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目的探讨血清瘦素及肿瘤坏死因子α(TNFα)在慢性阻塞性肺疾病(COPD)患者营养不良发生中的意义。方法用放射免疫法测定68例COPD患者(分为营养不良组,即COPDⅠ组35例;非营养不良组,即COPDⅡ组33例)及30例健康对照的血清瘦素、TNFα浓度、体重指数(BMI)、理想体重百分比(NW%)、肱三头肌皮皱厚度(TSF)、上臂中部臂围(MAC),血清白蛋白(ALB)、总淋巴细胞计数(LYM)等指标。分析瘦素与各项参数及TNFα的相关性。结果①COPD(Ⅰ+Ⅱ)组血清瘦素浓度明显低于对照组;COPDⅠ组血清瘦素浓度低于Ⅱ组和对照组;COPDⅡ组血清瘦素浓度低于对照组。②COPD患者血清TNFα水平明显高于对照组,且COPDⅠ组高于COPDⅡ组。③各组内血清瘦素浓度与BMI和NW%呈显著正相关,在COPD组瘦素浓度与TSF、MAC、ALB和LYM呈显著正相关,在COPDⅠ组和对照组瘦素浓度与TSF呈显著正相关。各组内血清瘦素浓度与TNFα浓度之间无显著相关性。④血清瘦素浓度在COPD组患者女性高于男性,差异有显著性意义;对照组血清瘦素浓度女性也高于男性,但差异无显著性意义。结论血清瘦素浓度与COPD患者的营养参数、性别有关,瘦素的调节不受TNFα系统的控制,瘦素可能参与了COPD患者的营养不良。
Objective To investigate the significance of serum leptin and tumor necrosis factor α (TNFα) in malnutrition in patients with chronic obstructive pulmonary disease (COPD). Methods Radioimmunoassay was used to determine the serum leptin concentrations, TNFα levels and body mass index in 68 COPD patients (malnourished group, 35 cases in COPD group Ⅰ, 33 cases in non-malnourished group, COPD group Ⅱ) and 30 healthy controls BMI, NW%, TSF, MAC, ALB and total lymphocyte count (LYM) were measured. The correlation between leptin and various parameters and TNFα was analyzed. Results ① The serum leptin concentration in COPD group Ⅰ and Ⅱ was significantly lower than that in control group. The serum leptin level in COPD Ⅰ group was lower than that in group Ⅱ and control group. The serum leptin level in COPD Ⅱ group was lower than that in control group. ② The level of serum TNFα in patients with COPD was significantly higher than that in the control group, and the COPDⅠgroup was higher than that of COPDⅡgroup. (3) There was a significant positive correlation between serum leptin concentration and BMI and NW% in each group. There was a significant positive correlation between leptin concentration and TSF, MAC, ALB and LYM in COPD group, and significant difference between TSC group and control group Positive correlation. There was no significant correlation between serum leptin concentration and TNFα concentration in each group. ④ Serum leptin concentrations in COPD patients were higher in women than in men, the difference was significant; the control group, serum leptin concentrations were higher in women than in men, but the difference was not significant. Conclusions Serum leptin concentration is related to nutritional parameters and gender in patients with COPD. The regulation of leptin is not controlled by TNFα system. Leptin may be involved in malnutrition in COPD patients.