慢性阻塞性肺疾病机械通气患者瘦素与营养和呼吸肌力的相关性研究

The correlation of serum Leptin,nutritional status and respiratory muscle strength in COPD patients with mechanical ventilation

目的研究慢性阻塞性肺疾病(COPD)行机械通气(MV)患者的血清瘦素水平与营养状况和呼吸肌力的相关性。方法 33例行机械通气的COPD住院男性患者,于停机前分别进行血清瘦素(Leptin)水平、营养状况参数及呼吸肌力的测定。营养参数包括肱三头肌皮褶厚度(TSF)、上臂肌围长(MAMC)、血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)、总淋巴细胞计数(TLC),呼吸肌力指标包括最大吸气负压(MIP)、0.1s末闭合气压(P0.1)及浅快呼吸指数(RSBI)。分析血清瘦素水平与营养状况和呼吸肌力有无相关性。结果血清瘦素水平与营养状况参数的相关性,血清瘦素与TSF、MAMC及TLC呈明显正相关(P<0.05)。血清瘦素与MIP呈正相关(P<0.05),血清瘦素与RSBI呈负相关(P<0.05)。营养参数与呼吸肌力指标的相关性,TSF与MIP呈正相关(P<0.05),TSF与P0.1负相关(P<0.05);MAMC与MIP正相关(P<0.05),MAMC与P0.1和RSBI均呈负相关(P<0.05);血清蛋白PA与MIP、P0.1、RSBI均有相关性(P<0.05)。结论行机械通气的COPD患者瘦素水平与大多数评价营养状况的参数及呼吸肌力指标有相关性,瘦素对行机械通气COPD患者的营养状况可能起生理性调节作用。COPD患者的营养状况和呼吸肌力之间有明显的正相关,提示有效的营养支持治疗可能会改善患者的营养状况,增强呼吸肌力,促使及时成功撤机。

Objective To study the correlation of serum Leptin,nutritional status and respiratory muscle strength in chronic obstructive pulmonary disease（COPD） patients with mechanical ventilation.Methods The serum Leptin and nutrition parameters including triceps skin-fold thickness（TSF）,mid-upper arm muscle circumference（MAMC）,albumin（ALB）,prealbumin（PA）,transferring（TRF） and total lymphocytes count（TLC） were determined in 33 COPD patients with mechanical ventilation.And the respiratory muscle strength including maximum inspiratory pressure（MIP）,inspired pressure at the early 0.1 second（P0.1）,rapid shallow breathing index（RSBI） were measured.Results Serum Leptin levels were associated positively with TSF,MAMC and TLC（P0.05）.Serum Leptin levels were associated positively with MIP（P0.05）,and associated negatively with RSBI（P0.05）.In nutrition parameters,TSF,MAMC were correlated positively with MIP,and were correlated negatively with P0.1（P0.05）.There was no relationship between TSF and RSBI,but MAMC were correlated negatively with RSBI（P0.05）.In serum protein,only PA had relationship with MIP,P0.1,RSBI（P0.05）.Conclusion Serum Leptin level is associated with nutritional status and respiratory muscle strength.Leptin has effect of physiologic accommodation to the nutritional status of COPD patients.The nutritional status is correlated positively with respiratory muscle strength.