体质指数对老年严重脓毒症患者预后和生存率的影响

目的探讨体质指数对老年严重脓毒症患者预后或生存率的影响。 方法选取于本院收治的100例严重脓毒症老年患者为研究对象。根据体质指数将患者分为体质量过轻组（30例）、体质量正常组（50例）和体质量过重组（20例）；根据患者预后将其分为生存组（75例）和死亡组（25例）。采用急性生理与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）对各组患者进行评价。 结果入组患者糖尿病发病率与体质指数均呈正相关（r = 0.63、P = 0.001）；慢性阻塞性肺病的发病率与体质指数呈负相关（r = 0.57、P = 0.003）；肿瘤、心血管疾病、肝脏疾病、肾脏疾病的发病率与体质指数无相关性（P均> 0.05）。死亡组中患者的年龄、降钙素原、乳酸、脓毒症休克发生率和APACHE Ⅱ评分均显著高于生存组患者；死亡组中患者的体质指数和糖尿病发病率均显著低于生存组，差异具有统计学意义（P均< 0.05）；入组患者的年龄、体质指数、糖尿病、乳酸、降钙素原、脓毒症休克和APACHE Ⅱ评分对脓毒症患者的预后均有显著影响（P均< 0.05）。 结论高体质指数有利于严重脓毒症患者的预后，其作用机制与胰岛素抵抗有关。

Influence of body mass index on the prognosis and survival status of elderly patients with severe sepsis

ObjectiveTo investigate the effect of body mass index (BMI) on the prognosis and survival rate of the elderly patients with severe sepsis. MethodsTotal of 100 patients with severe sepsis in our hospital were collected. According to the body mass index, patients were divided into quality light body mass group (30 cases) and the normal body mass group (50 cases) and the heavy body mass group (20 cases). According to the prognosis, 100 cases were divided into the survival group (75 cases) and the death group (25 cases). All the patients were evaluated by acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ). ResultsThe incidence of diabetes was positively correlated to BMI (r = 0.63, P = 0.001). The incidence of chronic obstructive pulmonary disease was negatively correlated to BMI (r = 0.57, P = 0.003). The incidence rates of tumor, cardiovascular disease, liver disease, kidney disease were all not correlated with BMI (all P > 0.05). The age, lactic acid, septic shock incidence and APACHE Ⅱ score of patients in the death group were significantly higher than those of the survival group; the BMI and the incidence of diabetes were significantly lower than those of the survival group, with significant differences (all P < 0.05). The age, BMI, diabetes, lactic acid, procalcitonin, septic shock and APACHE Ⅱ score had significant effect on the prognosis of patients with sepsis (all P < 0.05). ConclusionsHigh level of MBI was beneficial to the prognosis of patients with severe sepsis, and the mechanism was related to insulin resistance.