慢性阻塞性肺疾病营养状态与血清瘦素和肿瘤坏死因子及肺功能的关系

目的探讨不同营养状态慢性阻塞性肺疾病（COPD）患者血清瘦素、血清肿瘤坏死因子及肺功能关系。方法13例健康老年人为对照组和50例稳定期COPD患者为COPD组（包括营养不良COPD组18例，正常体重COPD组24例及超重及肥胖COPD组8例），测定各组患者体质指数（BMI）、血清瘦素、血清肿瘤坏死因子、第1秒用力呼气容积（FEV1）水平。分析血清瘦素与BMI、血清肿瘤坏死因子及肺功能相关性。结果营养不良COPD组患者血清瘦素水平显著低于正常体重COPD组、超重及肥胖COPD组患者，差异均有统计学意义（P〈0．01），正常体重COPD组患者血清瘦素水平与超重及肥胖COPD组患者相比，差异有统计学意义（P〈0．01），超重及肥胖COPD组患者血清瘦素水平与对照组比较差异无统计学意义（P〉0．05）。营养不良COPD组患者血清TNF—α水平显著高于正常体重COPD组、超重及肥胖COPD组患者，差异均有统计学意义（P〈0．01），正常体重COPD组患者血清肿瘤坏死因子水平与超重及肥胖COPD组、对照组患者相比，差异无统计学意义（P〉0.05）。营养不良COPD组患者FEV1水平明显低于正常体重COPD组及超重及肥胖COPD组（P〈0．01），正常体重COPD组与超重及肥胖COPD组及对照组患者FEV1水平相比，差异无统计学意义（P〉0．05）。稳定期各组COPD患者血清瘦索水平与BMI明显相关（P〈0．01或P〈0．05），与血清肿瘤坏死因子及肺功能水平无明显相关（P〉0.05）。营养不良COPD组患者FEV1水平与血清肿瘤坏死因子水平明显负相关（P〈0．01），超重及肥胖COPD组患者FEV1与血清瘦素水平明显负相关。结论稳定期COPD患者营养状态与血清瘦素水平有关，营养不良患者肺功能水平与血清肿瘤坏死因子水平有关，超重及肥胖COPD患者肺功能水平与血清瘦素水平有关。

Nutritional status,serum leptin,tumor necrosis factor and lung function in patients with chronic obstructive pulmonary disease

Objective To investigate the correlation among serum leptin,tumor necrosis factor,lung function and nutrition status in patients with chronic obstructive pulmonary disease(COPD).Methods Fifty COPD patients in stable stage were enrolled,including 18 malnutritional cases(group Ⅰ),24 normal body weight cases (groupⅡ)and 8 overweight and obesity cases(groupⅢ).Meanwhile 13 healthy cases were included as the control group.Body mass index(BMI),serum leptin,Tumor necrosis factor-α(TNF-α)and First forced expiratory volume (FEV1)were measured.Results Serum leptin level was significantly lower in group Ⅰ than that in group Ⅱ and group Ⅲ(P＜0.01).There was no significant difference between group Ⅲ and control group(P＞0.05).Serum TNF-αlevel was significantly higher in group Ⅰ than that in group Ⅱ and group Ⅲ(P＜0.05);there was no significant difference of TNF-αlevel among group Ⅱ,group Ⅲ and control group(P＞0.05);FEV1 was significantly lower in group Ⅰ than that in group Ⅱ,group Ⅲ and control group(P＜0.01),there were no statistically significant of FEV1 among group Ⅱ,group Ⅲ and control group(P＞0.05).The FEV1 in group Ⅰ showed a negative correlation with TNF-α.Moreover the FEV1 in group Ⅲ showed a negative correction with leptin.Conclusion The nutrition status in patients with COPD was related with serum leptin level.The lung function in patients with malnutritionul COPD was correction with serum TNF-αlevel.The lung function in patients with overweight and obesity was related with serum leptin.