Clinical significance of the soluble interleukin‐2 receptor as a putative systemic nutritional index in the elderly*

Background: The clinical significance of a slight increase in serum soluble interleukin‐2 receptor (sIL2R) concentration in the stable elderly was investigated. Methods: The subjects consisted of 35 residents of nursing homes with physical impairment as a sequela to cerebral infarctions, who had no inflammatory conditions, and were not receiving anodyne or immunological treatment. They were divided into two groups: 24 subjects without overt or suspected malignancy (NC) and 11 with a history of malignancy (CA). Serological screening with measurement of sIL2R concentrations was performed and numbers of lymphocytes with CD4 and CD8 markers were determined. The NC group was subdivided into control subjects (n = 15, sIL2R < = 883 U/mL) and subjects demonstrating elevated concentrations of sIL2R (n = 9, NH), as in a previous study. Results: Between the NH and control groups, differences were found in serum concentrations of albumin, blood urea nitrogen, total cholesterol concentration, Pettigrew's prognostic nutritional index (PNI) and activities of daily living score, but not in age or sex. Factor analysis in the NC group showed serum creatinine and blood urea nitrogen concentrations to be correlated positively, and serum albumin, total cholesterol concentrations, activities of daily living score, and PNI to be correlated negatively with sIL2R. Differences were found in sIL2R, albumin, total protein, total cholesterol, β‐lipoprotein and PNI between the CA and control groups, but no correlations among these parameters were found in the CA group. There was no difference in the rate of positive test results for rheumatoid factor between the NC and CA, or control and NH groups. The survival rate of control subjects over 24 months was better than that of NH subjects, but not that of CA subjects. Conclusion: Our results suggest that a slight increase in the concentration of sIL2R is related to subclinical systemic deterioration, especially regarding nutrition, with a plausible connection to prognosis, in stable elderly patients without malignancy.     

Soluble interleukin 2 receptors in sera of Japanese patients with adult T cell leukemia mark activity of disease

Serum concentrations of soluble interleukin 2 receptors (sIL 2R) were measured by an enzyme-linked immunosorbent assay (ELISA) in 30 patients with adult T cell leukemia (ATL), in 9 patients with other hematopoietic malignancies, and in 17 asymptomatic individuals seropositive for human T cell leukemia virus type I (HTLV-I). Sixty HTLV-I seronegative, age-matched controls showed a normal range of form 63.2 to 480.8 U/mL. All asymptomatic carriers of HTLV-I had sIL 2R in their sera within the normal range. sIL 2R in sera was not related to the anti-HTLV-I antibody titer. Eleven patients with acute ATL, a clinical phenotype with median survival rate of 4.4 months, had markedly elevated sIL 2R (11,100 to 99,000 U/mL), but eight patients with smoldering ATL had low sIL 2R values (less than 480.8 U/mL) comparable to controls. Eleven patients with chronic ATL had intermediate elevated levels of sIL 2R (480.8 to 37,300.0 U/mL). Serum levels of sIL 2R correlated with the number of ATL cells (r = 0.812) and CD25-positive cells (r = 0.725) circulating in the peripheral blood. Longitudinal studies performed in four patients with ATL showed significant correlation between serum concentration of sIL 2R and activity of the malignancy. These findings suggest that the level of sIL 2R in serum indicated tumor load and, possibly, prognosis.     

SERUM SOLUBLE INTERLEUKIN 2 RECEPTOR IN HYPERTHYROID Graves''DISEASE AND EFFECT OF CARBIMAZOLE THERAPY

To study the activation of T lymphocytes in hyperthyroid Graves' disease, the serum concentrations of soluble interleukin 2 receptors (sIL2R) were determined during active thyrotoxicosis and following the return to a euthyroid state with carbimazole therapy. Serum sIL2R was measured by an enzyme linked immunoassay. The mean +/- SD serum sIL2R concentration during untreated hyperthyroidism was elevated as compared with controls (919.1 +/- 523.4 vs 374.2 +/- 189.4 U/ml, P less than 0.005). However, after carbimazole therapy the serum sIL2R in euthyroid patients fell to 377.9 +/- 90.3 U/ml, which did not differ from healthy controls. Serum sIL2R correlated significantly with the serum free T3 only during hyperthyroidism (r = 0.678, P less than 0.01). Our study suggests that in vivo measurement of serum sIL2R released from activated T lymphocytes is a useful immunological indicator of disease activity.     

