危重病患者血清胆固醇与C反应蛋白检测的预后意义(1)
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[摘要] 目的 分析血清胆固醇(Total cholesterol,TC)和C反应蛋白(C-reactive protein,CRP)与危重病患者预后的关系，为危重病的临床预后判断提供指导。方法 收集2010年4月至2011年1月入重症监护室(intensive care unit,ICU)病例，检测入ICU第1、3、7天血清胆固醇和C反应蛋白浓度，对患者进行APACHEⅡ评分并以20分为界限分组，对以上数据进行统计学分析。结果 96例ICU患者中，存活病例入ICU第一周血清TC显著高于死亡病例，而CRP则相反(P<0.05 )。与APACHEⅡ评分低于20患者相比，APACHEⅡ评分高于20的患者血清CRP更高、TC更低(P<0.05 )。未发现ICU患者血清TC与CRP间有显著相关性(r=-0.161，P>0.05)。结论 低TC、高CRP是ICU患者病情严重与死亡的危险因素，血清TC与CRP同时监测对ICU患者预后判断可能有重要意义。
[关键词] 血清胆固醇 C反应蛋白 ICU 危重程度
[中图分类号] R392.7[文献标识码] A[文章编号] 1005-0515(2011)-08-038-02
Critically Ill Patients With Serum Total Cholesterol and Prognostic Significance of C-reactive Protein Test
[Abstract] Objective To assess the potential prognostic effects of plasma total cholesterol (TC) and C-reactive protein (CRP) on intensive care patients.Methods Cases admitted to intensive care unit were enrolled in this study; blood samples were collected at admission and on day 3, on day 7 separately. The plasma TC and CRP concentrations were detected. All cases were divided into two groups: groupⅠwith APACHEⅡ score below 20, group Ⅱ with APACHEⅡ score above 20. The above data were statistically analyzed.Results 96 cases were enrolled in the study, plasma TC in survivors were significantly higher than in non-survivors, whereas CRP in survivors were significantly lower than in non-survivors(P<0.05).Plasma CRP and TC in group Ⅱ cases were significantly higher and lower separately than in group I cases(P<0.05). No significant correlation was observed between plasma TC and CRP in ICU patients(r=-0.161，P>0.05 ).Conclusion Low plasma TC and high plasma CRP signal risk for severity and death in ICU patients, combined monitoring of plasma TC and CRP in ICU cases may be of great value in clinical prognosis.
[Keywords] Serum cholesterol; C reaction protein; ICU; Critical degree
重症患者因受到严重创伤、严重感染，多处于严重应激状态，多器官功能障碍、全身炎症反应综合征和败血症等危重症状多发，预后极差、死亡率极高。危重病患者的预后判断，在促进针对性治疗、提高生存率上意义重大。胆固醇是细胞膜结构重要组成成份，在机体代谢中发挥重要作用。研究发现，在胸心外科术后患者，血清胆固醇水平明显降低，死亡患者胆固醇显著低于存活患者，低胆固醇血症是危重患者死亡的独立危险因素，但机制还不清楚[1,2]。C反应蛋白(C reactive protein,CRP)是炎症反应、组织损伤与感染的敏感分子标志物。CRP与危重病患者预后关系的研究尚无定论[3,4] ......
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