Study On Correlation Between Serum Leptin, Thyroid Hormones And Nutritional State, Pulmonary Function Test In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

ObjectiveTo discuss the correlation between Serum Leptin ,Thyroid Hormones and Nutritional State, Pulmonary function test in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease to explore the pathophysiology of nutritional depletion in COPD and its effect on pulmonary function and immune function in order to provide theorial evidence for reasonable nutritional treatment in COPD patients with malnutrition.Methods1.object:(1) COPD group:45 cases of COPD, diagnosed according as the COPD guide Published in 2007, were enrolled in the study. They did not receive nutritional support and they have no other diseases as can influence organism metabolismand nutritional status.Such as active tuberculosis,malignant tumor,hyperthyroidism,diabetes and Liver function or kidney functional disturbance and other wasting disease.(2) Control group:18 healthy people were enrolled in study after the evenlation of history, physical inspection, auxiliary examination and without systemic infection in reneent 2 months.2. Measurement of the signal of nutrition:The height, bodyweight, BMI, %IBW, ALB and TLC were measured in all subjects to assess their nutritional status.3. Measure thyroid hormones and leptin in blood serum: 6 ml vein blood was collected from all subjects in the morning and separated serum through centrifuge 15 minutes with a speed of 3000rm/in,after standing for 30 minutes and put the serum into the icebox below zero 70 degree. we measured the levels of T3,T4,TSH and Leptin in serum by radio immunoassay.4. Measure T lymphocyte subgroup in blood serum: 6 ml vein blood was collected from all subjects, separated serum and put the serum into the icebox below zero 20 degree we measured the levels of T lymphocyte subgroup by flow cytometry.5. Pulmonary test:All the subjects received pulmonary function test,the main indext were as follows: MVV%,FVC%,FEVI% and FEVI/FVC.Results1. Nutritional state in COPD group:Comparing with the control group,there was no significant deviation with age and sex in COPD group(P>0.05). However, there was significant deviation with the state of nutrition between the two groups.2. Thyroid hormones and leptin in blood serum:Comparing with the control group, the levels of T3,T4 in blood serum of COPD group is below (P<0.05),and T3 was lower significantly .there was no significant difference with TSH between the two groups. conclusion of leptin in blood serum of COPD group is significantly below to control group. (P<0.01)3. T lymphocyte subgroup and pulmonary function index in blood serum:Comparing with the control group, CD3,CD4,CD4/CD8 was lower and CD8 was higher in COPD group,and the difference was statistically significant . (P<0.05)4. Comparing nutrition parmater,T lymphocyte subgroup,pulmonary function index,thyroid hormones and leptin between malnutrition group and none malnutrition group:There was statistically significant difference between the malnutrition group and none malnutrition group in ALB,TLC,CD3,CD4,CD8,CD4/CD8,leptin,T3 and TSH. ALB,TLC,CD3,CD4,CD8,CD4/CD8 and leptin were significantly lower in malnutrition group than none malnutrition group. (P<0.01)5. The levels of thyroid hormones and letin and their relationship to nutritional state,immune function,pulmonary test:By the analysis of 1inear correlation,T3 was positivly correlated with MVV%,FVC%(P<0.05或P<0.001); and even more with BMI(r= 0.496,P<0.01), the leptin was positivly correlated with MVV%(r=0.302,P<0.05), and even more with MVV%,FVC%(P<0.001); the leptin was positivly correlated with TSH(r=0.902,P<0.001)).Conclusion1.The evaluation of the nutritional status of patients with COPD shows that nutritionaldepletion is prevalent in COPD patients whose clinical manifestation includes the abnormalities of the althropometric measurement,biochemical andimmuno- logical criterion.2.There was closely correlation between triiodothyronine,leptin and nutritional status in COPD. Serum triiodothyronine correlates with leptin levels, which contributes to the malnutrition in COPD patients.3. There was correlation between the levels of thyroid hormones, leptin and immune function,pulmonary function test in the patients of COPD,which could be used a prognostic factor and help the clinical treatment of nutritional support.