老年心衰患者血清sIL—2R及T细胞亚群的变化

目的研究老年心衰（ＨＦ）患者血清中可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）及Ｔ淋巴细胞亚群（Ｔ－ＬＳ）的变化及临床意义。方法血清ｓＩＬ－２Ｒ测定采用酶联免疫吸附双抗体夹心法，Ｔ－ＬＳ采用抗体致敏的红细胞花环法。检测４０例老年ＨＦ及３０例正常组血清ｓＩＬ－２Ｒ及Ｔ－ＬＳ的变化。结果老年ＨＦ患者血清ｓＩＬ－２Ｒ水平与正常组比较显著增高（Ｐ＜０．０５，Ｐ＜０．０１）；Ｔ－ＬＳ在老年ＨＦ与正常组比较显著下降（Ｐ＜０．０５，Ｐ＜０．０１）。结论血清ｓＩＬ－２Ｒ水平及细胞免疫低下可影响老年ＨＦ的发病及预后     

Increased serum soluble interleukin 2 receptor levels in patients with viral liver diseases

Soluble interleukin 2 receptors (sIL 2R) in the sera of patients with viral liver diseases were quantified with a solid-phase enzyme immunoassay using two monoclonal antibodies against the receptors. The sIL 2R levels in patients with acute hepatitis, chronic hepatitis, liver cirrhosis and hepatocellular carcinoma were significantly higher than those in control subjects. In acute hepatitis patients, the high levels of sIL 2R observed during the florid stage returned to normal during remission. Levels in patients with chronic active hepatitis were significantly higher than in those with chronic persistent and lobular hepatitis, and levels observed during the exacerbation phase of chronic hepatitis were higher than they were during remission. Thus, in chronic hepatitis, sIL 2R levels increased in proportion to the inflammatory activity, and correlated well with serum transaminase (glutamic oxaloacetic transaminase: SGOT, glutamic pyruvic transaminase: SGPT) activities, but not with blood urea nitrogen or creatinine concentrations. In patients with a high degree of focal and piecemeal necrosis, serum sIL 2R levels increased further during recombinant interleukin 2 therapy. In post-hepatitic liver cirrhosis and hepatocellular carcinoma, sIL 2R levels correlated with serum cholinesterase and creatinine concentrations, but not with transaminase activities. Measurement of serum sIL 2R levels in patients with liver disease but without renal injury, may help in the diagnosis of inflammation in hepatitis, a process in which interleukin 2 may participate.     

老年高血压病患者血清可溶性白介素2受体与临床分期相关性的观察

目的探讨老年高血压病患者血清中可溶性白介素－２受体（ｓＩＬ－２Ｒ）的水平，并比较老年高血压病不同临床分期的ｓＩＬ－２Ｒ变化。方法采用双抗体夹心（ＥＬＩＳＡ）法，对４６例老年高血压病人血清ｓＩＬ－２Ｒ的水平，与３０例正常人（ＮＣ）进行检测对比，并对其老年高血压病患者不同临床分期的ｓＩＬ－２Ｒ的水平进行观察。结果老年高血压病患者ｓＩＬ－２Ｒ水平明显高于对照组（Ｐ＜０．０１）；且随临床分期的增加而增高（Ｐ＜０．０１），有明显的正相关性。结论老年高血压病患者体内存在有免疫功能系乱，导致ｓＩＬ－２Ｒ的增高。ｓＩＬ－２Ｒ可作为临床观察老年高血压病的细胞免疫功能及病情判定的有效指标。     

