摘要：目的 观察肿瘤手术后脓毒症患者TC、HDL和apoA-I水平与感染严重程度的关系以及对脓毒症预后的影响。方法 本研究为回顾性研究。选取2010年12至2011年12中山大学附属第三医院外科重症监护室的37例脓毒症患者。于确诊24小时内及第3、7、14天检测血清TC 、HDL、apoA-I、TNF-α、IL-6浓度，并做相关分析，以此评价其与炎症严重程度的相关性；同时采用ROC曲线评价TC 、HDL、apoA-I及APACHEII评分对脓毒症28天死亡率的诊断价值并确定诊断界值。利用Logistic回归分析筛选影响肿瘤手术后脓毒症患者死亡的独立危险因素。结果 相关性分析结果显示：HDL、apoA-I、TC分别与TNF-a、IL-6呈显著负相关；TC、HDL、apoA-I与中性粒细胞无明显相关性；TC、HDL、apoA-I、APACHE II评分的诊断界值分别为1.46mmol/L、0.175mmol/L、0.525g/L、20.5分；Logistic回归分析表明确诊脓毒症24小时内的apoA-I水平是影响患者预后的独立危险因素。结论 TC、HDL、apoA-I水平可以反应肿瘤手术后脓毒症患者感染的严重程度；TC、HDL、apaA-I 、APACHEII水平对脓毒症的预后有预警作用，其中apoA-I 的诊断价值最大。

Abstract: Objective To observe the relationship between the level of total cholesterol (TC)，high-density lipoprotein (HDL)，apolipoprotein A-I (apoA-I) and the severity of postoperative sepsis in cancer patients. Methods This is a retrospective study. A total of 37 patients hospitalized in the surgery intensive care unit of the Third Affiliated Hospital of Sun Yat-Sen University from December 2010 to December 2011were enrolled in the study. All patients were divided into two groups according to the status after 28 days. The correlations between the lipoprotein and inflammatory cytokines, the independent predictive factor for sepsis were analyzied. Receiver-operating-characteristic curve (ROC) was used to evaluate the cut-off of TC, HDL, apoA-1 and APACHⅡas well as their predictive value for 28 days mortality. Results There was negative correlation between HDL, TC, apoA-1 and tumor necrosis factor-α(TNF-α)、 interleukin (IL-6) seperately; whereas these lipoprotein indexes didn't have significant correlation with neutrophil.The cut-off point of TC，HDL，apoA-I，APACHEII score were 1.46mmol/L，0.175mmol/L，0.525g/L，20.5 points. apoA-I has the highest diagnostic and predictive value. Conclusions The levels of TC, HDL, apoA-I can reflect the degree of inflammatory response to the postoperative sepsis and the severity of the disease in cancer patients. TC, HDL, apoA-I, APACHEII within 24hrs of sepsis have predictive value. But apoA-I was the highest diagnostic one.