摘要
目的:评价高密度脂蛋白（HDL）水平对脓毒症相关的急性呼吸窘迫综合征（ARDS）发生的影响。方法:以航天中心医院重症医学科收治的222例脓毒症患者为观察对象，按是否发生ARDS将其分为ARDS组（102例）、非ARDS组（120例），收集全部患者的临床资料，采用单因素和多因素logistic回归分析脓毒症患者发生ARDS的危险因素，采用受试者工作特征曲线（ROC）分析HDL对脓毒症相关的ARDS患者发生的预测效能。结果:（1）在222例脓毒症患者中，有102例患者发生ARDS，发病率为45.95%。（2）ARDS患者外周血HDL、白蛋白（ALB）水平显著低于非ARDS患者，但急性生理学与慢性健康状况评价（APACHE Ⅱ）评分、降钙素原（PCT）、C反应蛋白（CRP）、白细胞计数（WBC）水平显著高于非ARDS患者，差异均有统计学意义（P＜0.05）。多因素logistic回归分析显示，高APACHE Ⅱ评分、高水平的CRP、低水平的HDL是脓毒症患者并发ARDS的危险因素。（3）HDL预测脓毒症并发ARDS患者的ROC的曲线下面积（AUC）为0.722，以HDL=0.81 mmol/L作为预测ARDS发生的临界点，其敏感度为76.67%，特异度为65.69%。结论:低水平的HDL是脓毒症患者并发ARDS的危险因素，HDL水平对脓毒症致ARDS的发生有一定的预测价值。
Abstract
Objective:To evaluate the effect of high density lipoprotein (HDL) level on the occurrence of sepsis-related acute respiratory distress syndrome (ARDS).Methods:A total of 222 patients with sepsis admitted to the Intensive Care Department of the Space Center Hospital were divided into ARDS group (102 cases) and non-ARDS group (120 cases) according to the occurrence of ARDS. Clinical data of all patients were collected. Unifactor and multifactor logistic regression were used to analyze the risk factors of ARDS in patients with sepsis. Receiver operating characteristic curves (ROC) was used to analyze the predictive efficacy of HDL for sepsis related ARDS patients.Results:(1) 102 cases of sepsis developed ARDS, the incidence rate was 45.95%. (2) The levels of HDL, albumin (ALB) in peripheral blood of ARDS patients were significantly lower than those of non-ARDS patients, but acute physiological and chronic health score (APACHE Ⅱ), the levels of procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) were significantly higher than those of non ARDS patients, all the differences were statistically significant (P＜0.05). Multifactor logistic regression analysis showed that high APACHE Ⅱ score, high level of CRP and low level of HDL were risk factors for ARDS in sepsis patients. (3) The area under curve (AUC) of ROC of HDL for predicting ARDS patients with sepsis was 0.722, and 0.81 mmol/L was used as the critical point for predicting ARDS. The sensitivity was 76.67%, and the specificity was 65.69%.Conclusion:Low level of HDL is an independent risk factor of sepsis complicated with ARDS. HDL level has certain predictive value in the occurrence and prognosis of ARDS induced by sepsis.
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