老年冠心病患者氧化修饰低密度脂蛋白与微量元素代谢变化的关系

目的探讨老年冠心病患者机体微量元素代谢与低密度脂蛋白氧化之间的关系。方法测定６０例老年冠心病患者及３６例正常人血浆氧化低密度脂蛋白（ＯＸ－ＬＤＬ）水平,同时测定血清锌、硒、铜等１３种元素及血清铜蓝蛋白（ＣＰ）、铁蛋白（ＳＦ）、脂质、脂蛋白等。各检测指标与ＯＸ－ＬＤＬ行直线相关分析及多因素逐步回归分析。结果冠心病组血浆ＯＸ－ＬＤＬ、血清ＴＧ、ＬＤＬ－Ｃ、铜、ＣＰ、ＳＦ、铜／锌水平均显著高于正常对照组,血清硒、锌、ＨＤＬ－Ｃ、铬水平均显著低于正常对照组。ＴＧ、铜、ＣＰ、铜／锌与ＯＸ－ＬＤＬ呈显著正相关,而ＨＤＬ－Ｃ、硒、锌与ＯＸ－ＬＤＬ呈显著负相关。多因素逐步回归分析表明硒、锌、铜、铁等微量元素可影响低密度脂蛋白的氧化。结论铁、铜可能促进体内ＯＸ－ＬＤＬ的形成,而硒、锌对低密度脂蛋白的氧化可能起保护作用。     

Serum soluble interleukin 2 receptor in systemic lupus erythematosus: effects of disease activity and infection.

Serum soluble interleukin 2 receptor (sIL2R) was measured in patients with active and inactive systemic lupus erythematosus (SLE). The concentration of sIL2R was higher in inactive SLE than in normal controls and was significantly increased in active compared with inactive SLE. When patients with active SLE were followed up serially it was found that the sIL2R concentration fell when the disease became inactive. There was no statistically significant association between sIL2R and the grades of disease activity, however. In patients with either active or inactive SLE and infection the sIL2R concentration was much higher than in those without infection. Chronic infection (tuberculosis or candida) was associated with a much higher concentration of sIL2R than pyogenic or herpes zoster infection. The sIL2R concentration helps to distinguish infection in patients with SLE.     

阿尔茨海默病患者血清和脑脊液中白细胞介素-2及白细胞介素-2受体水平的研究

目的　探讨阿尔茨海默病 (AD)的病因及发病机制。方法　采用双抗体夹心酶联免疫吸附试验分别对AD患者血清和脑脊液中白细胞介素 2 (IL 2 )及白细胞介素 2受体 (sIL 2R)水平进行检测。结果　 (1)AD组脑脊液 (CSF)中sIL 2R阳性率明显高于脑血管性痴呆 (VD)组及对照组 (P <0 .0 5 ) ;(2 )AD组血清和CSF中IL 2和sIL 2R含量明显高于VD组和正常对照组 (P <0 .0 5 ,P <0 .0 1) ;(3)AD组IL 2与sIL 2R在血清或CSF中含量均呈正相关 ,与简易智力状态检查量表得分呈负相关。结论　AD组患者CSF中IL 2和sIL 2R可来源于外周免疫系统 ,还可能来源于中枢神经系统的自身合成。检测AD患者CSF中IL 2和sIL 2R水平可反映AD的病理改变程度     

Severe ascites with hypothyroidism and elevated CA125 concentration: a case report

Ascites caused by hypothyroidism is rare and the pathogenesis is unclear. Several reports have presented cases of progressive ascites with hypothyroidism and elevated tumor markers. We report a 31-year-old female case with massive ascites and elevated serum CA 125 concentrations. The patient had no typical feature of hypothyroidism except an accumulation of ascitic fluid which showed elevated total protein concentration and a high serum-ascites albumin gradient (SAAG). There was no finding of malignancy. Following thyroid hormone replacement, the ascites was completely resolved accompanied by reduced concentrations of serum CA125. In general, primary hypothyroidism with ascites presents with coexisting massive pericardial or pleural effusion. The massive ascites and increased serum CA125 concentrations may have led us to make the incorrect diagnosis of ovarian malignancy. The evaluation of thyroid function is useful to determine the pathology of high-protein ascites or elevated tumor markers, and ascites may be treatable by thyroid replacement therapy.     

