Correlation of serum leptin concentrations with body composition and gender in Taiwanese hemodialysis patients without diabetes

OBJECTIVE: (1) To evaluate the impact of body composition and gender on serum leptin concentration in hemodialysis patients. (2) To study which marker of adiposity is most appropriate in Taiwanese hemodialysis patients without diabetes. (3) To compare the nutrition status between nonlean and lean subjects. PATIENTS AND METHODS: Serum leptin concentrations were measured by radioimmunoassay collected in 88 hemodialysis patients without diabetes. Bioimpedance analysis was performed to determine percent fat mass (%FM), lean body mass (LM), and total body water (TBW). Body mass index (BMI) was calculated as weight/height2. Albumin and transferrin were measured by standard laboratory methods. RESULTS: Serum leptin levels were more correlated with percent fat mass (r = 0.697; P < 0.001) than with body fat mass (r = 0.672; P < 0.001) or with BMI (r = 0.594; P < 0.001) in the group as a whole and in each subgroup when analyzed separately by gender. The mean (+/- SD) serum leptin levels were 32.5 +/- 34.3 ng mL(-1) in women subjects and 13.6 +/- 15.5 ng mL(-1) in men subjects (P < 0.001). Multiple regression analysis in all subjects revealed that serum leptin levels were independently affected by percent fat mass and gender. Adiposity corrected serum leptin, such as leptin/BMI, leptin/percent fat mass, and leptin/body fat mass was significantly different between sexes (P < 0.001). The significantly higher serum leptin concentrations in women than in men were observed in obese subjects with BMI > 25 kg/m2 (P < 0.001) as well as nonobese subjects with BMI < 25 kg/m2 (P < 0.05). There were no differences in lean mass and albumin between nonlean and lean subjects. CONCLUSION: Gender and adiposity had impact on serum leptin levels in hemodialysis patients without diabetes. In terms of adiposity, serum leptin levels had stronger correlation with percent fat mass than with body fat mass (FM) or BMI in Taiwanese hemodialysis patients. Steady-state serum leptin levels could serve as valuable clinical markers for the body adiposity in stable hemodialysis patients without diabetes. Protein malnutrition markers and lean mass should be checked in lean subjects for the evaluation of the protein stores of hemodialysis patients.     

Metabolic consequences of body size and body composition in hemodialysis patients

Small body mass index is associated with increased mortality in chronic hemodialysis patients. The reasons for this observation are unclear but may be related to body composition. This study aimed to investigate the body composition in chronic hemodialysis patients. The difference between body mass and the sum of muscle, bone, subcutaneous, and visceral adipose tissue masses, measured by whole body magnetic resonance imaging, was defined as the high metabolic rate compartment representing the visceral mass. Protein catabolic rate was calculated from urea kinetics. Forty chronic hemodialysis patients (mean age 54.7 years; 87.5% African Americans; 45% females) were studied. High metabolic rate compartment expressed in percent of body weight was inversely related to body weight (r=-0.475; P=0.002) and body mass index (r=-0.530; P<0.001). In a multiple linear regression model, protein catabolic rate was significantly correlated only with high metabolic rate compartment (r=0.616; P<0.001). Assuming that protein catabolic rate in addition to protein intake reflects urea and uremic toxin generation, it follows that high metabolic rate compartment is the major compartment involved in their generation. Consequently, uremic toxin production rate may be relatively higher in patients with low body weight and low body mass index as compared to their heavier counterparts. The poorer survival observed in smaller dialysis patients may be related to these relative differences.     

