肝炎后肝硬化患者血清瘦素测定的临床意义

目的　检测肝炎肝硬化患者血清瘦素水平 ,并探讨瘦素与肝硬化患者肝功能、胰岛素抵抗及其营养参数之间的关系。方法　 2 0 0 2 - 0 3～ 2 0 0 3- 0 1河北医科大学第二医院 32例男性肝炎肝硬化患者及 14名男性健康受试者均测定空腹血糖 (FPG)、空腹胰岛素 (FINS)和瘦素 ,同时测量肝硬化患者的营养参数 ,并对肝硬化患者进行Child -pugh分级。结果　肝硬化患者血清瘦素水平显著高于正常对照组 (P <0 . 0 5 ) ;但依据Child -pugh分级后的 3组肝硬化患者间的血清瘦素水平差异无显著性 (P >0 . 0 5 ) ;血清瘦素水平与体重指数 (BMI)、三头肌皮褶厚度 (TSF)及FINS均呈显著性正相关 (r值分别为 0 . 343、0 .340和 0 . 35 2 ,P值均 <0 . 0 5 ) ,而与肌酐身高指数 (CHI)及胰岛素敏感指数 (ISI)均呈负相关 (r值分别为 - 0 .36 0和 - 0 . 4 16 ,P值均 <0 . 0 5 )。结论　肝炎肝硬化患者血清瘦素水平的改变可能与肝功能无关 ,但参与了肝硬化的营养不良和胰岛素抵抗。

Clinical significance of the defermination of serum leptin in patients with post-hepatitis liver cirrhosis

Objective To determine serum leptin levels and investigate its relatio nship with liver function, insulin resistance and nutritional parameters in pati ents with post-hepatitis liver cirrhosis. Methods Thirty-two ma le patients with post-hepatitis cirrhosis and fourteen male control subjects were enrolled in thi s study. Fasting blood samples were obtained, and serum leptin levels, fasting g lucose and insulin levels were determined in all subjects, and nutritional param e ters were determined in cirrhosis patients. The cirrhosis patients were divided into three groups according to Child-Pugh classification. Results Serum leptin l evels in male hepatic cirrhosis were significantly higher than those of healthy control. There was no significant difference in serum leptin levels among the th ree groups of patients with cirrhosis according to Child-Pugh classification. Se rum insulin levels in male cirrhosis were significantly higher than that of heal thy control. The insulin sensitivity index in cirrhotic patients was decreased c ompared with normal control group. Serum leptin levels in liver cirrhosis were s ignificantly correlated with BMI, TSF and fasting insulin levels, respectively ( r=0.343, 0.340 and 0.352, P<0.05). There were significant negative correlation s both between serum leptin and CHI (r=-0.360, P<0.05) and between lep tin levels and ISI (r=-0.416, P<0.05). Conclusions Serum leptin levels in patients with po st-hepatitis cirrhosis may not relate to the liver function but participate in t he malnutrition and insulin resistance of cirrhosis patients.