肝硬化患者血清—氧化氮和几种白细胞介素检测的临床意义

目的　探讨肝硬化患者血清一氧化氮 (NO)、白细胞介素 2 (IL 2 )、白细胞介素 6 (IL 6 )、白细胞介素 8(IL 8)及可溶性白细胞介素 2受体 (sIL 2R)变化的临床意义。方法　应用ELISA法测定肝硬化患者及正常对照组的血清IL 6、IL 8及sIL 2R含量 ;应用MTT法检测血IL 2活性 ;应用荧光法检测血清NO水平。结果　肝硬化患者血清IL 2、sIL 2R、IL 6、IL 8及NO水平 :(5 741.5 3± 4376 .5 2 )U/ml、(486 .76± 46 .41)U/ml、(15 .78± 3.0 4) pg/ml、(2 3.89± 2 .13)pg/ml及 (6 .33± 0 .37) μmol/L ,显著高于正常对照组 :(173.88± 92 .2 1)U/ml、(2 42 .36± 35 .78)U/ml、(6 .14± 3.12 ) pg/ml、(17.71± 1.32 )pg/ml及 (3.6 8± 0 .34 ) μmol/L ,并随肝功受损程度进行性增加。 结论　肝硬化患者血清IL 2、sIL 2R、IL 6及IL 8增加可能为NO增多的诱发因素 ;肝功能损伤可能是白细胞介素活性增加的重要原因。     

血清可溶性IL-2受体测定在急慢性肝脏疾病中的意义

目的 探讨急慢性肝病可溶性白介素2受体的改变,为诊断病情演变和预后判定寻找可靠的依据。 方法 健康对照(n=30)研究,采用夹心酶联免疫吸附法测定173例各型肝病患者血清IL-2受体(sIL-2R)水平,包括急性病毒性肝炎80例,慢性乙型肝炎21例,肝炎后肝硬化35例和原发性肝癌37例,并对测定结果进行分析。 结果 各组患者血清sIL-2R均明显高于对照组(P<0.01),其中急性病毒性肝炎黄疸期血清sIL-2R明显高于恢复期(P<0.01),各型急性肝炎之间血清sIL-2R无显著差异(P>0.05);急性肝炎组明显高于慢性肝炎组(P<0.01);慢性乙型肝炎ALT异常组血清sIL-2R明显高于ALT正常组(P<0.01);Child's C级肝炎后肝硬化者明显高于CHild'B,A级者(P<0.01);原发性肝癌者血清sIL-2R水平与肿瘤体积大小有关(P<0.05)。 结论 急慢性肝病患者血清sIL-2R水平均明显增高,其水平的高低在一定程度上反映了机体免疫功能状态和肝细胞损伤的程度。     

老年急性脑血管病患者细胞因子及其受体的研究

目的　探讨老年急性脑血管病患者细胞因子及其受体的变化。方法　采用酶联免疫吸附试验测定 6 5例老年急性脑血管病患者血清可溶性白细胞介素 2受体 (sIL 2R)、可溶性白细胞介素 6受体 (sIL 6R)、可溶性细胞间粘附分子 1(sICAM 1)及转化生长因子 β1(TGF β1)的含量。另选 38名健康人作为对照。结果　老年急性脑血管病患者的血清sIL 2R为 (75 4± 2 0 3)U/ml,sIL 6R为 (5 8± 12 )mg/L ,sICAM 1为 (5 5 8± 2 11) μg/L ,比对照组均明显升高 ,而TGF β1[(2 2± 10 ) μg/L]含量明显减少。头颅CT显示病灶大小与血清sICAM 1含量呈显著正相关。 结论　血清sIL 2R、sIL 6R、sICAM 1及TGF β1含量可作为判断老年脑血管病患者病情变化的指标之一     

