Londrina State University, Londrina, Paraná, Brazil.
Eur J Clin Invest. 2010 Apr;40(4):330-8. doi: 10.1111/j.1365-2362.2010.02269.x.
The magnitude of lipoprotein level reduction during the acute-phase response may be associated with the severity and mortality of sepsis. However, it remains to be determined whether low lipoprotein levels can be considered a risk factor for developing sepsis. We aimed to investigate lipoprotein levels as risk factors for sepsis in hospitalized patients, and also describe sequential changes in lipoprotein and cholesterol ester transfer protein (CETP) levels during sepsis.
This is a prospective cohort study and case-control analysis from selected hospitalized patients. Blood samples were collected at admission, and participants were monitored for severe sepsis. Total cholesterol, high density lipoprotein (HDL), low density lipoprotein, and triglyceride levels were compared between sepsis cases and controls. Cholesterol, apolipoprotein, phospholipid and CETP concentrations were monitored in the case group.
Of 1719 enrolled patients, 51 developed severe sepsis and were paired with 71 controls by age, gender, presence of infection at admission and chronic disease. HDL cholesterol level at admission was a risk factor for severe sepsis (OR = 0.969; 95% CI: 0.944-0.995). Mean CETP levels diminished between hospital admission and day 3 of sepsis. The magnitude of this variation (Delta CETP) was more pronounced in non-survivors (0.78 +/- 1.08 microg mL(-1)) than that in survivors (0.02 +/- 0.58 microg mL(-1), P = 0.01).
HDL cholesterol may have a protective effect against sepsis. Each 1 mg dL(-1) increase in HDL decreased the odds of severe sepsis by 3% during hospitalization. The reduction of plasma CETP was associated with mortality.
在急性反应期间脂蛋白水平的降低幅度可能与脓毒症的严重程度和死亡率相关。然而，低脂蛋白水平是否可以被认为是发生脓毒症的危险因素仍有待确定。我们旨在研究脂蛋白水平作为住院患者发生脓毒症的危险因素，并描述脓毒症期间脂蛋白和胆固醇酯转移蛋白（CETP）水平的连续变化。
这是一项来自选定住院患者的前瞻性队列研究和病例对照分析。在入院时采集血样，并对严重脓毒症患者进行监测。比较脓毒症病例和对照组之间的总胆固醇、高密度脂蛋白（HDL）、低密度脂蛋白和甘油三酯水平。监测病例组中的胆固醇、载脂蛋白、磷脂和 CETP 浓度。
在 1719 名入组患者中，有 51 名发生严重脓毒症，并按年龄、性别、入院时是否存在感染和慢性疾病与 71 名对照进行配对。入院时的 HDL 胆固醇水平是严重脓毒症的危险因素（OR = 0.969；95%CI：0.944-0.995）。入院到脓毒症第 3 天之间，CETP 平均水平降低。在非幸存者中，这种变化的幅度（Delta CETP）更为明显（0.78 +/- 1.08 microg mL(-1)），而非幸存者为 0.02 +/- 0.58 microg mL(-1)，P = 0.01）。
HDL 胆固醇可能对脓毒症具有保护作用。住院期间 HDL 每增加 1mg/dL，严重脓毒症的几率就会降低 3%。血浆 CETP 的减少与死亡率相关。
