慢性阻塞性肺疾病患者营养状况与瘦素及肿瘤坏死因子α和甲状腺激素关系的研究

Relation among serum leptin, tumor necrosis factor, thyroid hormones and nutrition status in patients with chronic obstructive pulmonary disease

目的探讨血清瘦素、肿瘤坏死因子α（TNF—α）和甲状腺激素在慢性阻塞性肺疾病（COPD）患者营养不良发生中的意义。方法观察COPD临床稳定期患者148例，根据体质指数（BMI）、理想体质量百分比（NW％）、三头肌皮皱厚度（TSF）、上臂中点臂围（MAC）、血清白蛋白（ALB）、总淋巴细胞（LYM）等营养参数，分为COPD营养不良组（COPDⅠ组）47例，COPD非营养不良组（COPDⅡ组）101例，另选健康人30例为对照组。采用双抗体夹心酶联免疫吸附法检测血清瘦素、TNF-α，采用放射免疫法测定甲状腺激素（T3、T4、FT3、FT4、TSH），并探讨上述因素在COPD营养不良患者中的作用及相互之间的相关性。结果COPDI组BMI、NW％、TSF、MAC、ALB、LYM与COPDⅡ组、对照组比较差异均有统计学意义（P〈0．01），COPDⅡ组与对照组比较差异无统计学意义（P〉0．05）；COPDⅠ组瘦素水平分别与COPDⅡ组、对照组比较差异均有统计学意义（P〈0．01），COPDⅡ组与对照组比较差异无统计学意义（P〉0．05）；COPDⅠ组、COPDⅡ组TNF-α水平分别与对照组比较差异有统计学意义（均P〈0．01），而COPDⅠ组与COPDⅡ组比较差异无统计学意义（P〉0．05）；COPDI组T3、T4分别与COPDⅡ组、对照组比较差异有统计学意义（均P〈0．01）；COPDⅡ组T4与对照组比较差异有统计学意义（均P〈0．01）。COPDⅠ组、COPDⅡ组BMI、NW％、TSF与瘦素水平呈正相关（P〈0．01），瘦素水平与TNF—α、TSH呈正相关（P〈0．05）。结论COPD患者营养不良与血清瘦素水平、TNF-α及甲状腺激素有关，瘦素受TNF—α系统调控，瘦素与下丘脑-垂体-甲状腺轴之间存在相互调节关系，三者共同参与了COPD患者营养不良的发生。

Objective To study the significance of serum leptin, thyroid hormones and tumor necrosis factor-α（TNF-α）on malnutrition among chronic obstructive lung disease （COPD） patients. Methods A hundred and fourty-eight COPD patients in stable stage and 30 normal controls were studied. Nutritional parameters, including body mass index （BMI） , percentage of normal body mass （ NM% ） , triceps skin-fold thickness （TSF） , mid-upper arm circumference（MAC） , serum albumin（ALB）, total lymphocyte counts（LYM） were determined. COPD patients were divided into malnutrition group（ group Ⅰ ） and non-malnutrition group （group Ⅱ ）according to the nutritional parameter. Serum leptin levels and TNF-α were measured by ELISA, thyroid hormones （ T3 , T4, FF3, FT4, TSH） were tested by radioimmunoassay. The correlation among these parameters was analysed. Results There were significant difference on BMI, NW% ,TSF, MAC,ALB, LYM between group Ⅱ , control group and group Ⅰ . There were no significant difference on these parameters between group Ⅱ and control group. There were significant difference on serum leptin between group Ⅱ , control group and group Ⅰ. There were no significant difference on serum ]eptin between group Ⅱ and control group. There were significant difference on TNF-α levels between group Ⅰ , group Ⅱ and control group. There were no significant difference on TNF-α levels between group Ⅰ and group Ⅱ. There were significant difference on T3 ,T4 between group Ⅱ, control group and group Ⅰ. There were significant difference on T4 between group Ⅱ and control group. Serum leptin in group Ⅰ and group Ⅱ showed a positive correlation with BMI,NW% ,TSF,TNF-α and TSH. Conclusion Malnutrition correlate with serum leptin, thyroid hormones and TNF-α in COPD patients. Serum leptin levels were adjusted by TNF-α system. Serum leptin and hypothalamus-hypophysis-thyroid axial system regulate each other. Leptin, thyroid hormones and TNF-α contribute to the onset of malnutrition in COPD patients.