慢性阻塞性肺疾病患者急性加重期饮食摄入与血清瘦素及全身炎症状态关系的研究

The relationship between nutritional state and serum leptin as well as systemic inflammatory response during acute exacerbations of chronic obstructive pulmonary disease

目的研究慢性阻塞性肺疾病(COPD)患者急性加重期饮食摄入与血清瘦素水平及全身炎症状态的相关关系,探讨血清瘦素和全身炎症在COPD营养不良发生中的作用。方法观察40例COPD急性加重期患者治疗前,治疗第7天、第12天的饮食摄入量、血清瘦素及可溶性肿瘤坏死因子受体(sTNFR)的水平变化;测定患者治疗第12天的营养状态参数。12例正常健康者的血清瘦素、sTNFR水平作为正常对照。分析各参数相关性。用酶联免疫吸附试验(ELISA)测定血清瘦素、sTNFR水平,饮食摄入量由24小时膳食记录,经营养分析软件计算获得。结果①患者治疗前饮食摄入量低于日常习惯饮食,随着治疗时间的延长,饮食摄入量逐渐恢复至日常水平。在治疗第7天,饮食摄入量与瘦素的自然对数、sTNFR55均呈显著负相关(r=-0.536,P<0.01;r=-0.729,P<0.001);治疗第12天此相关关系仍存在。②治疗第7天和第12天,排除体重指数(BMI)影响后,血清瘦素与sTNFR55均呈显著正相关(r=0.53,P<0.05;r=0.512,P<0.05)。③治疗第12天,血清瘦素与BMI、理想体重百分比、三头肌皮皱厚度、肩胛下皮皱厚度、上臂中部周径等营养参数均呈显著正相关(P均<0.05)。结论COPD患者急性加重期存在短暂的饮食摄入减少,这与提高的血清瘦素水平及全身炎症反应有关。“细胞因子瘦素”作用机制可能参与了COPD营养不良的发生。

Objective To investigate the association between the impaired dietary intake and serum leptin as well as the systemic inflammatory response during acute exacerbations of chronic obstructive pulmonary disease（COPD）. Methods The dietary intake, serum concentrations of letpin and soluble tumor necrosis factor receptors（sTNF-R） were measured in 40 patients suffering from exacerbations of COPD,on the day before treatment and Day 7,Day 12 during treatment. On Day 12, some nutritional parameters were assessed in addition. Serum leptin and sTNF-R concentrations were measured by enzyme-linked immunoadsorbent assay （ELISA）. Dietary intake was evaluated using dietary records. Results ①Dietary intake before treatment was severely decreased,compared with the habitual intake （ P〈0. 001）,company with the higher concentration of serum leptin and sTNF-R55. On Day 7,Dietary intake was not only significantly inversely related with LN（leptin） （ r = -0. 536, P 〈0.01）, but also with sTNF-R55 （r =-0. 729, P 〈 0. 001）. Such were going on Day 12. ② Significant partial correlation coefficients were found between sTNF-R55 and leptin on Day 7 and Day 12（ r =0.53, P = 0.05 ; r = 0. 512, P 〈 0.05）.③ On Day 12, the serum leptin concentration was significantly correlated with body mass index, persent ideal body weight, tricept skin-fold thickness, subscapular skin-fold thickness, mid-upper arm crcumfcrence （ P 〈 0.05）. Conclusions Temporary decreases in the dietary intake were seen during acute exacerbations of COPD, related to increased leptin concentration as well as the systemic inflammatory responses. The link between cytokines and leptin may be involved in the malnutrition of COPD.