Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Health Administration Center, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Sci Rep. 2019 Jul 19;9(1):10484. doi: 10.1038/s41598-019-46990-3.
Weight loss progresses with the progression of idiopathic pulmonary fibrosis (IPF), and acute exacerbation of IPF (AE-IPF) frequently occurs in its advanced stage. Adiponectin and leptin are adipokines produced from adipose tissue, and are related to thinness and obesity, respectively. Additionally, these adipokines are implicated in the regulation of inflammation and fibrosis centering on peroxisome proliferator-activated receptor γ (PPARγ). However, the relationship between adiponectin/leptin and AE-IPF remains poorly known. We conducted this study to evaluate levels of serum adiponectin/leptin, and to elucidate the clinical importance of adiponectin and leptin in patients with AE-IPF. Thirty-two patients (39 episodes) who were diagnosed with AE-IPF at our hospital from 1997 to 2016 were retrospectively studied. Serum adiponectin and leptin concentrations were measured with enzyme-linked immunosorbent assay. Patients with AE-IPF showed higher levels of serum adiponectin and leptin than those at initial diagnosis of IPF (p = 0.007 and p = 0.027, respectively). Serum adiponectin/leptin (A/L) ratio was negatively correlated with body mass index at AE-IPF (r = -0.456, p = 0.003) and PaO before AE-IPF (r = -0.498, p = 0.034), and positively correlated with C-reactive protein at AE-IPF (r = 0.316, p = 0.049). Patients with higher A/L ratios had worse survival than those with lower A/L ratios (log-rank, p = 0.026). Further, in multivariate analysis, serum A/L ratio was a significant prognostic factor in patients with AE-IPF (HR 2.60, p = 0.042). In conclusion, the higher adiponectin/leptin ratio may be associated with a poor prognosis in patients with AE-IPF.
体重随着特发性肺纤维化（IPF）的进展而减轻，而 IPF 的急性加重（AE-IPF）常发生在其晚期。脂联素和瘦素是脂肪组织产生的脂肪因子，分别与消瘦和肥胖有关。此外，这些脂肪因子参与以过氧化物酶体增殖物激活受体γ（PPARγ）为中心的炎症和纤维化的调节。然而，脂联素/瘦素与 AE-IPF 之间的关系仍知之甚少。我们进行这项研究是为了评估血清脂联素/瘦素水平，并阐明脂联素和瘦素在 AE-IPF 患者中的临床意义。我们回顾性研究了 1997 年至 2016 年期间在我院诊断为 AE-IPF 的 32 名患者（39 例）。采用酶联免疫吸附法测定血清脂联素和瘦素浓度。AE-IPF 患者的血清脂联素和瘦素水平高于 IPF 初诊时（p=0.007 和 p=0.027）。AE-IPF 时血清脂联素/瘦素（A/L）比值与 AE-IPF 时的体重指数（r=-0.456，p=0.003）和 AE-IPF 前的 PaO（r=-0.498，p=0.034）呈负相关，与 AE-IPF 时的 C 反应蛋白（r=0.316，p=0.049）呈正相关。A/L 比值较高的患者的生存率低于 A/L 比值较低的患者（对数秩检验，p=0.026）。此外，在多变量分析中，血清 A/L 比值是 AE-IPF 患者的一个显著预后因素（HR 2.60，p=0.042）。总之，AE-IPF 患者脂联素/瘦素比值较高可能与预后不良有关。
