Beloborodova E I, Akimova L A, Asanova A V, Burkovskaia V A, Kritskaia N G
Ter Arkh. 2010;82(3):8-13.
To study the specific features of the nutritional status of patients with persistent chronic obstructive pulmonary disease (COPD) in relation to the hormone-regulating function of energy exchange in terms of leptin and to concurrently evaluate the functional status of fat and protein digestion and absorption and to measure body fat percentage. To assess the influence of these factors on the regulation of the serum concentration of leptin and its potential role in the development of trophological insufficiency in patients.
In 93 patients with COPD (Stages I, II, and III in 22, 36, and 35 patients, respectively, the nutritional status was evaluated by somatometric methods. The concentration of leptin was measured by enzyme immunoassay using a test system (DSL, USA). Absorption was estimated by biochemical studies and by using radionuclides. Body fat content was determined, by measuring bioelectric impedance with an OmRon BF-302 apparatus (Japan).
Protein and fat absorption was decreased in patients with moderate and mainly severe COPD as compared with that in the control group and correlated with body weight deficit and lower body fat percentage. Decreased leptin levels were detected in Stages II-III COPD and correlated with the degree of the disease and reduced protein (r = 0.68 +/- 0.02) and fat (r = 0.64 +/- 0.18) absorption.
Protein and fat absorption impairments correlating with body weight deficit in patients with COPD underline the significant role of this mechanism in the development of trophological insufficiency. In COPD patients with trophological insufficiency, the lower circulating leptin levels that correlate with impaired absorption of fatty acids and protein characterize the pathogenetic role of secondary malabsorption syndrome in leptin-mediated impairments of energy exchange mechanisms. Functional insufficiency of the hormone-regulating mechanism responsible for energy exchange in terms of leptin in patients with Stages II-III COPD gives warning of the insufficient stock of adipose tissue and its reduced energy reserve.
研究持续性慢性阻塞性肺疾病（COPD）患者营养状况的具体特征，涉及瘦素在能量交换激素调节功能方面的作用，并同时评估脂肪和蛋白质消化吸收的功能状态以及测量体脂百分比。评估这些因素对血清瘦素浓度调节的影响及其在患者营养不足发展中的潜在作用。
93例COPD患者（分别为Ⅰ期22例、Ⅱ期36例、Ⅲ期35例），采用人体测量方法评估营养状况。使用美国DSL检测系统通过酶免疫测定法测量瘦素浓度。通过生化研究和使用放射性核素评估吸收情况。使用日本欧姆龙BF - 302仪器通过测量生物电阻抗来确定体脂含量。
与对照组相比，中度及主要为重度COPD患者的蛋白质和脂肪吸收减少，且与体重不足和较低的体脂百分比相关。在COPDⅡ - Ⅲ期检测到瘦素水平降低，且与疾病程度以及蛋白质（r = 0.68 ± 0.02）和脂肪（r = 0.64 ± 0.18）吸收减少相关。
COPD患者中与体重不足相关的蛋白质和脂肪吸收障碍突出了该机制在营养不足发展中的重要作用。在患有营养不足的COPD患者中，循环瘦素水平降低与脂肪酸和蛋白质吸收受损相关，这表明继发性吸收不良综合征在瘦素介导的能量交换机制损害中具有致病作用。COPDⅡ - Ⅲ期患者中负责瘦素介导能量交换的激素调节机制功能不足提示脂肪组织储备不足及其能量储备减少。
