急性心肌梗死患者血清Leptin增高与其他相关因素的分析

目的探讨急性心肌梗死（AMI）和冠状动脉硬化（CS）患者血清瘦素（Leptin）的变化及与C反应蛋白（CRP）、肌钙蛋白T（TnT）、内皮素（ET）的相关性。方法收集临床确诊的AMI和Cs患者血清，采用高灵敏的Leptin及ET放射免疫分析法、TnT的自动生化分析法及高灵敏的CRP酶联免疫吸附法（ELISA）测定相应指标的血清水平。结果AMI组患者血清Leptin、TnT、CRP和ET水平均较正常对照组显著增高（P均〈0．01）；而CS组患者除TnT外，其他3种因子血清水平也明显高于正常对照组（P均〈0．01）；相关分析显示，上述增高因素互不相关，均为独立的影响因素之一，AMI组和CS组间仅TnT显示出差异有显著性（P〈0．01）。结论AMI和CS组患者血清Leptin水平均明显上升，但两组间差异无显著性；两组患者血清Leptin水平与CRP、TnT以及ET水平不存在相关性。     

急性心肌梗死患者血清C反应蛋白与心肌存活性及左心室功能相关性的研究

C反应蛋白（CRP）是机体的一种非特异性的炎症反应标志物,是在细胞因子如IL-6的刺激下由肝脏合成的急相反应蛋白。研究表明,炎症在急性心肌梗死（AMI）的发生、发展和恶化过程中起着非常重要的作用。本研究通过测定AMI患者血清CRP水平及左心室射血分数（LVEF）等指标,探讨了AMI时CRP水平与心肌存活性及左心室功能的关系。     

急性缺血性脑血管病患者慢性肺炎衣原体感染与外周炎症反应的关系

目的 探讨慢性肺炎衣原体感染在急性缺血性脑血管病外周炎症反应中的作用。方法 检测30例急性缺血性脑血管病患者和30例正常对照者血清肺炎衣原体特异性抗体（IgC），并检测其血清C反应蛋白（CRP）、血沉（ESR）及血中白细胞计数（WBC）。结果 急性缺血性脑血管病患者外周炎症指标高于对照组（P〈O.01）。肺炎衣原体特异性抗体IgG阳性患者血清CRP水平、血沉、白细胞计数均高于阴性者（P〉0.05）。结论 慢性肺炎衣原体感染参与缺血性脑血管病外周炎症反应，并与其他卒中因素共同引起急性期外周炎症指标水平升高。     

CRP、IL-6及D—Dimer在急性下肢深静脉血栓形成中的作用及相关性分析

【目的】探讨炎症因子血浆C反应蛋白（CRP）、白介素-6（IL-6）和I）_二聚体（D-Dimer）在急性下肢深静脉血栓形成（DVT）中的作用及相关性。【方法】30例DVT患者为DVT组,30例健康自愿者为正常对照组,检测DVT组患者治疗前、后及正常对照组血清CRP、IL-6及D-Dimer浓度并行相关性分析。【方法】DVT组患者治疗前血浆CRP、IL-6和D-Dimer浓度均明显高于正常对照组（P〈0．01）;治疗后DVT组患者血浆CRP、IL-6和DDimer浓度显著低于治疗前（P〈0．01）,而治疗后DVT组患者血清CRP、D-Dimer浓度仍高于正常对照组（P〈0．05）;CRP、IL-6和D-Dimer相互呈正相关。【结论】炎症因子CRP、IL-6及D-Dimer在下肢深静脉血栓急性期起重要作用。     

急性脑梗死患者超敏C-反应蛋白的检测及临床意义

近年的研究资料显示．炎症在动脉粥样硬化的发生和发展中具有重要作用．而动脉粥样硬化是缺血性脑血管疾病的危险因素，C反应蛋白（CRP）是一种急性期的反应蛋白，是炎症反应的敏感指标。为此，笔者观察了急性脑梗死患者超敏C反应蛋白（hs—CRP）检验指标的情况，现报告如下。     

血清超敏C反应蛋白水平与脑卒中病变的相关性分析

炎症在脑卒中的急性期中扮演着重要的角色,血清超敏C反应蛋白（hs—CRP）是炎症反应急性期的敏感指标,在正常人体中含量极低。C反应蛋白（CRP）也是目前研究最广泛的一个血液标志物,越来越多的证据表明血清CRP浓度升高与脑卒中相关,认为其与高血压、糖尿病一样,是脑卒中预后的独立危险因素。因此,本研究旨在观察hs—CRP水平在急性脑梗死、脑出血患者中的临床意义。     

