慢性肾衰患者瘦素基因表达及蛋白表达与高瘦素血症的相关病因研究

目的：探讨慢性肾衰患者高瘦素血症与瘦素基因表达及蛋白表达、肾小球滤过率、体质指数及炎症、空腹胰岛素之间的相关性.方法：检测150例分别处于不同慢性肾功能衰竭阶段患者的血清瘦素水平、肾小球滤过率、同型半胱氨酸、C-反应蛋白、空腹胰岛素的,并计算其体质指数.RT-PCR法检测15例终末期肾衰患者腹部脂肪组织瘦素基因表达;免疫组化法检测其瘦素蛋白表达.结果：肾功能损伤患者血清平均瘦素水平明显高于健康对照组（P〈0.01）,与体质量指数之间呈正相关（P〈0.01）,与肾小球滤过率呈负相关（P〈0.01）.相关性分析发现血清瘦素与C-反应蛋白、同型半胱氨酸及空腹胰岛素之间呈正相关（P均〈0.05）.终末期肾功能衰竭患者脂肪组织瘦素mRNA表达水平低于健康对照组（P〈0.01）,而蛋白表达高于健康对照组（P〈0.01）.血清瘦素水平与瘦素基因表达水平呈负相关（P〈0.05）.结论：慢性肾衰患者血清瘦素水平的升高与肾小球滤过率下降所导致的瘦素清除减少有关;终末期肾衰患者脂肪组织瘦素蛋白表达水平升高可能与慢性肾衰高瘦素血症有关.

Expression of leptin gene and protein and pathogeny of hyperleptinemia in chronic renal failure patients

AIM: To study the correlation of hyperleptinemia with leptin gene and protein expression, glomerular filtration rate (GFR), body mass index (BMI), inflammation and fasting insulin (FINS) in chronic renal failure (CRF) patients. METHODS: Serum leptin levels and GFR, C-reactive protein (CRP), total homocystein (tHcy) and FINS were measured in 150 patients with various degrees of renal failure. Leptin gene expressions in abdominal fat of 15 end-stage renal disease (ESRD) patients were determined by RT-PCR. Leptin level in the same set of fat tissue samples was determined by immunohistochemistry. RESULTS: Serum leptin level was significantly higher than that in healthy controls (P<0.01). A significantly positive correlation between serum leptin and BMI (P<0.01) was found in CRF patients. A negative correlation between serum leptin levels and GFR (P<0.01) was found in CRF patients. Positive correlations between serum leptin and CRP, tHcy, FINS (P<0.05) was found in these patients. The leptin mRNA expression was significantly lower in patients with ESRD than that in healthy controls (P<0.01), but protein expression was significantly higher than the latter (P<0.01). A negative correlation was seen between serum leptin and leptin gene expression in these patients (P<0.05). CONCLUSION: Increased serum leptin level is related to the decreased GFR in CRF patients. Elevated leptin concentration will increase leptin gene protein expression in fat tissue of ESRD patients.