维持性血液透析患者营养不良-慢性炎症综合征与血清瘦素的关系

Relationship between serum leptin levels and malnutrition inflammation complex syndrome in maintenance hemodialysis patients

目的 探讨在维持性血液透析患者(MHD)中血清瘦素水平的变化和瘦素与营养不良-慢性炎症之间的关系。方法 检测MHD患者31例,男性19例,女性13例,年龄(55±17)岁和正常对照组22例,男性10例,女性12例,年龄(47±15)岁,血清瘦素水平;MHD组患者测量身高、体重、上臂中份肌肉周径(MAMC)、肱三头肌皮褶厚度(TSF),检测血清白蛋白(ALB)、总铁结合力(TBC)、血脂全套、白介素-6(IL-6),结合临床症状评价主观综合评定(SGA)和营养不良-慢性炎症综合评分(MIS),计算体脂含量(F％)、体重指数(BMI)。结果 MHD患者血清瘦素水平较正常对照增高[(25.96±30.91)vs(7.58±6.84)ng/ml;P=0.0083],女性患者平均水平高于男性[(9.59±18.20)vs(50.02±30.12)ng/ml;P=0.000025];血清瘦素水平与年龄、透析时间无相关性,瘦素与ALB、TG、LDL、HDL、IL-6也无相关性;而体脂含量(r=0.747;P<0.0001)、BMI(r=0.62;P<0.0001)和CHOL(r=0.40;P=0.023)与瘦素呈正相关,SGA(r=-0.40;P=0.023)、MIS(r=-0.363;P=0.041)与瘦素呈负相关,在排除体脂含量影响后,SGA与瘦素相关性消失,当排除BMI和SGA的影响后,MIS与瘦素相关性也消失。结论 MHD患者瘦素水平高于正常人群,女性瘦素水平高于男性;MHD患者血清瘦索水平与体脂含量、BMI、SGA。

Objective To investigate the relationship between serum leptin levels and malnutrition inflammation complex syndrome in maintenance hemodialysis patients. Methods Serum leptin levels were measured in 31 MHD patients [ 19M , 13F,mean age (55±17)years] and 22 normal donors [10M, 12F, mean age (47±15)years]; height, weight, mid - arm muscle circumference (MAMC), triceps skinfold (TSF) thickness, serum albumin concentration, total iron - binding capacity (TIBC), serum lipid and IL - 6 were measured also in MHD patients. The subjective Global assessment (SGA) and malnutrition inflammation score (MIS) were evaluated by combining these indices and clinical symptoms, the body fat content and body mass index (BMI) were calculated too. Results The serum leptin levels were elevated in MHD patients compared to normal controls [ (25 .96±30.91) vs. (7.58±6.84)ng/ml; P= 0.0083], the average level was higher in female than in male [(9.59±18.20) vs. (50. 02±30. 12) ng/ml; P = 0. 000025)]; Serum leptin levels did not correlate with age, dialysis history, serum albumin, triglyceride, LDL, HDL and IL - 6; Serum leptin levels correlated positively with body fat content (r = 0.747, P < 0.0001) , BMI (r = 0.62,P<0.0001) and serum cholesterol (r= 0.40, P = 0.023), Negatively with SGA (r = - 0.40, P = 0.023), MIS (r= -0.363,P = 0.041). Controaled body fat content, the correlation between leptin level and SGA disappeared, and after excluding BMI and SGA, the correlation between leptin level and MIS disappeared. Conclusion The serum leptin levels are higher in MHD patients than in normal people, higher in female than in male, nutrition status of MHD patients are partly reflected by serum leptin level, especially lipid metabolism, there is no relationship between serum leptin level and protein metabolism. Malnutrition in MHD patients is caused by high serum leptin level, which can lead to anorexia and increased catabolism. Serum leptin level is not a kind of acute phase protein, cannot represent chronic inflammation in MHD patients.