高海拔地区慢性阻塞性肺疾病合并慢性肺源性心脏病患者血清瘦素和肿瘤坏死因子-α水平与营养不良的关系

Relationship between serum leptin/tumor necrosis factor-a and malnutrition in patients with chronic obstructive pulmonary disease and chronic cor puhnonale at high altitude

目的 探讨高海拔地区慢性阻塞性肺疾病（COPD）合并慢性肺源性心脏病患者血清瘦素和肿瘤坏死因子α（TNF-α）水平与营养不良的关系.方法 将162例高海拔地区COPD合并慢性肺源性心脏病稳定期患者分为营养不良组（A组,n=104）和营养正常组（B组,n=58）,并以40例健康志愿者为对照（C组）.采用双抗体夹心酶联免疫吸附法（ELISA）检测血清瘦素和TNF-α水平.结果 A组患者的血清瘦素水平为（9.5±1.8）ng/ml,明显高于B组的（7.3±2.0）ng/ml和C组的（6.7±2.3）ng/ml（P均＜0.01）;B组和C组间差异无统计学意义（P＞0.05）.A组患者的血清TNF-α水平为（17.3±2.2）ng/ml,明显高于B组的（13.5±2.3）ng/ml和C组的（12.8±2.1）ng/ml（P均＜0.01）;B组和C组间差异无统计学意义（P＞0.05）.A组患者的血清瘦素水平与体重指数（r=-0.745,P=0.0005）、理想体重百分比（r=-0.887,P=0.0005）、三头肌皮褶厚度（r=-0.725,P=0.0005）、上臂中部周径（r=-0.761,P=0.0005）和血清白蛋白水平（r=-0.558,P=0.0005）呈显著负相关,与血清TNF-α水平呈显著正相关（r=0.527,P=0.0005）.结论 高海拔地区COPD合并慢性肺源性心脏病患者的血清瘦素和TNF-α水平与营养不良有关.

Objective To investigate the relation between serum leptin/tumor necrosis factor-α （TNF-α）and malnutrition in patients with chronic obstructive pulmonary disease （COPD） and stable chronic cor pulmonale （CCP） at high altitude. Methods Totally 162 COPD and CCP patients and 40 normal controls （group C） were studied. COPD and CCP patients were divided into malnutrition group （group A, n = 104） and normal nutrition group （group B, n =58） according to the nutritional parameters. Levels of serum leptin and TNF-α were measured by enzyme-linked immunosorbent assay （ELISA）. Results Body mass index （BMI）, percentage of normal body weight （NW%）, triceps skinfold thickness （TSF）, mid-upper arm circumference （MAC）, serum albumin （ALB） ingroupA[（17.4±1.8） kg/m2, （82.3±4.3）%, （7.0±2.6） mm, （17.8±2.8） cm, （30.3±3.9）g/L, respectively] were significantly lower than those in group B and group C [（21.8 ± 2.0） kg/m2,（98.6±5.5）%, （9.3±2.6） mm, （21.5±2.9） cm, （36.2±3.8） g/L, and （23.1±2.3） kg/m2,（102.2±5.2）%, （9.7±3.8） mm, （22.1±2.8） cm, （36.8±3.9） g/L, respectively; all P〈0. 01].The levels of serum leptin and TNF-α in group A [（9.5 ±1. 8） ng/ml and （17.3 ±2. 2） ng/ml, respectively]were significantly higher than those in group A and group C [（7.3 ± 2. 0） ng/ml, （13.5 ± 2. 3） ng/ml; and （6. 7 ±2. 3） ng/ml, （12. 8 ±2. 1） ng/ml, respectively; all P 〈0.01）. However, they were not significantly different between group A and group B （all P 〉 0. 05）. The level of leptin was negatively correlated with BMI （r=-0.745, P=0. 0005）, NW% （r= -0.887, P=0. 0005）, TSF （r= -0.725, P=0. 0005）, MAC （r= -0. 761, P=0. 0005）, serum albumin （r= -0. 558, P=0. 0005） in group A, and was positively correlated with TNF-α （r = 0. 527, P = 0. 0005）. Conclusion Serum leptin and TNF-α correlate with malnutrition in patients with COPD and CCP at high altitude.