严重烧伤患者血浆凝溶胶蛋白水平及其与预后的关系

目的 观察严重烧伤患者血浆凝溶胶蛋白水平变化规律,探讨其与脓毒症和死亡之间的关系. 方法 2010年5月-2012年5月,将2家笔者单位收治的102例烧伤总面积大于或等于30％ TBSA的患者设为烧伤组,另设25名健康志愿者为健康对照组.分别于伤后1、3、7、14、21 d采集患者外周静脉血,双抗体夹心ELISA法检测血浆凝溶胶蛋白水平;同法取健康对照组人员血液行相同检测.(1)按烧伤总面积将烧伤组患者分为小面积(30％ ～ 49％ TBSA)烧伤组39例、中面积(大于49％且小于或等于69％ TBSA)烧伤组33例、大面积(大于69％且小于或等于99％ TBSA)烧伤组30例;(2)根据烧伤脓毒症诊断标准,将烧伤组患者分为脓毒症组43例与非脓毒症组59例;(3)根据脓毒症患者的预后情况,将脓毒症组患者分为脓毒症死亡组14例与脓毒症存活组29例.比较各组患者血浆凝溶胶蛋白水平,分析其与患者并发脓毒症及死亡的关系.对数据进行方差分析、LSD检验、单因素Logistic回归分析. 结果 (1)伤后l、3、7、14、21 d,烧伤组患者血浆凝溶胶蛋白水平均较健康对照组明显降低(F值分别为140.01、369.52、702.15、360.14、84.16,P值均小于0.01).(2)大、中、小面积烧伤组患者血浆凝溶胶蛋白水平5个时相点均值分别为(43±11)、(85 ±23)、(124±38) mg/L,组间比较差异有统计学意义(F=367.76,P＜0.01),且均明显低于健康对照组的(326±51) mg/L(P值均小于0.01).(3)脓毒症组、非脓毒症组患者血浆凝溶胶蛋白水平5个时相点均值分别为(77±12)、(122±38)mg/L,脓毒症组患者伤后3、7、14、21 d血浆凝溶胶蛋白水平显著低于非脓毒症组(F值分别为30.35、111.59、209.36、422.76,P值均小于0.01).(4)脓毒症死亡组、脓毒症存活组患者血浆凝溶胶蛋白水平5个时相点均值分别为(53±8)、(103±25) mg/L,脓毒症死亡组患者伤后1 ～21 d血浆凝溶胶蛋白水平均显著低于脓毒症存活组(F值分别为9.05、18.48、41.34、107.11、180.48,P值均小于0.01).(5)Logistic回归分析显示,血浆凝溶胶蛋白水平是患者并发脓毒症(优势比为5.44,95％置信区间为2.35 ～12.74,P＜0.01)及死亡(优势比为5.52,95％置信区间为2.34～12.19,P＜0.01)的独立危险因素. 结论 严重烧伤可导致患者血浆凝溶胶蛋白水平明显降低,患者烧伤面积越大、病情越重该指标水平越低.凝溶胶蛋白水平可作为早期预测严重烧伤患者并发脓毒症或死亡的独立指标.     

Low plasma dehydroepiandrosterone sulfate level and its relationship to adiponectin in hemodialysis patients

The aim of the present study was to assess the relationship between plasma DHEA-S and adiponectin concentrations in hemodialyses patients (HD). Plasma adiponectin, DHEA-S, cholesterol, and albumin levels were estimated in 94 HD and 46 healthy subjects (HS). In HD, a significantly lower plasma DHEA-S concentration (2.5+/-0.2 vs. 4.7+/-0.4 micromol/L respectively; p = 0.002) but significantly higher plasma adiponectin level (15.0+/-0.7 vs. 8.7+/-0.8 microg/mL respectively; p = 0.004) than in HS were found. Only in uremic patients was a significant negative correlation found between plasma adiponectin and DHEA-S concentrations (tau = -0.210; p = 0.001). Decreased plasma DHEA-S level is associated with increased adiponectinemia in uremic patients.     

Effects of body size and body composition on survival in hemodialysis patients

It is unclear whether increased muscle mass or body fat confer the survival advantage in hemodialysis patients with high body-mass index (BMI). Twenty-four-hour urinary creatinine (UCr) excretion was used as a measure of muscle mass. The outcomes of hemodialysis patients with high BMI and normal or high muscle mass (inferred low body fat) and high BMI and low muscle mass (inferred high body fat) were studied to study the effects of body composition on outcomes. In 70,028 patients who initiated hemodialysis in the United States from January 1995 to December 1999 with measured creatinine clearances reported in the Medical Evidence form, all-cause and cardiovascular mortality were examined in Cox and parametric survival models. When compared with normal BMI (18.5 to 24.9 kg/m(2)) group, patients with high BMI (> or = 25 kg/m(2)) had lower hazard of death (hazard ratio [HR], 0.85; P < 0.001). However, when compared with normal BMI patients with UCr >25th percentile (0.55 g/d), high BMI patients with UCr >0.55 g/d had lower hazard of all-cause (HR, 0.85; P < 0.001) and cardiovascular death (HR, 0.89; P < 0.001), and high BMI patients with UCr < or =0.55 g/d had higher hazard of all-cause death (HR, 1.14; P<0.001) and cardiovascular death (HR, 1.19; P <0.001). Both BMI and body composition are strong predictors of death. The protective effect conferred by high BMI is limited to those patients with normal or high muscle mass. High BMI patients with inferred high body fat have increased and not decreased mortality.     

