Stejskal D, Růzicka V, Hrubísková L, Hrebícek J, Bartek J, Franková M, Pastorková R, Mohapl P, Vávrová J
Metabolická a diabetologická ambulance Nemocnice, Sternberk.
Vnitr Lek. 1997 Sep;43(9):555-61.
Obesity is a disease with distinct genetic determination and its phenotype is defined by the still unknown number of genes whose expression can be influenced by environmental factors. Several years ago, "obesity gene" was isolated in animals. This gene, coding protein which consists of 165 amino acids, is called leptin. Leptin is supposed to be a key substance controlling homeostasis of body weight and energy balance; it is produced by adipocytes and its value correlates highly significantly with anthropometric parameters that characterize physical constitution and amount of subcutaneous fatty tissue. The obese individuals often display hyperleptinemia which is frequently caused by a postreceptor disorder; sporadically, a different leptin structure or hypoleptinemia (caused by genetic anomaly) are reported. It is supposed that either absolute or relative leptin deficiency in obese persons are associated with causal obesity (e.g. appetite stimulation). Leptinemia values correlate with percentage of subcutaneous fatty tissue, insulinemia and sometimes with glycemia. In our study we examined 200 probands, patients of the Metabolic and Diabetologic Out-Patient Department, Hospital in Sternberk. A very close correlation between the amount of subcutaneous fatty tissue (measured by a caliper in 10 skinfolds) and the leptine serum concentration was found. The values of leptinemia in men of normal constitution ranged within 1-11 ng/ml, non-obese women had 3-4 times higher values. Leptinemia in some obese individuals reached up to 70 ng/ml. However, the currently calculated and reported parameters of physical constitution (BMI, WHR, Grant index) did not correlate significantly with leptinemia. Similarly, biochemical parameters considered as general markers of insulin resistance (often associated with obesity) did not correlate significantly with leptinemia. This finding indicates that some calculated parameters, quantifying and gualifying physical constitution, may be ambiguous and leptinemia was found to give more detailed information about the amount of subcutaneous fatty tissue than WHR or BMI. An accidental finding was an important positive correlation between myoglobin concentration and creatinemia. At monitoring the effect of hypolipidemic agents we use the myoglobin examination and therefore we consider this correlation to be very important and every physician performing this analysis should be informed about it. The present study thus confirmed that a more accurate quantification of subcutaneous fatty tissue is required. On the other hand, we believe that examination of leptinemia can contribute significantly to stratification of patients into risk groups (with respect to clinical, economic and time differentiation) and subsequently to the treatment of these patients. In future, criteria for quantification of leptinemia and leptine resistance should be defined precisely.
肥胖是一种具有明确遗传决定因素的疾病，其表型由数量尚不清楚的基因所定义，这些基因的表达会受到环境因素的影响。几年前，在动物体内分离出了“肥胖基因”。该基因编码由165个氨基酸组成的蛋白质，被称为瘦素。瘦素被认为是控制体重和能量平衡稳态的关键物质；它由脂肪细胞产生，其值与表征身体构成和皮下脂肪组织量的人体测量参数高度显著相关。肥胖个体常表现为高瘦素血症，这通常是由受体后紊乱引起的；偶尔也有报道称存在不同的瘦素结构或低瘦素血症（由基因异常引起）。据推测，肥胖者的绝对或相对瘦素缺乏与因果性肥胖（如食欲刺激）有关。瘦素血症值与皮下脂肪组织百分比、胰岛素血症，有时还与血糖相关。在我们的研究中，我们检查了200名先证者，他们是施特恩贝格医院代谢和糖尿病门诊部的患者。发现皮下脂肪组织量（通过卡尺测量10个皮肤褶皱处）与血清瘦素浓度之间存在非常密切的相关性。正常体质男性的瘦素血症值在1 - 11 ng/ml范围内，非肥胖女性的值高出3 - 4倍。一些肥胖个体的瘦素血症高达70 ng/ml。然而，目前计算和报告的身体构成参数（BMI、WHR、格兰特指数）与瘦素血症没有显著相关性。同样，被视为胰岛素抵抗一般标志物（常与肥胖相关）的生化参数与瘦素血症也没有显著相关性。这一发现表明，一些用于量化和描述身体构成的计算参数可能存在歧义，并且发现瘦素血症比WHR或BMI能提供更多关于皮下脂肪组织量的详细信息。一个意外发现是肌红蛋白浓度与肌酸血症之间存在重要的正相关。在监测降血脂药物的效果时我们会进行肌红蛋白检查，因此我们认为这种相关性非常重要，每个进行此项分析的医生都应该了解这一点。本研究因此证实需要对皮下脂肪组织进行更准确的量化。另一方面，我们认为瘦素血症检查可以显著有助于将患者分层到风险组（在临床、经济和时间差异方面），进而有助于对这些患者进行治疗。未来，应精确界定瘦素血症和瘦素抵抗的量化标准。
