1(LDL-C) .The hs-CRP concentrations were determined .At the same time , APACHEⅡscore was introduced to evaluate the disease severity .The patients were divided into group Ⅰ(19 pa-tients ,APACHEⅡscore greater than or equal to 20)and group Ⅱ(27 patients ,APACHEⅡscore less than 20) .In addition ,the patients were divided into death group (12 patients)and survival group (34 patients) according to the patients'prognosis during the following 2 weeks .Results TC and HDL-C levels in group Ⅰ were lower than those in group Ⅱ (P<0.05 or P<0.01) .hs-CRP levels in group I were lower than those in group Ⅱ (P<0.05) .The patients in death group had significantly higher APACHE Ⅱ score than patients in survival group (P< 0.01) . HDL-C levels in death group were lower than those in survival group (P<0.05) .hs-CRP levels in death group were lower than those in survival group(P<0.05) .A statistically significant negative correlation was found be-tween APACHEⅡscore and the levels of TC ,HDL-C and hs-CRP .Conclusion The patients with sepsis at the initial stage were prone to develop low serum lipid levels ,it may be related of inflammatory reaction .The low lipid levels and high hs-CRP levels at may serve predict that the prognosis was worse .
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