Plasma leptin and insulin levels in weight-reduced obese women with normal body mass index: relationships with body composition and insulin.

Obesity is a complex disease with multiple features that has confounded efforts to unravel its pathophysiology. As a means of distinguishing primary from secondary characteristics, we compared levels of fasting plasma leptin and insulin in a cohort of weight-reduced obese women who have attained and maintained a normal BMI for more than 1 year with the levels in cohorts of never-obese and currently obese women. Weight-reduced obese women showed decreased plasma concentrations of leptin and insulin compared with obese women, but these levels remained significantly higher than those of never-obese women. Plasma leptin levels were highly correlated with plasma insulin levels (r = 0.60, P < 0.001). To further explore relationships with body composition, total body fat was determined by dual-energy X-ray absorptiometry and body fat distribution by computed tomography in subsets of these groups. Weight-reduced obese women had a significantly greater percent body fat and subcutaneous abdominal fat mass than did the never-obese women, and these were highly correlated with plasma leptin (r = 0.90, P < 0.001, and r = 0.52, P < 0.001, respectively). In these weight-reduced obese women, visceral fat mass was similar to that of the never-obese. The insulin sensitivity index and first-phase insulin response were also comparable. These results demonstrate that higher leptin levels in weight-reduced obese women are related to the higher total fat and particularly the subcutaneous fat masses. Normalization of visceral fat mass in the weight-reduced obese was accompanied by normalization of insulin sensitivity index and first-phase insulin response. This study suggests that increases in plasma leptin and insulin in obesity are secondary features of the obese state.     

Adjusting dry weight by extracellular volume and body composition in hemodialysis patients

BACKGROUND: At present, the determination of dry weight in patients on hemodialysis is largely made empirically by trial and error. Extracellular volume (ECV) assessment by bioimpedance analysis (BIA) is a preferable technique for determining dry weight, and it also provides useful data on body composition. METHODS: We measured the ECV of 74 normal subjects and 121 stable chronic hemodialysis patients postdialysis. In addition, for the dialysis patients, we measured intracellular volume (ICV) and lean body mass (LBM) by BIA, and analyzed the ECV, blood pressure and complications of dialysis. We adjusted dry weight according to the ECV and repeated a BIA exam 4 months later to evaluate changes in body composition, blood pressure and dialysis status of these patients. RESULTS: The ECV as a percentage of weight (ECV%) of hypertensive patients was significantly higher than that of normotensive patients (24.29 +/- 3.56% vs. 21.50 +/- 2.38%, p < 0.001). All patients with excessive ECV% had hypertension, but not all hypertensive patients had excessive ECV%. None of the normotensive patients had ECV excess. Some hypertensive patients with symptoms of dialysis complications still had excessive ECV%. Eight hypertensive patients with excessive ECV had decreased dry weight. ECV% (29.80 +/- 2.03% vs. 27.10 +/- 2.99%, p < 0.001) and blood pressure (159 +/- 7 / 97 +/- 4 vs. 137 +/- 10 / 86 +/- 8 mm Hg, p = 0.006 for systolic and p = 0.004 for diastolic) decreased. ECV was the only portion of body composition that decreased (p < 0.001) after decreasing dry weight, the other parameters remaining unchanged. Twenty symptomatic normotensive patients improved with elevation of the dry weight. The ECV (p = 0.007), ICV (p = 0.009) and LBM (p < 0.001) were significantly increased after increasing dry weight, while the ECV% (p = 0.39) and fat (p = 0.46) remained unchanged. CONCLUSIONS: (1) For hypertensive patients, ECV must be evaluated in order to adjust dry weight and correct hypertension. (2) For normotensive patients, if dialysis complications occur, dry weight should be increased until symptoms disappear or the blood pressure begins to rise.     

Assessment of body composition in long-term hemodialysis patients: rationale and methodology.

