高糖危象患者血清瘦素和氧化应激的关系

The relationship between serum level of leptin and oxidative stress in patients with hyperglycemia crisis

目的探讨高糖危象患者血清瘦素水平变化及与氧化应激的关系。方法选择糖尿病酮症酸中毒和非酮症高血糖患者96例，静脉泵入胰岛素0．1U·kg^-1·h^-1，同时给予补液、对症治疗以及胃肠和静脉营养。检测高糖危象患者治疗前及病情缓解时（72h）血清瘦素、超氧化物歧化酶（SOD）活性、丙二醛（MDA）含量、总抗氧化能力（TAC）和8-异前列腺素F2α（8-iso—PGF2α）水平。另外选择35例健康体检者作为对照组。结果高糖危象患者治疗前SOD、TAC和瘦素水平均显著低于健康对照组，而MDA和8-iso—PGF2α均显著高于健康对照组（P均〈0．05）；高糖危象患者治疗后SOD、TAC和瘦素均显著高于治疗前，而MDA和8-iso—PGF2α均显著低于治疗前（P均〈0．05）。高糖危象患者治疗前瘦素与MDA呈显著正相关（r=0．38，P〈0．05），治疗后瘦素与MDA和8-iso—PGF2α呈显著负相关（r1=-0．35，r2=0．37，P均〈0．05）。多元逐步回归分析显示MDA和8-iso—PGF2α均为影响血清瘦素水平的显著因素。结论高糖危象患者血清瘦素水平明显下降，且与氧化应激有关。

Objective To investigate the relationship between the levels of serum leptin and oxidative stress in patients with hyperglycemia crisis. Methods A total of 96 patients with diabetic ketoacidosis （DKA） and nonketotic hyperglycemia （NKH） were treated on a low-dose insulin protocol using intravenous infusion of insulin with the established rate of 0.1 U·kg^-1·h^-1, with the patients on intravenous fluids and receiving nutrition by mouth and vein. The levels of serum leptin, 8-iso-prostaglandin Fzo（8-iso-PGFzα）, the activities of superoxide dismutase （SOD）, total antioxidant capacity （TAC） and the contents of malondialdehyde （MDA） in 96 patients with hyperglycemia crisis on admission and after insulin therapy with resolution of hyperglycemia and ketoacidosis （72 hours） were measured. Another 35 healthy individuals served as normal control. Results The activities of SOD, TAC and the levels of leptin before treatment were lower in patients with hyperglycemia crisis than in normal controls, and the levels of MDA and 8-iso-PGFzo were more markedly elevated than those in normal controls （all P〈0.05）. The activities of SOD, TAC and the levels of leptin in patients after treatment were significantly higher than those in patients before treatment, and the levels of MDA and 8-iso-PGFzo were significantly lower than those in patients on admission （all P〈0.05）. There was significant positive correlation between leptin and MDA in patients before treatment （r= 0.38, P〈0.05）, and the level of leptin was negatively correlated with MDA and 8-iso-PGF2α in patients after treatment （r1=-0. 35, r2=0.37, both P〈0.05）. In stepwise regression analysis, MDA and 8-iso-PGF2α showed a significant association with leptin. Conclusion The levels of leptin are significantly lowered in patients with hyperglycemia crisis. Oxidative stress may participate in determining the leptin level in hyperglycemia crisis.