急性脑梗死患者超敏C-反应蛋白的检测及临床意义

近年的研究资料显示．炎症在动脉粥样硬化的发生和发展中具有重要作用．而动脉粥样硬化是缺血性脑血管疾病的危险因素，C反应蛋白（CRP）是一种急性期的反应蛋白，是炎症反应的敏感指标。为此，笔者观察了急性脑梗死患者超敏C反应蛋白（hs—CRP）检验指标的情况，现报告如下。     

急性感染患者血清肿瘤坏死因子、白介素-6和C-反应蛋白水平的比较

目的：探讨急性感染时肿瘤坏死因子（TNF-α）、白介素-6（IL-6）和c一反应蛋白（CRP）水平的变化情况及相关因素。方法：肿瘤坏死因子和白介素-6用双抗体夹心酶联免疫吸附分析法（ELIsA），C-反应蛋白测定采用散射比浊法。结果：60例急性肺炎患者中以链球菌属细菌感染率最高7例（11．6％），血清TNF-α、IL-6和CRP水平，TNF-α阳性60例（100％）；IL-6阳性45例（75％）；CRP阳性41例（68．3％）。结论：TNF-α水平测定作为急性感染的非特异性免疫指标，其敏感性和适用范围均优于IL-6和CRP，是名符其实的“广谱炎症性介质”。     

脑梗死患者血清中炎症细胞因子含量的变化与临床神经功能缺损程度的关系

目的：探讨脑梗死患者血清中炎症细胞因子含量的变化与临床神经功能缺损程度的关系。方法：将75例脑梗死组患者按照1995年中国脑中卒中患者临床神经功能缺损程度评分标准的评分结果分为轻度脑损伤（轻度）组，25例；中度损伤（中度）组，28例；重度损伤（重度）组，22例。选择同期健康体检正常者70例为对照组。检测两组血清肿瘤坏死因子-a（TNF-a）、白细胞介素-1B（IL-1B）、白细胞介素-6（IL-6）和C反应蛋白（CRP）的含量。结果：脑梗死组患者血清TNF—a、IL-1B、IL-6和CRP的含量，明显高于对照组（P值均〈0．001），脑梗死组中各亚组之间比较：重度组的含量分别高于中度组和轻度组（P〈0．05和〈0．01），中度组含量高于轻度组（P〈0．05），随着患者血清中炎症细胞因子含量的升高，患者的临床神经功能缺损程度评分（score）也增加，两者有显著的正相关关系。结论：脑梗死急性期存在炎症反应，检测血清TNF—a、IL-1B、IL-6和CRP的含量有助于脑梗死患者神经功能损伤程度的判断。其中CRP对神经功能损伤有独立的预测作用。     

尿毒症维持性血液透析患者不同透析龄血清氧化应激和炎症因子等指标的变化

目的：探讨长期与短期血液透析的尿毒症患者透析前后血清中脂质过氧化物丙二醛（MDA）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）、同型半胱氨酸（Hcy）等指标的改变。方法：按透析龄（3a以上和3a以内）分为长期组和短期组，每组各13例。其中长期组男7例，女6例；短期组男10例，女3例。在血液透析前后分别抽取患者静脉血进行生化指标检测，分别测定血红蛋白、尿素氮、肌酐、MDA、CRP、血清IL-6、Hcy。结果：长期血透的尿毒症患者透析前CRP、IL-6血清水平低于短期患者，而其MDA、Hcy水平高于短期患者；血液透析前后两组患者上述指标血清水平均有一定水平的改变，两组患者CRP水平透后均明显升高，长期组患者IL-6水平透后均明显下降，短期组患者IL-6水平透析前后无显著改变，而MDA、Hcy透后均明显下降。结论：随透析时长增加，肾衰患者血清中氧化应激水平呈上升趋势，炎症水平有所减轻；血液透析对患者血清中MDA、Hcy有-定的清除作用。     

Obesity, Inflammation and Acute Myocardial Infarction - Expression of leptin, IL-6 and high sensitivity-CRP in Chennai based population