Protein-energy malnutrition is seen in patients with advanced stages of chronic kidney disease (CKD) and is even more pronounced in patients receiving long-term hemodialysis treatment. Both entities have great impact on patient morbidity and mortality. Analysis of body composition is an integral part of nutritional assessment and includes the estimation of muscle, fat, and fat-free mass, as well as the extracellular water compartment. Clinical assessment of these compartments is difficult, and gold-standard methods such as tracer dilution, magnetic resonance imaging, and dual-energy x-ray absorptiometry are expensive, cumbersome, and rarely available. We report an ongoing study of body composition in hemodialysis patients involving deuterium and sodium bromide dilution, total body potassium counting, magnetic resonance imaging, whole-body and segmental bioimpedance spectroscopy, and anthropometry. The goals of the study are (1) to validate bioimpedance technology against gold-standard methods for assessment of the various body compartments, (2) to directly quantify visceral adipose tissue mass, a potential source of cytokine production (adipokines) promoting chronic inflammation, and to study its relation to inflammatory markers, and (3) to directly quantify visceral organ mass and to study its relation to uremia toxin generation as assessed by protein catabolic rate and resting energy expenditure. Preliminary results based on up to 40 hemodialysis patients are reported.     

Plasma leptin concentration in patients with acute renal failure

BACKGROUND: Acute renal failure (ARF) is characterized by impaired excretory, endocrine, homeostatic and metabolic function of the kidneys. It is well-known that leptin is an adipose-derived polypeptide hormone which is predominantly biodegraded by the kidneys. Therefore, plasma leptin concentration is increased in chronic renal failure (CRF). However, its' concentrations in patients with ARF were not investigated until now. The aim of the present study was to evaluate plasma leptin concentration in patients with ARF. PATIENTS AND METHODS: 27 patients with ARF (age 44 +/- 4 years, BMI 26.0 +/- 0.9 kg/m2, means +/- SEM, 17 patients 15 M, 2 F recovered kidney function and 10 patients 7 M, 3 F died during the anuric phase), 27 hemodialysis patients (22 M, 5 F; age 45 +/- 2 years; BMI 26.2 +/- 0.8 kg/m2) with chronic renal failure (CRF) and 27 healthy subjects (HS) (22 M, 5 F; age 42 +/- 3 years; BMI 25.9 +/- 0.6 kg/m2) were examined. In patients with ARF, blood samples for plasma leptin and routinely assessed biochemical parameters were withdrawn before the first HD session (I), and in patients who survived a second time 5 days later during the anuric/oliguric phase (II), and a third one during the polyuric phase before discharge of the patient from hospital (III). In patients with CRF all examined parameters were estimated only once before a subsequent HD session. RESULTS: Patients with ARF (before the first HD session) and CRF did not differ significantly with respect to BMI, serum creatinine and blood hydrogen ion concentrations. Plasma leptin level in patients with ARF before the first HD session was similar to values obtained in HS, but significantly lower (p < 0.01) than in patients with CRF (2.5 (1.9 - 8.2) vs. 3.4 (2.5 - 8.3) vs. 8.4 (2.9 - 16.9) ng/ml in ARF, HS and CRF, respectively). There was no significant difference in leptinemia between patients with ARF who survived and who died. In patients with ARF who survived, improvement ofrenal function was accompanied by a slightly (not significant) declining tendency in plasma leptin concentration (5.6 +/- 2.2 vs. 4.8 +/- 1.7 vs. 4.5 +/- 1.3 ng/ml; I, II, III phases of ARF, respectively). CONCLUSIONS: In contrast to hemodialysis patients with chronic renal failure, patients with acute renal failure are characterized by normal plasma leptin concentration. Thus, difference in leptinemia between patients with chronic and acute renal failure seems to be due to preservation of large amounts of active renal parenchyma in ARF patients.     

藏族大学生骨强度指数特点及与体成分关系研究

目的调查藏族大学生的跟骨骨强度指数,获得该人群骨强度指数随性别及年龄的变化特点。同时分析藏族大学生骨强度指数及其与体成分之间的关系,为该群体骨质疏松的预防和干预提供参考依据。方法采用超声骨密度仪及生物电阻抗分析仪测量800例(男400例,女400例)藏族大学生右足跟骨骨强度指数及体成分等相关指标,采用Pearson相关分析法研究骨强度指数与体成分各指标之间的关系。结果 (1)藏族大学生骨强度指数曲线的一般变化特点为从21岁组起随年龄的增加先升高后降低,且男生各年龄组骨强度指数值均大于女性;(2)藏族男生骨强度指数最大值出现在22岁组,藏族女生骨强度指数最大值出现在20岁组;(3)与其他民族、地区大学生群体比较得知,藏族大学生骨强度指数较高;(4)藏族大学生各项体成分指标与骨强度指数之间均无相关性。结论藏族大学生骨强度指数较高,骨质状况良好。     

Effect of body iron stores on serum aluminum level in hemodialysis patients.

