【作者】 黄伟；

【导师】 季峰；

【作者基本信息】 浙江大学 ， 内科学， 2004， 硕士

【摘要】 背景 瘦素是脂肪细胞肥胖基因(obese gene)的产物，分子量为16Kda；最近发现胃黏膜上皮细胞亦能产生瘦素，有促进胃粘膜上皮细胞增殖的作用。神经肽Y(NPY)是由36个氨基酸组成的肽链，广泛存在于中枢神经系统。两者对调节食欲和能量消耗有重要作用。有动物研究表明，两者可能参与肿瘤相关的厌食、消瘦及恶病质的发病机制，但是两者对临床胃癌相关的厌食、体重下降及恶病质意义研究较少。另外，瘦素直接或间接与多种肿瘤细胞的增殖与分化有关，如乳癌、前列腺癌等；NPY则可作用于胃的微血管引起血管收缩导致急性黏膜损伤。但目前瘦素及NPY与胃溃疡及胃癌发生是否有关，研究较少。 目的 探讨胃癌及胃溃疡血液中瘦素、神经肽Y检测的意义，为肿瘤相关的营养不良发病机制及治疗提供理论依据。 材料与方法 研究分胃溃疡组(48例，男性37例，女性11例，中位数年龄54岁)、胃癌组(71例，男性55例，女性16例，中位数年龄57岁)和正常对照组(79例，53例为瘦素对照组，男性41例，女性12例，中位数年龄60岁；26例为NPY对照组，男性16例，女性10例，中位数年龄55岁)，并对胃癌患者进行手术干预。硕士研究生毕业论文观测指标包括性别，年龄，身高，体重，体重指数(BMI)，体脂，血清瘦素和血浆NPY。胃癌患者术后1天和7天再次检测瘦素和NPY。用体脂仪检测体脂。用放射免疫法检测血清瘦素和血浆NPY。各指标结果用中位数表示，用SpSS10.o统计软件进行统计学处理，P<0.05为具有统计学差异的标志。 结果 胃癌组、胃溃疡组和正常对照组血清瘦素与体脂均呈正相关(p=0.400，p=0.003:p=0.675，P=o.000:p=0.557，介0.000)。胃癌组血清瘦素显著低于正常对照组(1.83ng/ml vs 2.98n岁ml，P=0.000)，但两组间瘦素/体脂差别无显著性意义(9.79ng/ml vs 13.76ng/ml，P=O.O59)。瘦素与胃癌的组织类型、分化程度、淋巴结转移个数无关(乃0.05)。胃癌组与正常对照组间NPY差别亦无显著性意义(223.86pg/ml vs 226.01pg/ml，P=O.158)。胃溃疡组血清瘦素和瘦素/体脂低于胃癌组和正常对照组俨<0.05);胃溃疡组血浆NPY低于正常对照组(207.84pg/mlvs226.01pg/ml，P:aoos)，而与胃癌组间差别无显著性意义(P> 0.05)。NPY与胃癌的组织类型、淋巴结转移个数无关俨，0.05)，但中一低分化胃癌患者NPY低于低分化(165.16pg/ml vs 235.22pg/ml，P=0.018)。胃癌患者术后1天IfIl-清瘦素明显增高，术后7天恢复至术前水平(2.2ong/ml vs 4.79ng/ml vs i.gong/ml);NPY术后1天明显下降，i周内维持较低水平(228.25pg/角1 vs 211.49pg/mlvs 213.63pg/ml)。 结论 瘦素未参与胃癌的发生发展。低瘦素水平可反映胃癌患者较差的营养状态。外周血瘦素和NPY降低可能参与了胃溃疡的发病机制。瘦素和NPY作用失调可能参与了肿瘤相关的厌食、恶病质的发病机制。手术引起血清瘦素短期增高及NPY降低。更多还原

【Abstract】 BackgroundLeptin, a Product of the ob gene, is a 16 kDa Protein synthesised by adipose tissue . Recently leptin is found in the gastric epithelium and to accelerates Proliferation of gastric epithelium cell. Neuropeptide Y (NPY), a 36-amino acid peptide, is abundant in the brain. Leptin and NPY play an important role in the regulation of appetite and energy expenditure. Leptin is also related to proliferation and differentiation of some cancer cells, including mastocarcinoma and carcinoma of prostate et al. NPY acts on the gastric microvasculature to induce vasoconstriction and can induce acute mucosal damage. It has been revealed that the two substances take part in the pathogenesis of cancer-related anorexia and cachexia by studying tumor-bearing animals. But there is little study of their effects on the gastric ulcer patients and clinical anorexia ..and cachexia of gastric cancer patients.ObjectiveTo study the significance of detecting leptin and neuropeptid Y level of gastic cancer and ulcer patients’ blood.Methods and materialsThere were 48 gastric ulcer patients, 71 gastric cancer patients and 79 normal controls in this study. Eight parameters, including gender, age, body height, body weight, body mass index, percent body fat(fat%), level of serum leptin and plasm NPY, were examined in all subjects. The volume of gastric cancer patients’ serum leptin and plasm NPY was detected again 1 day and 7day after surgery. Fat% was detected by body composition analyzer. Leptin and NPY were detected by radioimmunoassay. The data was analyzed with the SPSS10.0 statistical Package. We considered differences significant at P<0.05.ResultsThe level of serum leptin was positively correlated with percent body fat. The leptin level of gastric cancer patients’ was significantly lower than that of normal controls’ ( P =0.400, P=0.003; P =0.678, p=0.000; P =0.557, P=0.000) , but there was no difference in leptin/fat% among the two groups(1.83ng/ml vs 2.98ng/ml, P=0.000). There was no relationship between leptin and histological type proliferation, lymph nude metastasis and stage of gastric cancer(P>0.05). The level of gastric ulcer patients’ leptin and leptin/fat% was significantly lower than that of gastric cancer patients’ and normal controls’(P<0.05). The NPY level of gastric ulcer patients was also significantly lower than that of normal controls(207.84pg/ml vs 226.01pg/ml, P=0.005), but had no difference than that of gastric cancer patients(P>0.05). There was no relationship between NPY and histological type, lymph nude metastasis and stage of gastric cancer(P>0.05). But NPY level of middle-low differentiation of gastric cancer patients was lower than that of low differentiation(165.16pg/ml vs 235.22pg/ml, P=0.018). Serum leptin ascended quickly after surgery, but recovered in one week(2.20ng/ml vs 4.79ng/ml vs 1.90ng/ml). The level of plasm NPY kept low in a week after surgery(228.25pg/ml vs 211.49pg/ml vs 213.63pg/ml).ConclusionsLeptin deosn’t take Part in gastric cancer formation. The low level of gastric cancer patients’ leptin is associated with their Poor nutrition. Low level of leptin and NPY perhaps is a factor for gastric ulcer. Gastric cancer weight loss/cachexia perhaps is due to maladjustment of leptin and NPY, but more studies should be done in the future. The leptin level increases and the NPY level decreases because of surgery.更多还原