ABSTRACT: BACKGROUND: Obesity which is characterised by increased fat mass is currently regarded as a pro-inflammatory state and often associated with increased risk of cardiovascular diseases (CVD) including Myocardial infarction. There is an upregulation of inflammatory markers such as interleukin-6, interleukin-6 receptor and acute phase protein CRP in Acute Myocardial Infarction (AMI) patients but the exact mechanism linking obesity and inflammation is not known. It is of our interest to investigate if serum leptin (ob gene product) is associated with AMI and correlated with inflammatory proteins namely Interleukin-6 (IL-6) and high sensitivity - C reactive protein (hs-CRP). RESULTS: Serum leptin levels were significantly higher in AMI patients when compared to Non-CVD controls. IL-6 and hs-CRP were also elevated in the AMI group and leptin correlated positively with IL-6 and hs-CRP. Incidentally this is the first report from Chennai based population, India. CONCLUSIONS: The strong correlation between serum levels of leptin and IL-6 implicates an involvement of leptin in the upregulation of inflammatory cytokines during AMI. We hypothesise that the increase in values of IL-6, hs-CRP and their correlation to leptin in AMI patients could be due to participation of leptin in the signaling cascade after myocardial ischemia.     

Dysregulated adipokine metabolism in chronic obstructive pulmonary disease

Eur J Clin Invest 2012; 42 (9): 983-991 ABSTRACT: Background Research concerning the involvement of body composition and systemic inflammatory markers in adipokine metabolism in chronic obstructive pulmonary disease (COPD) is still limited. Therefore, we primarily aimed to investigate the adipokine metabolism in relation to these systemic inflammatory biomarkers and to evaluate possible gender-related differences in the adipokine metabolism in patients with COPD. Materials and methods One hundred and eighty-six subjects with COPD [mean (SD) FEV(1) %pred: 50 (±16)] and 113 controls, matched for age, gender and body composition were selected from the ECLIPSE cohort. The following serological data were collected: serum levels of leptin, adiponectin and systemic inflammatory biomarkers such as C-reactive protein (CRP), Interleukin-6 (IL-6) and fibrinogen. Results Compared with controls, patients with COPD had higher levels of CRP, IL-6, fibrinogen and adiponectin. After stratification for gender, men with COPD had higher CRP, IL6 and fibrinogen levels compared with male controls, while women with COPD had higher levels of CRP and fibrinogen compared with the female controls. Moreover, in both female controls and patients with COPD, leptin correlated with CRP and fibrinogen, while leptin only correlated with CRP in male controls. Adiponectin correlated negatively with CRP, only in patients with COPD. Body mass index and gender were the strongest determinants for both leptin and adiponectin. Conclusions This study shows a gender-dependent dysregulation of adipokine metabolism in patients with COPD compared with BMI-matched controls. Furthermore, results from this study suggest a more prominent role of adiponectin in the systemic response to COPD.     

Clinical evaluation of the measurement of serum procalcitonin: comparative study of procalcitonin and serum amyloid A protein in patients with high and low concentrations of serum C-reactive protein

Levels of C-reactive protein (CRP) and serum amyloid A protein (SAA) in blood are increased as acute phase proteins in patients with inflammatory conditions. Most of the currently used inflammatory markers, such as erythrocyte sedimentation rate and CRP or SAA levels, are non-specific parameters. By contrast, procalcitonin (PCT) has been reported to be selectively induced by severe infection in systemic inflammatory response syndrome (SIRS) and also in sepsis or multiorgan dysfunction syndrome. PCT expression is induced only slightly, if at all, by viral infections, autoimmune disorders, neoplastic disorders and trauma arising from surgical intervention. Serum PCT and SAA levels were compared in 93 patients with a CRP concentration higher than 100 mg/L and in 26 patients with a CRP concentration lower than 1.5 mg/L. In patients with high levels of CRP, all patients with sepsis and severe bacterial infection showed a significantly increased PCT concentration of more than 1.0 microg/L and it was possible to differentiate between the patients with neoplastic disorders and those with other inflammatory diseases. In patients with low levels of CRP, the PCT concentration was less than 0.3 microg/L and an increased PCT level was not seen in patients with autoimmune disorders or viral and fungal infections. These results suggest that determining the serum PCT level may be useful in the differential diagnosis of severe infection.     