To evaluate the influence of body iron stores on the serum aluminum (Al) level, we studied the correlation between iron status (the serum ferritin, serum iron and transferrin saturation) and serum Al levels in 68 severely anemic hemodialysis patients. Among them, 36 underwent the desferrioxamine (DFO) mobilization test. These 68 patients were divided into three groups according to their serum ferritin level. The basal Al level in the patient group was 41.4 +/- 37.4 micrograms/l (control, 4.1 +/- 2.4 micrograms/l). The serum Al level after DFO infusion of the patient group was 111.1 +/- 86.8 micrograms/l. A significantly higher basal Al and peak Al level after DFO infusion were found in group 1 patients (serum ferritin less than 300 micrograms/l) when compared to group 2 (serum ferritin 300-1,000 micrograms/l) and group 3 (serum ferritin greater than 1,000 micrograms/l) patients. A significant negative correlation between serum ferritin and basal serum Al (r = -0.544, p = 0.0001), as well as peak serum Al after DFO infusion (r = -0.556, p = 0.0001), was noted. Similarly, a negative relationship between serum Al (both basal and peak) and either serum iron or transferrin saturation was noted. However, there was no correlation between the serum Al level and the dosage of aluminum hydroxide. In conclusion, serum ferritin, serum iron and transferrin saturation were inversely correlated with serum Al in our hemodialysis patients. Iron deficiency may probably increase Al accumulation in these patients.     

2型糖尿病患者骨密度与身体成分关系的研究

目的分析不同性别中老年2型糖尿病患者骨密度与身体成分的关系。方法纳入2017年1月至2018年7月在南京医科大学附属常州市第二人民医院内分泌科治疗的657例2型糖尿病患者,年龄50～80岁,其中男性351例,女性306例。记录受试者的糖尿病病程、身高、体重、体质量指数(body mass index,BMI),检测血脂(TC、TG、HDL、LDL)、糖化血红蛋白(Hb A1c)。采用双能X线骨密度仪测定受试者腰椎(L_(1～4))、股骨颈(Neck)、大转子(Troch)和Ward三角(Wards)的骨密度(bone mineral density,BMD)。采用生物电阻抗法测定体脂率(PBF)、去脂体重(FFM)、肌肉量(SLM)、骨骼肌含量(SMM)及骨骼肌质量指数(SMI),并进行统计学分析。结果男性2型糖尿病患者的FFM、SLM、SMM、SMI、腰椎L_(1～4)、股骨颈、大转子和Ward三角的BMD均显著高于女性2型糖尿病患者(P0. 001),而体脂率明显低于女性(P0. 001);按性别分组,男性、女性的BMI、FFM、SLM、SMM、SMI与各部位的BMD均呈显著正相关(P0. 01)。其中,反映骨骼肌肉含量的指标如FFM、SLM、SMM、SMI与BMD的相关性高于反映脂肪含量的指标PBF;多元线性回归显示,骨密度随着年龄增长呈下降趋势。身体成分中,SLM对各部位BMD无明显影响,PBF、FFM、SMM、SMI对各部位BMD的影响不同。结论骨骼肌肉含量及体脂率对2型糖尿病患者骨密度有重要影响,糖尿病患者需重视体成分对骨质疏松的影响,应加强锻炼,合理控制体脂率。     