Urinary hGH, albumin, alpha 1 MG and beta 2 MG in normal and diabetic children

I measured urinary hGH level in children with insulin dependent diabetes mellitus (DM) and studied the relation with urinary albumin alpha 1-microglobulin (alpha 1 MG), beta 2-microglobulin (beta 2MG) and plasma HbA1. 24-hour urine or night-time urine was collected in 54 normal children (NC) and 61 DM. Urinary hGH was estimated by using a sensitive sandwich enzyme immunoassay. Urinary albumin, alpha 1 MG and beta 2MG were measured by RIA. HGH concentration in 24-hour urine in NC significantly correlated with urinary albumin and beta 2MG concentrations (p less than 0.01). In DM, hGH concentration in 24-hour urine also correlated with urinary albumin concentration (p less than 0.05). To avoid the effects of posture and exercise, night-time urine was used in the following study. Urinary hGH concentration was significantly higher in DM for all age (p less than 0.05-0.01) than that in NC. Urinary alpha 1MG and beta 2MG concentrations were also significantly higher in DM than those in NC. HGH concentration in night-time urine in NC has not correlated with urinary albumin, alpha 1MG nor beta 2MG. In DM, however hGH significantly correlated with urinary albumin and beta 2MG. Even in DM with normal concentrations of urinary albumin and beta 2MG, urinary hGH was significantly higher than in NC. Urinary hGH in poorly controlled DM was higher than in well controlled DM. Urinary hGH concentration showed positive correlation with plasma HbA1 in DM. We conclude that urinary hGH relates to not only serum hGH concentration but also renal function. In DM with normal renal function, hGH concentration in night-time urine was higher than in NC, which suggested high serum hGH concentration in DM.     

Evaluation of the measurement of plasma fructosamine concentration in aged subjects

Recently, plasma fructosamine concentration has been used as an indication of mean plasma glucose level preceding at last 1 to 2 weeks. In the present study, to characterize the clinical significance and problems of plasma fructosamine concentration in aged subjects (greater than or equal to 65 yrs), we determined plasma fructosamine concentration as well as serum albumin, total protein, HbA1, AbA1c and fasting plasma glucose concentrations in 81 (less than 65 yrs) non-diabetic subjects (group A), 161 aged (greater than or equal to 65 yrs) non-diabetic subjects and 26 aged diabetics (group D). Aged non-diabetic subjects were further classified into 75 subjects with good ADL (group B) and 86 with poor ADL (group C). The normal limit of plasma fructosamine concentration (mean +/- 2SD) in group A was 24% higher (3.1 mmol/l) than that in group B (2.5 mmol/l) but the plasma fructosamine/serum albumin ratio (F/ALB) was similar in these two groups. Plasma fructosamine correlated negatively (p less than 0.01) with age. This aging effect was explained by the reduced serum albumin in aged subjects. However, in group C, reduced plasma albumin was not associated with reduced plasma fructosamine. Plasma fructosamine corrected by albumin (F/ALB) is a useful parameter of blood glucose control in aged subjects. In aged subjects with poor ADL, HbA1, HbA1c and plasma glucose should be determined with fructosamine.     

