瘦素与血液透析并发的营养不良

慢性肾功能衰竭（CRF）血液透析（血透）患者广泛存在蛋白质－能量营养不良，其发生与日益增高的发病率和死亡率密切相关，但其发病机制仍不完全清楚。目前，在许多研究热点中，leptin（瘦素）颅受关注。瘦素是肥胖基因编码的产物，可调控进食行为和能量消耗。在血透过程中，透析的充分性、血胰岛素浓度等均可影响患者血瘦素水平。它主要作用于下丘脑，引起神经肽（NPY）分泌减少，从而抑制食欲，增强物质与能量代谢，最终导致营养不良。因此，许多学者反素作为一个营养指标。现就血透中影响瘦素水平的因素及其在营养不良中的作用作一简要综述。

Leptin and hemodialysis with malnutrition

Protein calorie malnutrition is a common problem in hemodialysis(HD) patients with advanced chronic renal failure and is associated with increased morbidity and mortality.The mechanisms causing malnutrition is not fully understood.At present,leptin is highly concerned.Leptin,the product of the adipose specific ob gene,regulates food intake and energy expenditure.In HD patients many factors influence serum leptin level such as the adequacy of dialysis,plasma insulin.Its major action on the hypothalamus is to decrease the production of neuropeptide Y(NPY).The reduction of NPY leads to decreased appetite and increased energy expenditure,ultimately resulting in malnutrition.So leptin has been regarded as a nutritional marker.In this paper,the factors influencing serum leptin level and its relevance to the pathogenesis of malnutrtion were reviewed.