危重症病患与血脂.ppt

危重症病患与低血脂血症 武汉市第一医院 脂质的主要生理功能 脂肪 甘油 脂肪酸 糖 磷酸丙糖 ?-氧化 丙酮酸 乙酰CoA H2O TCA CO2 能量 1、可预测感染： These data suggest that persistent or progressive hypocholesterolemia may be a more sensitive indicator of the onset of infection than is WBC response. 2、可预测预后： We consider the serial measurements of cholesterol and triglycerides as clinically re- levant to assess the morbidity of a patient and thereby to estimate the patients out- come. Kamolz LP et al, Burns. 2003 Dec;29(8):810-5 Serum cholesterol and triglycerides: potential role in mortality prediction Burns. 2003 Dec;29(8):810-5 C Michael Dunham， Michael H Fealk and Wilbur E Sever III ： Following severe injury, hypocholesterolemia improves with convalescence but persists with organ failure or onset of infection Critical Care 2003, 7:R145-R153 (DOI 10.1186/cc2382) 低血脂损伤机制 1、抑制炎性介质的产生: all lipoprotein classes have been shown to bind LPS and to attenuate the biological response to LPS in vitro and in rodents. Moreover , triglyceride-rich lipoproteins protect rodents against death from LPS and bacterial sepsis. Berbée JF et al. Apolipoproteins modulate the inflammatory response to lipopolysaccharide J Endotoxin Res. 2005;11(2):97-103. 对 P-选择素和细胞间黏附分子-1 的作用: rHDL reduced the degree of histological tissue injury in the lung, liver and intestine and attenuated the expression of P-selectin and intercellular adhesion molecule-1 in the renal glomerulus . We propose that the mechanisms of these beneficial effects of HDL may be related to direct inhibition of adhesion molecule expression McDonald M C, Dhadly P, Cockerill G W, et al. Reconstituted High-density Lipoprotein Att