结肠癌患者血清可溶性sIL-2R含量的变化

目的探讨结肠癌患者手术前血清可溶性白介素２受体（ｓｏｌｕｂｌｅｉｎｔｅｒｌｕｋｉｎ２ｒｅｃｅｐｔｏｒ，ｓＩＬ２Ｒ）含量改变与疾病的诊断、分期、预后判断等的关系．方法采用ＥＬＩＳＡ法对２７例结肠癌患者（ＤｕｋｅｓＡ，Ｂ期１９例），Ｃ，Ｄ期８例）及４２例对照组（正常３２例及肠易激综合征１０例）分别测定血清ｓＩＬ２Ｒ含量．同时使用间接荧光染色法对各组进行血ＣＤ３，ＣＤ４，ＣＤ８及ＣＤ４／ＣＤ８的测定．结果结肠癌患者ＤｕｋｅｓＡ，Ｂ期组血清ｓＩＬ２Ｒ含量（８３５ｐｍｏｌ／Ｌ±２１８ｐｍｏｌ／Ｌ）与对照组（６９２ｐｍｏｌ／Ｌ±２７９ｐｍｏｌ／Ｌ及７６２ｐｍｏｌ／Ｌ±２４６ｐｍｏｌ／Ｌ）无明显差异，而有淋巴结转移的ＤｕｋｅｓＣ，Ｄ期患者（３２１６ｐｍｏｌ／Ｌ±２３４４ｐｍｏｌ／Ｌ）则明显高于ＤｕｋｅｓＡ，Ｂ期患者，且ＣＤ４／ＣＤ８值明显下降（１０６±０４９比１５８±０３６）；另外，血清ｓＩＬ２Ｒ含量还与肿瘤细胞分化程度密切关联．结论结肠癌术前血清ｓＩＬ２Ｒ含量与疾病分期及预后有关．     

Circulating lipids and minor abnormalities of thyroid function

OBJECTIVE: We determined the effect of subclinical hyperthyroidism (defined as low circulating TSH with normal serum free T4) and subclinical hypothyroidism (raised serum TSH with normal free T4) on fasting levels of blood lipids. DESIGN: Prospective study of lipid concentrations in patients identified as having abnormal TSH. PATIENTS: Patients were identified in a population screening study of those over 60 years, with persistently low TSH with normal free T4 (n = 27) or high TSH but normal free T4 (n = 57). Patients were matched to controls with normal serum TSH by age, sex and body mass index. MEASUREMENTS: Serum TSH, free T4, free T3, total cholesterol, low density lipoprotein (LDL) cholesterol and high density lipoprotein (HDL) cholesterol. RESULTS: Serum free T4 measurements were significantly higher in those with subclinical hyperthyroidism than in their controls (P < 0.001) and lower in those with subclinical hypothyroidism than in matched controls (P < 0.001). Measurement of fasting lipids in patients and controls revealed a marked (12.2%) reduction in serum total cholesterol in subclinical hyperthyroidism (P < 0.01); no significant difference in fasting lipids between patients with subclinical hypothyroidism and controls was observed. CONCLUSIONS: Differences in free T4 between those with low or high TSH and controls with normal TSH suggest that abnormalities of TSH directly reflect thyroid hormone excess and deficiency. A reduction in cholesterol in those with subclinical hyperthyroidism suggests a direct influence of thyroid hormone excess on lipid metabolism in these patients.     

Serum interleukin‐6 receptor in polymyalgia rheumatica: A potential marker of relapse/recurrence risk

Objective

To investigate the modulation of systemic levels of soluble interleukin‐6 receptor (sIL‐6R) and soluble gp130 (sgp130) in untreated and treated polymyalgia rheumatica (PMR) patients during a followup period of at least 24 months in order to evaluate the relationship of these molecules with clinical outcome and their feasibility to provide a prognostic tool in clinical practice.

Methods

We analyzed sIL‐6R and sgp130 serum levels in 93 PMR patients, and 46 age‐matched normal controls, at disease onset and at 1, 3, 6, 12, and 24 months of followup during corticosteroid therapy by enzyme‐linked immunosorbent assay.

Results

No difference in sIL‐6R and sgp130 levels was observed between PMR patients and normal controls at disease onset or during followup. A significant correlation was found between the number of relapses and sIL‐6R concentrations at baseline and after 1, 3, and 12 months of therapy. No correlation was found between sgp130 levels and the number of relapses. Cox multivariate analysis indicated that the best model for predicting relapses was identified by sIL‐6R levels and the hemoglobin value at baseline. We found that high sIL‐6R levels combined with low hemoglobin values resulted in a 10.1‐fold increased risk of relapse.

