慢性阻塞性肺疾病患者血浆瘦素和生长激素释放肽水平研究

Circulating leptin and ghrelin in patients with chronic obstructive pulmonary disease

目的探讨血浆瘦素和生长激素释放肽 ghrelin 与慢性阻塞性肺疾病(COPD)患者的营养状况和循环炎症因子水平的关系,以及排除营养因素的影响后,瘦素和 ghrelin 是否与 COPD 有关。方法检测53例稳定期 COPD 患者和26名健康对照者的血浆瘦素、总 ghrelin、活性 ghrelin、肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)水平,评价去脂组织和脂肪组织重量。结果低体重 COPD患者血浆瘦素水平[2.6(2.0～4.4)ng/L]显著低于正常体重的 COPD 患者[6.1(5.1～7.8)ng/L]和健康对照者[4.8(3.3～6.1)ng/L],COPD 患者的瘦素含量与脂肪组织重量和 TNF-α水平呈显著正相关;校正脂肪组织重量等影响因素后,COPD 患者血浆瘦素含量显著高于对照组,且与 TNF-α水平显著相关。低体重 COPD 患者血浆总 ghrelin 和活性 ghrelin 水平[1090(860～2838)ng/L 和63(50～97)ng/L]均显著高于正常体重的 COPD 患者[765(651～941)ng/L和47(41～56)ng/L]和健康对照者[844(676～1045)ng/L 和54(41～60)ng/L],COPD 患者的总 ghrelin 水平、活性 ghrelin 水平均与体重指数呈显著负相关。结论营养不良的稳定期 COPD 患者血浆瘦素水平降低,总 ghrelin 和活性 ghrelin 水平升高,3种激素受营养状态影响,并且对稳定期 COPD 患者的营养状态起着生理性调节作用。在排除营养因素的影响后,COPD 患者瘦素水平相对升高,并与 TNF-α水平呈显著正相关,提示瘦素可能与 COPD 的疾病本身和全身炎症反应有关。

Objective To investigate the potential roles of leptin and ghre]in in malnutrition in patients with chronic obstructive pulmonary disease （COPD）. Methods Plasma leptin, total ghrelin and active ghrelin, TNF-α and IL-6 levels were determined in 53 patients with COPD and 26 control subjects. Body compositions were assessed by bioelectrical impedance analysis. Results Plasma leptin levels were significantly lower in underweight patients than those in normal weight patients and in healthy controls E 2. 6 （2. 0 -4. 4） vs. 6. 1 （5. 1 -7. 8） vs. 4. 8 （3. 3 -6. 1） ng/L]. The leptin level was associated positively with fat mass （ r =0. 662, P =0. 000） and TNF-α （ r =0. 431, P =0. 001 ） in the patients. By a stepwise multiple regression analysis, fat mass, TNF-α, presence of COPD, smoking and sex were found to affect leptin level （ R2 = 0. 635）. Both plasma total ghrelin levels and active ghrelin levels were significantly higher in underweight patients than those in normal weight patients and in healthy controls E total ghrelin： 1090 （860-2838） vs. 765 （651 -941） vs. 844 （676-1045） ng/L; active ghrelin： 63 （50-97） vs. 47 （41 -56） vs. 54 （41 -60） ng/L~. Plasma total ghrelin and active ghrelin were associated negatively with BMI respectively （ total ghrelin： r = - 0. 517, P = 0. 000; active ghrelin： r=0. 417, P = 0. 002 ）. Conclusions Plasma leptin levels were decreased, while plasma total ghrelin and active ghrelin levels were elevated in underweight patients with COPD, and the levels were associated with nutritional parameters. The plasma levels of leptin and ghrelin may be a compensatory mechanism in malnutritional status of COPD. After adjustment for nutritional parameters, leptin levels were elevated in COPD patients and correlated to TNF-α The result suggests that leptin may play a role in systemic inflammation of COPD.