Metabolic and hemodynamic markers of endothelial dysfunction in patients with hypertension and patients with type 2 diabetes during the cold pressor test

Leptin, a 167-amino acid peptidic hormone secreted by adipose tissue, acts mainly in the arcuate hypothalamus nucleus as a satiety signal, but given its closed connections with inflammatory and endothelial systems, a probable regulatory role in blood pressure (BP) control by interaction with nitric oxide (NO) and C-reactive protein (CRP) has also been described. The cold pressor test (CPT) is a simple test that indirectly determines endothelial dysfunction. In this work, biochemical indicators (CRP, leptin, and NO) and hemodynamic indicators (systolic and diastolic BP) were performed and evaluated in patients with hypertension, patients with type 2, and control subjects during a single CPT for assessment of endothelial dysfunction. A total of 43 subjects aged 25 to 60 years were divided into three groups: 15 healthy volunteers, 13 patients with hypertension, and 15 patients with type 2 diabetes were included in the study. A complete clinical history was obtained from each subject and a complete physical examination, including an electrocardiogram, was carried out. During the 30-minute assay, 0.9% saline solution was infused intravenously. CPT was performed to assess the cardiovascular reactivity at 15 minutes. The cardiovascular variables (systolic and diastolic BP) were measured at 0, 16, and 30 minutes. In addition, serum variables were extracted at the beginning and at the end of the experiment and statistical analysis was performed. CPT caused in all subjects a significant increase in BP and pulse. There were no significant differences in CRP or leptin in all groups, although we observed significant differences for NO (P < 0.05). Sensibility and specificity for all biochemical variables resulted in nonsignificant statistical or clinical importance as markers of endothelial dysfunction; however, a positive association was found when leptin and NO were evaluated together (sensibility, 0.2; specificity, 0.8). CRP, leptin, and NO did not show any direct or significant association with the hemodynamic variables in this study, although a relationship was observed in NO according to group and among biochemical variables when studied together.     

多发性硬化患者血清leptin水平与PBMCs分泌细胞因子关系的研究

目的 探讨多发性硬化(MS)患者血清瘦素(leptin)水平的变化与外周血单个核细胞(PBMCs)分泌细胞因子水平的关系及其临床意义.方法 采用放射免疫法检测25例活动期MS患者、22例缓解期MS患者和30例健康对照者的血清leptin水平,同时测定其PBNCs在外源性leptin干预下培养上清液IL-4、INF-γ水平.结果 活动期MS患者血清leptin水平、PBMCs在leptin干预下培养上清液INF-γ、IL-4水平均高于缓解期MS患者和对照组(P<0.01);经过糖皮质激素治疗后活动期MS患者血清leptin水平、PBMCs在leptin干预下培养上清液INF-γ水平明显降低(P<0.01),而IL-4水平显著升高(P<0.01).结论 活动期MS患者血清leptin水平升高,leptin能够影响Ms患者PBMCs炎性细胞因子分泌,这可能与瘦素增加MS的易感性相关.     

Cardiovascular death and the metabolic syndrome: role of adiposity-signaling hormones and inflammatory markers

OBJECTIVE: Levels of adiposity-signaling hormones and inflammatory markers are less favorable in individuals with the metabolic syndrome; their role in the association between the metabolic syndrome and cardiovascular mortality remains unclear. RESEARCH DESIGN AND METHODS: We conducted a prospective study of 977 men and 1,141 women aged 40-94 years in 1984-1987, followed for mortality for a maximum of 20 years. Adiponectin, leptin, ghrelin, interleukin-6 (IL-6), C-reactive protein (CRP), and Adult Treatment Panel III-defined metabolic syndrome components were measured in fasting blood samples obtained in 1984-1987. Cox-proportional hazards models were used in survival analyses. RESULTS: The age- and sex-adjusted hazard ratio (HR) (95% CI) for coronary heart disease (CHD) mortality associated with the metabolic syndrome was 1.65 (1.25-2.18) (P < 0.001); this association did not differ significantly by sex, age, or diabetic status (P > 0.2 for each interaction). The association between the metabolic syndrome and CHD mortality was not materially changed after adjustment for adiponectin, leptin, and ghrelin; it was attenuated by 25% after adjustment for IL-6 and 35% after adjustment for CRP. CHD mortality increased linearly with greater levels of IL-6 and CRP (P(trend) < 0.001 for each); the age- and sex-adjusted HRs comparing highest versus lowest quarter were 3.0 (1.87-4.89) for IL-6 and 2.1 (1.41-3.21) for CRP. IL-6, but not CRP, remained a significant predictor of CHD mortality in models including both inflammatory markers and the metabolic syndrome. CONCLUSIONS: Adiposity-signaling hormones and inflammatory markers explain little to some of the association between the metabolic syndrome and CHD mortality. IL-6 levels predict CHD mortality independently of CRP.     

