CAJ | 학술논문

目的探讨血清瘦素、肿瘤坏死因子α(TNF-α)和甲状腺激素在慢性阻塞性肺疾病(COPD)患者营养不良发生中的意义.方法观察COPD临床稳定期患者148例,根据体质指数(BMI)、理想体质量百分比(NW%)、三头肌皮皱厚度(TSF)、上臂中点臂围(MAC)、血清白蛋白(ALB)、总淋巴细胞(LYM)等营养参数,分为COPD营养不良组(COPD Ⅰ组)47例,COPD非营养不良组(COPDⅡ组)101例,另选健康人30例为对照组.采用双抗体夹心酶联免疫吸附法检测血清瘦素、TNF-α,采用放射免疫法测定甲状腺激素(T3、T4、FT3、FT4、TSH),并探讨上述因素在COPD营养不良患者中的作用及相互之间的相关性.结果 COPD Ⅰ组BMI、NW%、TSF、MAC、ALB、LYM与COPDⅡ组、对照组比较差异均有统计学意义(P<0.01),COPD Ⅱ组与对照组比较差异无统计学意义(P>0.05);COPD Ⅰ组瘦素水平分别与COPDⅡ组、对照组比较差异均有统计学意义(P<0.01),COPDⅡ组与对照组比较差异无统计学意义(P>0.05);COPD Ⅰ组、COPDⅡ组TNF-α水平分别与对照组比较差异有统计学意义(均P<0.01),而COPD Ⅰ组与COPDⅡ组比较差异无统计学意义(P>0.05);COPD Ⅰ组T3、T4分别与COPDⅡ组、对照组比较差异有统计学意义(均P<0.01);COPDⅡ组T4与对照组比较差异有统计学意义(均P<0.01).COPD Ⅰ组、COPD Ⅱ组BMI、NW%、TSF与瘦素水平呈正相关(P<0.01),瘦素水平与TNF-α、TSH呈正相关(P<0.05).结论 COPD患者营养不良与血清瘦素水平、TNF-α及甲状腺激素有关,瘦素受TNF-α系统调控,瘦素与下丘脑-垂体-甲状腺轴之间存在相互调节关系,三者共同参与了COPD患者营养不良的发生.
목적 탐토혈청수소、종류배사인자α(TNF-α)화갑상선격소재만성조새성폐질병(COPD)환자영양불량발생중적의의.방법 관찰COPD림상은정기환자148례,근거체질지수(BMI)、이상체질량백분비(NW%)、삼두기피추후도(TSF)、상비중점비위(MAC)、혈청백단백(ALB)、총림파세포(LYM)등영양삼수,분위COPD영양불량조(COPD Ⅰ조)47례,COPD비영양불량조(COPDⅡ조)101례,령선건강인30례위대조조.채용쌍항체협심매련면역흡부법검측혈청수소、TNF-α,채용방사면역법측정갑상선격소(T3、T4、FT3、FT4、TSH),병탐토상술인소재COPD영양불량환자중적작용급상호지간적상관성.결과 COPD Ⅰ조BMI、NW%、TSF、MAC、ALB、LYM여COPDⅡ조、대조조비교차이균유통계학의의(P<0.01),COPD Ⅱ조여대조조비교차이무통계학의의(P>0.05);COPD Ⅰ조수소수평분별여COPDⅡ조、대조조비교차이균유통계학의의(P<0.01),COPDⅡ조여대조조비교차이무통계학의의(P>0.05);COPD Ⅰ조、COPDⅡ조TNF-α수평분별여대조조비교차이유통계학의의(균P<0.01),이COPD Ⅰ조여COPDⅡ조비교차이무통계학의의(P>0.05);COPD Ⅰ조T3、T4분별여COPDⅡ조、대조조비교차이유통계학의의(균P<0.01);COPDⅡ조T4여대조조비교차이유통계학의의(균P<0.01).COPD Ⅰ조、COPD Ⅱ조BMI、NW%、TSF여수소수평정정상관(P<0.01),수소수평여TNF-α、TSH정정상관(P<0.05).결론 COPD환자영양불량여혈청수소수평、TNF-α급갑상선격소유관,수소수TNF-α계통조공,수소여하구뇌-수체-갑상선축지간존재상호조절관계,삼자공동삼여료COPD환자영양불량적발생.
Objective To study the significance of serum leptin, thyroid hormones and tumor necrosis fac-tor-α(TNF-α) on malnutrition among chronic obstructive lung disease (COPD) patients. Methods A hundred and fourty-eight COPD patients in stable stage and 30 normal controls were studied. Nutritional parameters, including body mass index (BMI), percentage of normal body mass (NM%), triceps skin-fold thickness (TSF), mid-upper arm circumference(MAC),serum albumin(ALB) ,total lymphocyte counts(LYM) were determined. COPD patients were divided into malnutrition group(group Ⅰ) and non-malnutrition group (group Ⅱ)according to the nutritional parameter. Serum leptin levels and TNF-α were measured by ELISA, thyroid hormones (T3,T4, FT3, FT4, TSH) were tested by radioimmunoassay. The correlation among these parameters was analysed. Results There were sig-nificant difference on BMI,NW% ,TSF,MAC,ALB,LYM between group Ⅱ, control group and group Ⅰ. There were no significant difference on these parameters between group Ⅱ and control group. There were significant difference on serum leptin between group Ⅱ, control group and group Ⅰ. There were no significant difference on serum leptin be-tween group Ⅱ and control group. There were significant difference on TNF-α levels between group Ⅰ, group Ⅱ and control group. There were no significant difference on TNF-α levels between group Ⅰ and group Ⅱ. There were signifi-cant difference on T3,T4 between group Ⅱ, control group and group Ⅰ. There were significant difference on T4 between group Ⅱ and control group. Serum leptin in group Ⅰ and group Ⅱ showed a positive con-elation with BMI,NW% ,TSF,TNF-α and TSH. Conclusion Malnutrition correlate with serum leptin, thyroid hormones and TNF-α in COPD patients. Ser-am leptin levels were adjusted by TNF-α system. Serum leptin and hypothalamus-hypophysis-thyroid axial system regulate each other. Leptin, thyroid hormones and TNF-α contribute to the onset of malnutrition in COPD patients.