Conclusion

Our data support the identification of a potential prognostic marker of PMR outcome that might have important implications in clinical practice. Because targeting sIL‐6R with blocking antibodies has proven useful in other rheumatic disorders, our results could suggest the opportunity to evaluate sIL‐6R–blocking treatment in patients with PMR and elevated levels of sIL‐6R at disease onset.     

Expression of proinflammatory cytokines and their inhibitors during the course of spontaneous bacterial peritonitis

The aim of this work was the evaluation, in cirrhotic patients with noninfected ascites and with spontaneous bacterial peritonitis (SBP), of serum and ascitic fluid levels of proinflammatory cytokines [interleukin (IL) 1-, tumor necrosis factor (TNF-), and IL6] and antiinflammatory compounds [IL10, soluble IL-1 receptor antagonist (sIL-1Ra), soluble receptors of TNF p55 and p75 (sTNFR55 and sTNFR75), and soluble receptor of IL6 (sIL6R)], as well as their relationship with the outcome of the infection in those with SBP. These molecules were assayed by ELISA in noninfected cirrhotic controls (n = 15), patients with SBP (n = 32), and healthy controls (n = 20). Serum levels of IL6 and of the majority of antiinflammatory mediators, sIL1Ra, sTNFR75, and sIL6R, were higher in control cirrhotic patients compared to healthy subjects. SBP was associated with significantly elevated ascitic fluid levels of every one of the proinflammatory cytokines compared to those in cirrhotic controls. Also, serum levels of IL10 and both TNF receptors and ascitic fluid levels of sIL1Ra and sTNFR55 were higher in patients with SBP compared to cirrhotic controls. Ascitic fluid levels of proinflammatory cytokines decreased rapidly after resolution of the infection; however, nonsignificant changes were detected in ascitic fluid concentrations of antiinflammatory molecules. Thus, elevated levels of antiinflammatory compounds both in noninfected cirrhotic patients and in patients with SBP suggest a regulatory control of the inflammatory process by these molecules in liver cirrhosis patients.     

Concentration of leptin in patients on hemodialysis and peritoneal dialysis

Leptin, the obese gene (ob) product, is a plasma protein synthesized exclusively in adipocytes and plays an important role in regulation of food intake and energy expenditure. The aim of the study was to compare serum leptin concentration in hemodialyzed (HD) patients and in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and to assess the relationship between leptinemia and parameters of nutritional state and inflammatory markers. We studied two group of patients with end-stage renal failure: 52 hemodialyzed individuals aged 24-74 years and 19 peritoneally dialyzed patients aged 20-70 years. Serum hemoglobin concentration, erythrocyte count, cholesterol, triglycerides, total protein, albumin, urea before and after HD, urea in CAPD patients, CRP, peritoneal protein loss were determined by standard laboratory methods. Serum leptin concentration before and after HD, in CAPD patients, leptin in ultrafiltrate and in peritoneal fluid was measured by commercially available radioimmunoassay. Plasma TNF-alpha and IL-1 concentration were measured by ELISA. We found that the serum leptin concentration was higher in hemodialyzed patients than in peritoneal dialyzed individuals (19.97 +/- 22.57 ng/mL vs 3.52 +/- 4.39 ng/mL, p < 0.01). There was a significant correlation between serum leptin levels and BMI in both studied groups (r = 0.81, p < 0.01 in HD group; r = 0.46, p < 0.05 in CAPD group). Concentrations of inflammatory markers (CRP, TNF-alpha, IL-1) were higher in hemodialyzed patients. Peritoneally dialyzed patients presented higher serum lipid concentrations (cholesterol and triglycerides) (p < 0.05). Neither inflammatory markers concentrations nor serum lipid concentrations correlate with the serum concentration of leptin.