Dervisevic Amela, Subo Anela, Avdagic Nesina, Zaciragic Asija, Babic Nermina, Fajkic Almir, Lepara Orhan, Hadzovic-Dzuvo Almira
Department of Human Physiology, Faculty of Medicine, University of Sarajevo, Cekalusa 90, 71 000 Sarajevo, Bosnia and Herzegovina.
Department of Internal Medicine, General Hospital "Prim. Dr Abdulah Nakas", Kranjceviceva 12, 71 000 Sarajevo, Bosnia and Herzegovina.
Mater Sociomed. 2015 Apr;27(2):99-103. doi: 10.5455/msm.2015.27.99-103. Epub 2015 Apr 5.
Aim of the present study was to investigate serum concentration of leptin and its association with values of body mass index (BMI), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in hemodialysis (HD) patients.
This cross-sectional study included 60 HD patients (34 male, 26 female) and 30 age- and sex-matched (4 males, 26 females) apparently healthy subjects. Serum leptin concentration was determined by an enzyme-linked immunosorbent assay (ELISA). Serum CRP concentration was measured by means of particle-enhanced immunonephelometry. ESR value was determined by Western Green method. BMI was calculated as weight (kg) divided by height squared (m(2)).
Results have shown that median serum leptin concentration (30.65 ng/mL; 12.48-86.40 ng/mL) was statistically significantly higher in HD patients compared to median serum leptin concentration (15.75 ng/mL; 9.15-30.65 ng/mL) in the control group of healthy subjects (p<0.05). Likewise, median serum CRP concentration (5.5 mg/L; 1.93-8.9 mg/L) and median ESR value (57.5 mm/h; 40.5-77.0 mm/h) were significantly higher in HD patients compared to median serum CRP concentration (0.8 mg/L; 0.38-1.43 mg/L) (p<0.001) and median ESR value (10.0 mm/h; 6.5-14.0 mm/h) (p<0.001) determined in the control group. Statistically significant positive correlation was found between BMI values and serum leptin concentration in HD patients (rho=0.434; p<0.001). Positive, although not significant, correlation was observed between serum CRP and leptin levels in HD patients (rho=0.171; p>0.05). Negative correlation between ESR values and serum leptin concentrations in HD patients was determined but it was not statistically significant (rho= -0.029; p>0.05).
Increased serum concentration of leptin as pro-inflammatory cytokine as well as elevated serum values of CRP and ESR indicate presence of systemic micro inflammation in HD patients. Results of the present study point to possible use of serum leptin concentration as an indicator of nutritional status in HD patients based on observed significant positive correlation between serum leptin concentrations and BMI values. However, absence of significant association between serum leptin and CRP levels as well as between serum leptin concentrations and ESR values in HD patients requires further investigation and clarification.
本研究旨在调查血液透析（HD）患者血清瘦素浓度及其与体重指数（BMI）、C反应蛋白（CRP）和红细胞沉降率（ESR）值之间的关联。
这项横断面研究纳入了60例HD患者（男性34例，女性26例）以及30例年龄和性别匹配的（男性4例，女性26例）明显健康的受试者。采用酶联免疫吸附测定（ELISA）法测定血清瘦素浓度。通过颗粒增强免疫比浊法测量血清CRP浓度。ESR值采用魏氏法测定。BMI计算为体重（kg）除以身高的平方（m²）。
结果显示，HD患者血清瘦素浓度中位数（30.65 ng/mL；12.48 - 86.40 ng/mL）与健康受试者对照组血清瘦素浓度中位数（15.75 ng/mL；9.15 - 30.65 ng/mL）相比，差异具有统计学意义（p<0.05）。同样，HD患者血清CRP浓度中位数（5.5 mg/L；1.93 - 8.9 mg/L）和ESR值中位数（57.5 mm/h；40.5 - 77.0 mm/h）与对照组测定的血清CRP浓度中位数（0.8 mg/L；0.38 - 1.43 mg/L）（p<0.001）和ESR值中位数（10.0 mm/h；6.5 - 14.0 mm/h）（p<0.001）相比，显著更高。在HD患者中，BMI值与血清瘦素浓度之间存在统计学意义的正相关（rho = 0.434；p<0.001）。HD患者血清CRP与瘦素水平之间观察到正相关，尽管不显著（rho = 0.171；p>0.05）。确定HD患者ESR值与血清瘦素浓度之间存在负相关，但无统计学意义（rho = -0.029；p>0.05）。
作为促炎细胞因子的血清瘦素浓度升高以及血清CRP和ESR值升高表明HD患者存在全身微炎症。基于观察到的血清瘦素浓度与BMI值之间显著的正相关，本研究结果表明血清瘦素浓度可能可作为HD患者营养状况的指标。然而，HD患者血清瘦素与CRP水平之间以及血清瘦素浓度与ESR值之间缺乏显著关联，这需要进一步研究和阐明。
