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目的研究慢性阻塞性肺疾病(COPD)患者急性加重期饮食摄入与血清瘦素水平及全身炎症状态的相关关系,探讨血清瘦素和全身炎症在COPD营养不良发生中的作用。方法观察40例COPD急性加重期患者治疗前,治疗第7天、第12天的饮食摄入量、血清瘦素及可溶性肿瘤坏死因子受体(sTNFR)的水平变化;测定患者治疗第12天的营养状态参数。12例正常健康者的血清瘦素、sTNFR水平作为正常对照。分析各参数相关性。用酶联免疫吸附试验(ELISA)测定血清瘦素、sTNFR水平,饮食摄入量由24小时膳食记录,经营养分析软件计算获得。结果①患者治疗前饮食摄入量低于日常习惯饮食,随着治疗时间的延长,饮食摄入量逐渐恢复至日常水平。在治疗第7天,饮食摄入量与瘦素的自然对数、sTNFR55均呈显著负相关(r=-0.536,P<0.01;r=-0.729,P<0.001);治疗第12天此相关关系仍存在。②治疗第7天和第12天,排除体重指数(BMI)影响后,血清瘦素与sTNFR55均呈显著正相关(r=0.53,P<0.05;r=0.512,P<0.05)。③治疗第12天,血清瘦素与BMI、理想体重百分比、三头肌皮皱厚度、肩胛下皮皱厚度、上臂中部周径等营养参数均呈显著正相关(P均<0.05)。结论COPD患者急性加重期存在短暂的饮食摄入减少,这与提高的血清瘦素水平及全身炎症反应有关。“细胞因子瘦素”作用机制可能参与了COPD营养不良的发生。
Objective To investigate the relationship between dietary intake, serum leptin level and systemic inflammatory status in patients with chronic obstructive pulmonary disease (COPD) at acute exacerbations and to explore the role of serum leptin and systemic inflammation in the pathogenesis of malnutrition in COPD. Methods The changes of dietary intake, serum leptin and soluble tumor necrosis factor receptor (sTNFR) levels in 40 patients with acute exacerbation of COPD before treatment, on day 7 and 12 of treatment were observed. Nutritional status parameters. Serum leptin and sTNFR levels in 12 healthy controls were used as normal controls. Analyze the correlation of each parameter. Serum leptin and sTNFR levels were measured by enzyme-linked immunosorbent assay (ELISA). The dietary intake was recorded by a 24-hour diet and was calculated by nutritional analysis software. Results ① The dietary intake of patients before treatment was lower than that of daily routine diet. As the treatment time prolonged, the dietary intake gradually returned to the daily level. On the 7th day of treatment, the dietary intake was negatively correlated with the natural logarithm of leptin, sTNFR55 (r = -0.536, P <0.01; r = -0.729, P <0.001) The relationship still exists. ② On the 7th and 12th days after treatment, the serum leptin and sTNFR55 had significant positive correlation (r = 0.53, P <0.05; r = 0.512, P <0.05) after excluding the influence of body mass index (BMI) ③ On the 12th day of treatment, there was a significant positive correlation between serum leptin and other nutritional parameters such as BMI, the percentage of ideal body weight, the thickness of trichoderma skin, the thickness of subcaposal skin and the middle of the upper arm (all P <0.05). Conclusions There is a transient decrease in dietary intake during acute exacerbation of COPD, which is associated with increased serum leptin levels and systemic inflammatory response. “Leptin cytokine” mechanism may be involved in the occurrence of COPD malnutrition.