【作者】 易志刚；

【导师】 杜心清； 黄子扬；

【作者基本信息】 福建医科大学 ， 内科学， 2003， 硕士

【摘要】 目的：检测充血性心力衰竭(CHF)患者空腹瘦素(Leptin)、胰岛素、肿瘤坏死因子α(TNF-α)水平。探讨其瘦素水平的变化及瘦素与心力衰竭胰岛素抵抗的相关情况。 方法： 1．测定全部受试对象的体重指数(BMI)、腰臀围比(WHR)、脂肪百分比(％Fat)、左室射血分数(EF)、左室舒张功能(E／A)及空腹静脉血糖(YPG)、血清甘油三酯(TG)、总胆固醇(TC)等生化指标。 2．采用放射免疫的方法检测53例CHF患者和21例健康对照组空腹血清瘦素水平及用化学发光免疫分析法检测空腹胰岛素(FINS)、TNF-α水平。用HOMA胰岛素抵抗指数(HOMA-IR=FPG×FINS／22.5)评价CHF患者的胰岛素抵抗情况。 3．将瘦素与年龄、BMI、WHR、％Fat、TG、TC、HDL、FPG、FINS、TNF-α作相关分析，探讨瘦素的相关因素；以HOMA-IR为因变量，以年龄、BMI、WHR、％Fat、TG、TC、HDL、TNF-α、瘦素为自变量进行多元逐步回归分析，探讨胰岛素抵抗的影响因素。 结果： 1、心衰组与正常对照组相比，各指标的均数±标准差如下：瘦素分别为8.47±4.52 ng／ml Vs 6.19±3.89ng/ml(p＜0.01)，FINS分别为18.65±5.09 mIU／LVs14.66±4.82 mlU／L(p＜0.01)，TNF-α分别为0.46±0.14ng／ml Vs 0.16±0.26ng／ml(p＜0.01)，HOMA-IR分别为4.09±1.05 Vs 3.09±1.84(p＜0.01)，前者均显著高于后者。 2、心衰心功能Ⅲ级、Ⅳ级组的瘦素水平均高于心功能Ⅱ级组(9.04±5.43 Vs7.41±4.32ng／ml，9.10±6.52 Vs 7.41±4.32ng／ml，p均＜0.01)有显著性差异，但心功能HI级与W级之间无显著性差异(9，04士5.43 Vs 9.10士6.52ng/成p>o，o匀;心衰组TNFF一a随心功能不全的恶化逐渐升高，心功能11一W级各亚组间差异有显著性意义(p<0 .01)。 3、瘦素与B呱价刃.647，p<0.01)、认叼R(二0.601，p<0 .01)，%Fat(厂。.刁·91，p<0.01)，FINs(间.598，P<o.01)均呈正相关。以HoM叭~仅为因变量的多元逐步回归方程为:HQM人，皿=。.91 2+0.24凡+2 .516凡(Xs为瘦素，凡为T卜T一。，戈、戈显著性分别为Pl<0.05，娇。.01)，表明HOM叭.仅与瘦素、TNF一Q呈显著正相关。 结论: 1.心力衰竭患者瘦素水平升高，且心功能m、W级均高于心功能n级，心功能W级与心功能班级之间无显著性差别。 2.心衰患者血清中瘦素水平和FL叮S、BMI、认任田R、%Fat呈正相关。瘦素水平的升高可能与F刀呵S有关。3.瘦素、TNF一。可能参与心衰患者胰岛素抵抗的形成。更多还原

【Abstract】 Objective: To observe the alteration of plasma leptin, insulin and TNF- a in patients with congestive heart failure (CHF), and to assess the relation between plasma leptin and insulin resistance in CHF. Methods:1 Several biochemical parameters were measured, including fasting glucose, triglyceride and total cholesterol, et al. Body mas index, WHR, %Fat, left ventricular ejection fraction and E/A were estimated.2 The level of fasting plasma leptin was examined by means of adioimmunoassay. the level of fasting plasma insulin and TNF- a were examined by means of chemiluninescence immunoassay. Insulin resistance was determined using HOMA index (HOMA-IR=FPGX FINS/22.5) .3 The correlation between plasma leptin and age, BMI, WHR, %Fat, TG, TC, HDL, FPG, FINS, TNF- a were analyzed. Homa insulin resistance index was regarded as dependent variable, and age, BMI, WHR, %Fat, serum total cholesterol, triglyceride, high density lipoprotein, palsma TNF- a and leptin were regarded as independent variables. Multiple stepwise regression was performed to study the influencing factor of insulin resistance. Results:1 Plasma Leptin of patients with NYHA grade III and NYHA grade IV were significantly higher than that with NYHA grade II.2 Plasma leptin was not different between patients with NYHA grade III and NYHA grade IV . Plasma TNF- a were elevated in patients with CHF when compared with those in control subjects (p<0.01). More specifically, their levels wereprogressively elevated with severity of CHF deteriorated and there were significant differences in subgroups of NYHA II-IV(p<0.01) .3 Plasma insulin was related positively to plasma leptin (r=0.598, p<0.01) and BMI, WHR, %Fat were also related positively to plasma leptin. The multiple stepwise regression suggested that HOMA-IR was positively associated wth plasma leptin and TNF-a .Conclusion:1 Plasma leptin level is raised in patients with CHF. plasma leptin of patients with NYHA grade III and NYHA grade IV are significantly higher than that with NYHA grade II. There are not different between patients with NYHA grade III and NYHA grade IV .2 Plasma leptin is related positively to plasma insulin BMI, WHR, %Fat. Plasma insulin may increases the release of leptin.3 Plasma leptin and TNF- a may are involved in insulin resistance.更多还原