【作者】 谢恺庆；

【导师】 罗佐杰； 孙安远； 廖蕴华；

【作者基本信息】 广西医科大学 ， 内科学， 2002， 硕士

【摘要】 目的 研究慢性肾功能衰竭（CRF）患者血清瘦素水平及其与营养状态的关系。方法 选择CRF患者85例，其中非透析55例，按体重指数（BMI）<20kg/m2归为ND1组29例,其余归为ND2组26例,维持性血透30例，健康对照组30例，应用放免分析法测定空腹血清瘦素水平，同时检测BMI、肱三头肌皮皱厚度（ＴＳＦ）、上臂肌围（ＭＡＭＣ）、血清总蛋白（TP）、血清白蛋白（Alb）、血清前白蛋白（Pre-A）、血清转铁蛋白（TRF）、血清总胆固醇（TC）、血清甘油三酯（TG）、血清高密度脂蛋白胆固醇（HDL-C）、血清低密度脂蛋白胆固醇（LDL-C）、及肾功能、血清空腹胰岛素（FINS）、空腹血糖（FBG），计算胰岛素敏感指数（ISI），分析瘦素与各项参数的关系。结果 ⑴非透析ND2组瘦素水平比对照组明显增高（P<0.05）；校正BMI差异后，非透析ND1组瘦素水平比对照组明显增高（P<0.05）,血透组的瘦素水平虽高于对照组，但无统计学差异（P>0.05）。⑵CRF各组Alb、Pre-A、TRF等营养参数低于对照组（P<0.05）。⑶多元回归分析显示，血清瘦素水平与BMI、MAMC、FBG、年龄、性别相关，标准偏回归系数分别为0.674、-0.401、-0.312、0.164、0.214，而与血尿素氮（BUN）、血清肌酐（Scr）、Alb、TRF、Pre-A、ISI、透析治疗等无明显线性相关关系；Pearson相关分析显示血透组的血清瘦素与FINS、TC、TG、LDL-C呈正相关（r值分别为0.458、0.386、0.753、0.417，P<0.05）,与HDL-C呈负相关（r=-0.407，P<0.05）。<WP=4>结论 ⑴CRF患者存在高瘦素血症。⑵瘦素与BMI呈显著正相关，CRF血瘦素水平与体脂含量密切相关。⑶CRF时血清瘦素水平的改变是一个复杂的过程，除了肾脏清除瘦素的能力下降、体脂含量、性别等因素外，肾功能衰竭状态下诸多病理性因素可能也参与影响瘦素水平。⑷瘦素可能导致CRF患者骨骼肌的消耗，并可能对糖代谢产生影响。⑸本研究中未提示CRF的瘦素水平对Alb、Pre-A、TRF等反映内脏蛋白含量的指标有明显影响。更多还原

【Abstract】 Objective To investigate the leptin in chronic renal failure(CRF) and its effects on nutritional status.Methods Serum leptin was measured by radioimmunoassay in 115 individuals in groups of non-dialysed(ND，n=55), hemodialysed patients(HD，n=30) and healthy controls(n=30). Non-dialysed patients included ND1 group(n=29,body mass indeces（BMI）<20kg/m2) and ND2 group(n=26,BMI≥20kg/m2).BMI, triceps skin-fold thickness(TSF), mid-arm muscle circumference (MAMC),total protein（TP），serum albumin（Alb）,prealumin（Pre-A）, transferrin（TRF）, total cholesterol（TC）,triglycerides（TG）, highdensity lipoprotein cholesterol（HDL-C）,lowdensity lipoprotein cholesterol（LDL-C）,blood urea nitrogen(BUN),serum creatinine(Scr),fasting insulin(FINS),insulin sensitivity index（ISI）,fasting blood glucose（FBG） were also determined. The relationship between serum leptin concentration and these indeces was analysed.Results ⑴Mean serun leptin concentration was significantly higher in the ND2 group than that in the control(P<0.05),and so in the ND1 group when BMI was corrected by covariance analysis.The difference in serun leptin concentration between the HD group and the control was not statistically significant although BMI was<WP=6>corrected by covariance analysis. ⑵ Each group in CRF had significantly higher concentrations of BUN,Scr(P<0.001) and lower concentrations of Alb,Pre-A,TRF(P>0.05)than control group.⑶Multiple regression analysis showed that the leptin concentration in CRF was significantly correlated to BMI, MAMC , FBG, age, sex ( the standardized regression coefficients were 0.674,-0.401,-0.312,0.214,0.164 repectively) and unrelated to BUN,Scr,Alb Pre-A,TRF,dialysis therapy,etal.Pearson correlation analysis showed leptin concentration in HD group significantly positively correlated to FINS,but no significant correlation was observed between leptin and ISI in CRF.Conclusions ⑴There is presence of hyperleptinemia in CRF.⑵Serun leptin concentration is highly correlate to BMI,and BMI may be the index in nutritional assessment. ⑶Serun leptin concentration in CRF is influenced by multiple factors,such as BMI,renal fuction,sex,age,FINS.⑷Leptin may contribute to the consumption of skeletal muscles and influence metabolism of blood sugar.⑸Hyperleptinemia is not correlated with markers of protein malnutrition in CRF.更多还原