烧伤患者外周血高密度脂蛋白变化的临床意义

目的探讨烧伤患者高密度脂蛋白的变化特点及其与感染并发症的关系。方法选取120例伤后24h内入院的18～59岁热力烧伤患者,其中轻中度、重度和特重度烧伤各40例,于入院时和伤后1、2、3、5、7、14、21d空腹采集外周血,检测甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A1(apoA1)、载脂蛋白B(apoB)水平,并监测感染并发症及预后情况。以40例健康体检者作为对照组。结果120例患者中有32例发生医院感染51例次,死亡6例,其中5例与感染有关。轻中度、重度和特重度烧伤患者的感染发生率分别为7·5%、20·0%和52·5%,三者比较差异显著(P<0·001)。TC、HDL、apoA1在伤后1d已明显降低(P<0·05),伤后5d降至最低水平,此三项指标的水平随伤情加重递减,其中以HDL降幅最大。与对照组比较,轻中度、重度和特重度组HDL平均降低33%、45%和70%。TG在伤后7d升至最高水平,其浓度随伤情加重递增,与对照组比较,轻中度、重度和特重度组TG平均升高30%、67%和153%。特重度组40例中有21例发生感染37例次,在入院时和伤后1d,感染者与非感染者血脂水平无显著差别,伤后2d感染者的TC、HDL、apoA1开始低于非感染者,直至伤后21d差别仍具有显著性(P<0·05)。伤后3～21d,感染者TG明显高于非感染者。结论烧伤患者TC、HDL、apoA1、LDL水平降低,TG水平升高,血脂异常程度与伤情及感染并发症有关。

Clinical significance of the dynamics of high-density lipoproteins in peripheral blood of burn patients

Objective To investigate the dynamic features of high-density lipoproteins(HDL) in burn patients and the relationship between the changes and infectious complications.Methods One hundred and twenty patients,aged from 18 to 59 years and admitted within 24 hours of with thermal injury,were involved in present study including mild-moderate,severe and extensive burns groups each of 40 cases.Empty stomach blood samples were drawn on admission and at day 1,2,3,5,7,14 and 21 after burn injury.Serum triglyceride(TG),total cholesterol(TC),high-density lipoproteins(HDL),low-density lipoproteins(LDL),apolipoprotein A1(apoA1) and apolipoprotein B(apoB) were measured in all patients and compared with those of 40 healthy volunteers(control group).The infectious complications and outcome were monitored.Results In 120 patients,a total of 51 identifiable nosocomial infection episodes occurred in 32 patients.Of 6 dead cases,5 were related to infections.The incidence of infection in mild-moderate,severe and extensive burn groups were 7.5%,20.0% and 52.5%,respectively,with statistically significant difference(P<0.001).The concentrations of TC,HDL and apoA1 decreased significantly at day 1 after burn injury,and were lower than those of control group(P<0.05),and reached the nadir at day 5,and the decreasing was parallel to the aggravation of injury.Compared with those of control group,the average concentrations of HDL in mild-moderate,severe and extensive burn groups decreased 33%,45% and 70% at day 5,respectively,whereas the levels of TG reached peaks at day 7 in three burn groups,increasing 30%,67% and 153%,respectively.Of 40 extensive burn patients,37 infection episodes occurred in 21 patients,the concentrations of serum lipids were no significant difference between infection and non-infection patients(P>0.05) on admission and day 1;from day 2 to day 21,the concentrations of TC,HDL and apoA1 in infection patients were lower than those in non-infection patients(P<0.05);and from day 3 to day 21,the concentrations of TG in infection patients were higher than those in non-infection patients.Conclusions The concentrations of serum TC,HDL,apoA1 and LDL have been decreased while TG increased in burn patients,and the degree of lipids abnormality might be related to the traumatic condition and infection.