维持性血液透析患者血尿酸水平及其相关分析

目的通过对单中心维持性血液透析(maintenance hemodialysis,MHD)患者透析前血尿酸(serum uric acid,SUA)水平的横断面调查,分析透析人群中SUA的分布特点和影响因素,并探讨其临床意义。方法对海南省人民医院血液净化中心治疗的165例MHD患者进行透析前SUA、血肌酐、白蛋白及C反应蛋白等水平监测,研究高尿酸血症(hyperuricemia,HUA)的发生率及其影响因素。结果患者透析前平均SUA为(485±109)μmol/L,其中男性为(484±103)μmol/L,女性为(487±118)μmol/L,透析前男、女性平均SUA比较差异无统计学意义(P0.05)。HUA发生率为74.5%,其中男性为69.2%,女性为83.6%,男、女性HUA发生率比较差异有统计学意义(P0.05)。每周透析8 h及每周透析12 h的患者SUA比较差异无统计学意义[(493±102)μmol/L比(461±125)μmol/L,P0.05],2组HUA发生率比较差异无统计学意义(77%比67.4%,P0.05)。在年龄分组中SUA随年龄的增长呈先升后降趋势,其中40~50岁患者SUA最高。在原发病分组中,慢性肾炎组血尿酸水平高于糖尿病肾脏疾病组,差异有统计学意义[(503±102)μmol/L比(455±118)μmol/L,P0.017]。SUA与血红蛋白(r=0.223,P=0.004)、血磷(r=0.349,P0.0001)、血肌酐(r=0.490,P0.0001)呈正相关。结论 MHD患者透析前SUA高于正常人群,SUA水平不仅与肾脏功能减退有关,而且与透析患者的营养相关。SUA是反映MHD患者营养状态的指标之一。     

Plasma osteoprotegerin is associated with mortality in hemodialysis patients

Expression of bone proteins resulting from transdifferentiation of vascular smooth muscle cells into osteoblasts suggests that vascular calcifications are a bioactive process. Regulating molecules such as osteoprotegerin (OPG) and receptor activator of NF-kappaB ligand (RANKL) could play a key role in bone-vascular calcification imbalance. This study investigated the contribution of these proteins as well as mineral metabolism disorders in hemodialysis (HD) patient outcome. A total of 185 HD patients were followed up prospectively for 2 yr. In addition to clinical characteristics, mineral metabolism markers as well as OPG and soluble RANKL (sRANKL) were measured at baseline. After 2 yr, survival rates were described with Kaplan-Meier and compared with Cox regression analyses; 50 patients died (27 from cardiovascular diseases). Calcium, phosphate, and calcium x phosphate product were not associated with mortality. Both hyperparathyroidism (parathyroid hormone > or =300 pg/ml) and hypoparathyroidism (parathyroid hormone <150 pg/ml) were poorly associated with all-cause and cardiovascular mortality. By contrast, elevated OPG levels predicted all-cause (relative risk [RR] 2.67; 95% confidence interval [CI] 1.32 to 5.41; P = 0.006) and cardiovascular mortality (RR 3.15; 95% CI 1.14 to 8.69; P = 0.03). Low levels of sRANKL were associated with a protective effect for all-cause mortality (RR 0.45; 95% CI 0.21 to 0.94; P = 0.03). The association of OPG with all-cause mortality was stronger in patients with C-reactive protein > or =12.52 mg/L. In this condition, both highest (RR 5.68; 95% CI 1.48 to 22.73; P = 0.01) and lowest tertiles (RR 5.37; 95% CI 147 to 1968; P = 0.01) significantly predicted poor outcome. These results show that regulating-bone molecules, especially OPG, are strong predictors of mortality in HD patients, suggesting that OPG is a vascular risk factor, in particular in patients who have high C-reactive protein levels. OPG determination therefore should be added to the biologic follow-up of these patients.     

Hepatitis G virus infection in hemodialysis patients and its relationship with hepatitis C virus infection

Our aim was to study the characteristics of hepatitis G virus (HGV) infection in hemodialysis (HD) patients. We evaluated 108 patients from two different units (A: 67 patients; B: 41 patients). HGV RNA and HCV RNA were detected by PCR. Nineteen patients (17.6%) were HGV RNA positive (20.9% in unit A and 12.2% in unit B (NS)). HCV RNA was positive in 19 patients (17.6%) (28.4% in unit A and 0 in unit B (p < 0.01)). Eight patients were HGV RNA and HCV RNA positive (group I), 11 HGV RNA positive (group II), 11 HCV RNA positive (group III), and 78 negative for both viruses (group IV). Time on HD was 51.3 +/- 37.0 months for group I, 36.0 +/- 27.9 months for group II, 63.5 +/- 40.2 months for group III, and 26.4 +/- 27.1 months for group IV (p < 0.01 for I and III). Seven patients (87.5%) from group I, 9 (81.8%) from group II, 10 (90.9%) from group III, and 44 (56.4%) from group IV had a history of transfusion (p < 0.03 for I, II and III). Two patients (25%) from group I, none from group II, 5 (45.4%) from group III, and 6 (7.7%) from group IV had chronic ALAT elevation (p < 0.01 for I and III). We conclude that HGV infection was frequent in our HD patients, related to transfusions and independent of HCV prevalence, and that HGV infection itself was not a cause of ALAT elevation suggesting chronic hepatitis.     

