慢性肾功能衰竭患者血清瘦素水平与营养不良的关系

Relationship between serum levels of leptin and malnutrition in patients with chronic renal failure

目的 :探讨慢性肾功能衰竭 (chronicrenalfailure,CRF)患者血清瘦素水平与营养不良的关系 .方法 :84例CRF患者分为 3组 :非血液透析组 2 8例 (I组 ) ,常规血液透析组 31例 (II组 ) ,高通量血液透析滤过组 2 5例 (III组 ) .2 9例健康志愿者作为对照组 .测定其血清生化指标 ,ELISA法测定其血清瘦素水平 .同时对患者进行营养状况评估 .结果 :3组CRF患者血清瘦素水平均较对照组显著增高 (P <0 .0 5 ) ,I ,II组分别较III组血清瘦素水平显著增高 (P <0 .0 1 ) .3组CRF患者的体脂百分比均与其血清瘦素水平显著正相关 (r=0 .341 5 ,0 .2 0 31和 0 .2 1 6 3,P <0 .0 1 ,<0 .0 5和 <0 .0 5 ) .3组客观营养指标之间无显著差异 ,II组和III组血清瘦素水平分别与其血清白蛋白显著负相关 (r =- 0 .2 1 6 9和 - 0 .1 986 ,P <0 .0 5 ) .SGA评估表明CRF患者存在明显的营养不良 ,其营养状况越差 ,血清瘦素水平越高 (P <0 .0 1 ) .III组SGA积分明显高于其他两组 (P <0 .0 1和P <0 .0 5 ) .结论 :CRF患者存在高瘦素血症 ,其增高与CRF患者的营养不良有关 .高通量血液透析滤过治疗有助于CRF患者血清瘦素的清除 。

AIM: To investigate the relationship between the serum levels of leptin and malnutrition in chronic renal failure (CRF) patients. METHODS: 84 CRF patients were divided into three groups: 28 patients with non hemodialysis therapy (group I), 31 patients treated with standard hemodialysis (group II) and 25 cases treated with high flux hemodiafiltration (HF HDF) (group III). 29 healthy persons were as controls. Serum biochemical markers were detected in all patients and controls, and the serum leptin was detected by ELISA. The nutritional status was assessed by subjective global assessment (SGA) at the same time. RESULTS: The serum levels of leptin in CRF patients were significantly higher than those in healthy controls (at least P < 0.05), and those in group I and group II were significantly higher than those in group III, respectively (both P < 0.01) . The percentages of body fat were positively correlated with serum levels of leptin in all the three groups respectively ( r =0.3415, 0.2031 and 0.2163; P <0.01, P <0.05 and P <0.05). There were no significantly differences in objective nutritional indices among the three groups. The serum levels of leptin were negatively correlated with the serum levels of albumin in group II and group III respectively ( r =-0.2169 and -0.1986, all P <0.05). The assessment by SGA demonstrated the presence of malnutrition in CRF patients, and the worse the nutritional status of CRF patients was, the higher the serum level of leptin ( P <0.01). SGA integra in group III was significantly higher than that in group I and group II, respectively ( P <0.01 and P <0.05). CONCLUSION : CRF patients have hyperleptinemia, which may be related to the malnutrition in CRF patients. HF HDF can obviously remove the serum leptin, thus improving the malnutrition in CRF patients.