Department of Emergency Medicine, College of Medicine, University of Florida, Jacksonville, Florida.
Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida.
Shock. 2018 Jul;50(1):66-70. doi: 10.1097/SHK.0000000000001030.
Proper functioning of high-density lipoprotein (HDL) is necessary for protection against sepsis. However, previous work has demonstrated that HDL becomes oxidized and dysfunctional (Dys-HDL) during sepsis. Older (aged >65 years) patients are at particularly high risk of sepsis and poor outcomes from sepsis.
The aim of the study was to compare functional properties of HDL (cholesterol efflux capacity and paraoxonase enzyme 1 [PON-1] activity) and Dys-HDL between older (aged >65 years) sepsis patients and older healthy volunteers.
This was a subanalysis of a prospective study in which patients with sepsis were prospectively enrolled from the emergency department within the first 24 h. Serum and plasma samples were drawn from septic patients and age- and sex-matched control subjects. Percent cholesterol efflux, HDL inflammatory index, and PON1 activity were measured. Data were analyzed using Student t test or Wilcoxon rank-sum test.
Ten sepsis and 10 healthy controls were analyzed. Mean age of sepsis patients (80 ± 2 years [SD]) and control subjects (77 ± 2 years) was similar (P = 0.31). Mean systolic blood pressures were significantly different in sepsis patients (113 ± 8 mmHg) compared with controls (133 ± 6 mmHg) (P = 0.049). Median SOFA scores for sepsis patients were 5.5 (interquartile range [IQR] 4-9). Mean percent cholesterol efflux was significantly reduced in sepsis (24.1 ± 1.2%) compared with controls (31.5 ± 1.0%) (P < 0.001). HDL inflammatory index was also significantly elevated in septic patients (1.63, IQR 1.3-2.34) compared with controls (0.62, IQR 0.56-0.67) (P < 0.001). However, PON1 activity was not significantly different between septic patients (70.3 ± 16.3 nmol/min/mL) and control subjects (88.8 ± 18.3 nmol/min/mL).
Cholesterol efflux capacity seems to be significantly impaired in sepsis patients who also exhibited a higher index of Dys-HDL. The findings suggest that HDL function may be impaired in older individuals with sepsis.
高密度脂蛋白（HDL）的正常功能对于预防败血症至关重要。然而，先前的研究表明，HDL 在败血症期间会发生氧化和功能障碍（Dys-HDL）。年龄较大（>65 岁）的患者尤其容易发生败血症，并且败血症的预后较差。
本研究旨在比较老年（>65 岁）败血症患者和老年健康志愿者之间 HDL（胆固醇外排能力和对氧磷酶 1 [PON-1] 活性）和 Dys-HDL 的功能特性。
这是一项前瞻性研究的亚分析，其中在发病后 24 小时内从急诊科前瞻性招募败血症患者。从败血症患者和年龄及性别匹配的对照组中抽取血清和血浆样本。测量胆固醇外排百分比、HDL 炎症指数和 PON1 活性。使用学生 t 检验或 Wilcoxon 秩和检验进行数据分析。
分析了 10 例败血症患者和 10 例健康对照者。败血症患者（80±2 岁[标准差]）和对照组（77±2 岁）的平均年龄相似（P=0.31）。败血症患者的平均收缩压明显低于对照组（113±8mmHg 比 133±6mmHg）（P=0.049）。败血症患者的 SOFA 评分中位数为 5.5（四分位距[IQR] 4-9）。败血症患者的胆固醇外排百分比明显降低（24.1±1.2%），而对照组为（31.5±1.0%）（P<0.001）。败血症患者的 HDL 炎症指数也明显升高（1.63，IQR 1.3-2.34），而对照组为（0.62，IQR 0.56-0.67）（P<0.001）。然而，败血症患者的 PON1 活性与对照组无显著差异（70.3±16.3nmol/min/mL 比 88.8±18.3nmol/min/mL）。
胆固醇外排能力似乎在败血症患者中明显受损，这些患者还表现出更高的 Dys-HDL 指数。这些发现表明，HDL 功能可能在患有败血症的老年个体中受损。