胰腺癌患者血浆中内皮素水平变化及其意义的研究

目的　检测胰腺癌患者围手术期血浆中内皮素（ｅｎｄｏｔｈｅｌｉｎ , Ｅ Ｔ） 水平,探讨内皮素与胰腺癌的关系及其临床意义。 方法　 应用放射免疫分析法对胰腺癌３４ 例（ 胰头癌２７ 例,胰体尾癌７ 例）患者血浆中 Ｅ Ｔ 水平进行测定,并对其行姑息性手术及根治性手术前后 Ｅ Ｔ 水平的变化进行观察。结果　本组胰头癌患者术前 Ｅ Ｔ 水平〔（５８ ±７） ｎｇ／ Ｌ〕明显高于胰体尾癌组〔（５１ ±４） ｎｇ／ Ｌ, Ｐ＜ ００１〕及正常人组〔（５１ ±６） ｎｇ／ Ｌ, Ｐ＜ ００１〕,在减轻黄疸的手术后胰头癌组降至（５２ ±５） ｎｇ／ Ｌ,胰体尾组降至（５２ ±３） ｎｇ／ Ｌ 与正常水平相近。根治术后,胰头癌组 Ｅ Ｔ 水平为（５５ ±３） ｎｇ／ Ｌ,胰体尾癌组为（５３ ±３）ｎｇ／ Ｌ,均较姑息手术后有所升高,但差异均无显著意义（ Ｐ＞ ００５） 。 结论　 胰腺癌患者血浆中内皮素水平升高主要为合并梗阻性黄疸所致,胰腺癌虽可产生内皮素,但其可能仅是参与癌细胞间的调节作用。     

糖尿病大鼠血清瘦素与肾脏瘦素受体表达观察

目的研究2型糖尿病大鼠血清瘦素（leptin）及肾脏瘦素受体（Ob-R）表达变化。方法高糖高脂饮食结合小剂量链脲佐菌素建立2型糖尿病大鼠动物模型。在8周末测量大鼠体质量、血压、空腹血糖、三酰甘油、胆固醇和24h尿蛋白排泄量等指标，用酶联免疫吸附法测定大鼠的血清瘦素、胰岛素，计算胰岛素抵抗指数。免疫组化检测Ob-R在肾脏的表达情况。结果糖尿病大鼠体质量、血糖、总胆固醇、三酰甘油、血清胰岛素较对照组均明显升高，24h尿蛋白排泄量轻度升高。与对照组比较，大鼠血清瘦素明显升高，同时糖尿病组肾脏Ob—R的表达水平下降，二者呈负相关。结论2型糖尿病大鼠高血清瘦素可能对肾脏0b-R表达有抑制作用。     

Plasma sulfate concentration and hyperhomocysteinemia in hemodialysis patients

BACKGROUND: Severe hyperhomocysteinemia is common in hemodialysis patients, who also present a dramatic increase in plasma concentrations of sulfate, one of the main products of methionine and cysteine catabolism. The aim of this study was to verify the relationship between high plasma sulfate levels and cysteine or homocysteine concentrations in hemodialysis patients. METHODS: Plasma sulfate, cysteine and homocysteine concentrations and some renal efficiency parameters were determined in 18 patients with end-stage renal failure, all undergoing 4h hemodialysis three times a week. The pattern of post-dialysis rises on plasma concentrations of sulfate, cysteine and homocysteine was established. RESULTS: Plasma sulfate, cysteine and homocysteine levels were significantly higher in patients than in normal controls. Plasma sulfate concentrations positively correlated with cysteinemia (p = 0.031; r = 0.482) which, in turn correlated with homocysteinemia (p = 0.042; r = 0.460). Sulfate levels also correlated with blood creatinine (p = 0.004; r = 0.630), nitrogen (p = 0.000; r = 0.899), protein (p = 0.014; r = 0.555), and albumin (p = 0.003; r = 0.642). Post-dialysis rises in sulfate and cysteine were detected some hours before homocysteine. CONCLUSION: The results suggest that high sulfate levels, due mainly to impaired renal function, are involved in the altered metabolism of homocysteine in hemodialysis patients.