Clinical evaluation of the measurement of serum procalcitonin: comparative study of procalcitonin and serum amyloid A protein in patients with high and low concentrations of serum C‐reactive protein

Levels of C‐reactive protein (CRP) and serum amyloid A protein (SAA) in blood are increased as acute phase proteins in patients with inflammatory conditions. Most of the currently used inflammatory markers, such as erythrocyte sedimentation rate and CRP or SAA levels, are non‐specific parameters. By contrast, procalcitonin (PCT) has been reported to be selectively induced by severe infection in systemic inflammatory response syndrome (SIRS) and also in sepsis or multiorgan dysfunction syndrome. PCT expression is induced only slightly, if at all, by viral infections, autoimmune disorders, neoplastic disorders and trauma arising from surgical intervention. Serum PCT and SAA levels were compared in 93 patients with a CRP concentration higher than 100?mg/L and in 26 patients with a CRP concentration lower than 1.5?mg/L. In patients with high levels of CRP, all patients with sepsis and severe bacterial infection showed a significantly increased PCT concentration of more than 1.0?μg/L and it was possible to differentiate between the patients with neoplastic disorders and those with other inflammatory diseases. In patients with low levels of CRP, the PCT concentration was less than 0.3?μg/L and an increased PCT level was not seen in patients with autoimmune disorders or viral and fungal infections. These results suggest that determining the serum PCT level may be useful in the differential diagnosis of severe infection.     

肠缺血再灌注损伤对血清及脂肪组织Leptin水平的影响

背景近年来的研究发现脂肪组织不仅仅是脂肪的储存库,还是一种能够分泌多种功能性细胞因子的多潜能内分泌器官.Leptin是一种由脂肪组织特异性分泌的蛋白质,主要功能是抑制摄食和增加能量消耗.目的研究肠缺血再灌注损伤对血清及脂肪组织Leptin水平的影响,探讨Leptin在急性炎症反应中的作用.设计完全随机设计,自身及组间对照.地点和材料本实验于解放军总医院生化研究室完成.3只雄性新西兰白兔及54只雄性SD大鼠作为实验动物.干预免疫新西兰白兔获得Leptin抗体,采用氯胺-T法碘标记Leptin抗原,由此建立一种简便的鼠Leptin放射免疫分析法.建立大鼠肠缺血再灌注损伤模型,实验大鼠随机分为6组假手术组(sham)、缺血60min-再灌注30 min组(I60-R30),I60-R90,I60-R150,I60-R240及I60-R360组,每组9只.主要观察指标采用放射免疫分析法测量血清及脂肪组织Leptin浓度变化.结果与损伤前自身对照组的血清Leptin水平相比,肠缺血60min再灌注损伤30min(I60-B30)组显著降低(t=2.389 1, P＜0.05),I60-R150组呈现增高的趋势,而I60-R360组显著增高(t=-2.343 7,P＜0.05);与损伤后sham组的血清Leptin水平(9.88±1.87)βg/L相比,I60-R240组呈现增高的趋势,而I60-R360组(19.43±2.84)μg/L显著增高(t=-2.808 5,P＜0.05);与损伤后sham组的脂肪组织Leptin水平(11.12±1.27)ng相比,I60-R30(4.46±2.63)ng、I60-R90组(3.45±2.77)ng显著降低(t=2.280 4,2.517 0,两者P均＜0.05),而I60-R360组(17.54±1.87)ng显著增高(t=-2.840 1,P＜0.05).结论Leptin对肠缺血-再灌注损伤等急性炎症刺激具有时间依赖效应,并在急性炎症反应的能量代谢障碍中发挥一定作用.     

脂肪因子在评估急性胰腺炎预后价值中的探讨

目的脂肪因子在急性胰腺炎发病机制中的作用及对预后评估的价值。方法重型急性胰腺炎(SAP)患者14例。轻型急性胰腺炎(MAP)患者62例,检测两组血清中抵抗素、瘦素、脂联素、C反应蛋白和APACHEⅡ评分。结果抵抗素,瘦素及C反应蛋白在SAP组、MAP组之间存在显著差异(P0.05)。SAP组在APACEII评分和MODS患病率明显高于MAP组。MAP组抵抗素和瘦素水平较高的8例发展为重症胰腺炎,在入院24 h并未见CRP的明显增高,其中3例出现多系统器官衰竭。结论监测急性胰腺炎患者血清抵抗素、瘦素、CRP对评估急性胰腺炎的严重程度、早期预警MODS和评估患者预后方面有一定的临床应用价值,脂肪细胞因子的改变能够在CRP并未发生明显变化前出现,早期提示轻型胰腺炎的恶化。