慢性肾脏病5期患者血清瘦素水平及甲状旁腺切除术的影响
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国家自然科学基金(12981270408),中华医学会临床科研专项基金首届肾脏病青年研究基金(13030300415),江苏省“医学重点人才”资助项目(RC201162)


Parathyroidectomy and serum leptin levels in stage 5 CKD patients
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    摘要:

    目的:探讨慢性肾脏病(chronic kidney disease,CKD)5期患者血清瘦素变化以及与临床和血生化指标的关系,评估严重继发性甲状旁腺功能亢进患者行甲状旁腺切除术(parathyroidectomy,PTX)对上述指标的影响-方法:对113例CKD 5期患者和76例健康人进行横断面研究,并对PTX成功组(n = 23)和PTX失败组(n = 4)进行随访,记录其临床特征-血生化及血清瘦素水平-结果:在健康男性人群,血清瘦素水平与年龄和体质指数(body mass index,BMI)呈正相关,与血白蛋白(albumin,Alb)水平呈负相关;健康女性中,血清瘦素水平与BMI呈正相关-与健康人相比,CKD患者血清瘦素水平无明显差异-男性患者血清瘦素与BMI-血糖-甘油三酯(triglyceride,TG)和Alb呈正相关,与高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)和甲状旁腺激素(intact parathyroid hormone,iPTH)负相关;女性患者血清瘦素与BMI-血红蛋白(hemoglobin,Hb)-红细胞压积(hematocrit,Hct)和TG正相关,与HDL-C负相关-PTX成功组术后血瘦素升高值与增高的体重-Hb-Hct以及下降的血iPTH值呈正相关,手术未成功组无上述变化-结论:CKD 5 期患者血清瘦素水平与健康人无差异,但与患者异常的骨矿物质代谢-造血和营养有关,成功的PTX使血清瘦素升高并与上述指标改善相关-

    Abstract:

    Objective:To evaluate the correlation between serum leptin with clinical and blood biochemical indexes,and longitudinal changes of above parameters after parathyroidectomy (PTX) in stage 5 chronic kidney disease(CKD) patients. Methods:This cross-sectional study not only included 113 stage 5 CKD patients together with 76 healthy controls but also contained a follow-up of two subgroups classified as successful (n = 23) and unsuccessful (n = 4) PTX. Clinical characteristics,blood biochemistry and serum leptin levels were measured. Results:Serum leptin concentration was positively correlated with age and body mass index (BMI),but negatively correlated with serum albumin (Alb) level in healthy men. In healthy women,serum leptin concentration was positively correlated with BMI. There was no significant difference of serum leptin between healthy controls and stage 5 CKD patients. Serum leptin concentration in patients with stage 5 CKD was correlated positively with BMI,serum glucose,serum triglyceride (TG) and serum Alb in males and BMI,hemoglobin (Hb),hematocrit (Hct) and serum TG in females. However,serum leptin had a negative relationship with serum high density lipoprotein (HDL) and serum intact parathyroid hormone (iPTH) in males and only serum HDL in females. Compared with baseline,the successful PTX subgroup had significant improvement in serum leptin level. Increased serum leptin change was positively related to increased weight,Hb and Hct change as well as decreased lgiPTH change in this group. There was no improvement in the above parameters in the unsuccessful PTX group. Conclusion:Serum leptin level has no significant difference between stage 5 CKD patients and health subjects. However,it is associated with bone-mineral metabolism,hematopoiesis and nutritional indexes in stage 5 CKD patients. Successful PTX contributes to increased serum leptin level and improved nutrition,anemia and bone-mineral metabolism..

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张晶晶,柏建岭,张丽娜,程 晨,杨 光,崔一尧,曾 鸣,葛益飞,孙 彬,俞香宝,张 波,欧阳春,毛慧娟,刘 佳,邢昌赢,查小明,王宁宁.慢性肾脏病5期患者血清瘦素水平及甲状旁腺切除术的影响[J].南京医科大学学报(自然科学版),2014,(8):1080-1086

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  • 收稿日期:2014-03-21
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  • 在线发布日期: 2014-08-03
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