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瘦素在胆囊胆固醇结石形成中的作用
作者:
希龙夫 薛荣泉 夏医君 韩晓月 
Authors: Xi Longfu, Xue Rongquan, Xia Yijun, Han Xiaoyue.
单位: 010010呼和浩特,内蒙古医科大学(希龙夫、韩晓月);010017呼和浩特,内蒙古自治区人民医院肝胆胰脾外科(薛荣泉、夏医君)
Units: Inner Mongolia Medical University, Hohhot 010010, China
关键词: 瘦素; 胆囊; 胆固醇; 胆石; 脂蛋白类
Keywords: Leptin; Gallbladder; Cholesterol; Gallstones; Lipoproteins
分类号:
出版年,卷(期):页码:2017,44(6):383-387
摘要:

 目的 通过临床病例研究,探讨血清及胆汁中的瘦素在胆囊胆固醇结石形成中的作用与影响。方法 选取2016年3月1日-11月30日在内蒙古自治区人民医院肝胆胰脾外科住院行腹腔镜下或开腹胆囊切除术患者共91 例,分为胆囊胆固醇结石组(A组)58 例和非胆囊胆固醇结石组(B组)33 例,以体重指数=24 kg/m2为标准,又将A组分成A1组30 例(体重指数≥24 kg/m2)和A2组28 例(体重指数<24 kg/m2);B组分成B1组18 例(体重指数≥24 kg/m2)和B2组15 例(体重指数<24 kg/m2)。对A、B两组病例一般情况、体重指数、血清瘦素含量、胆汁瘦素含量、高密度脂蛋白、低密度脂蛋白、脂蛋白(a)、载脂蛋白AI、载脂蛋白B、载脂蛋白AI/载脂蛋白B比值、血清总胆固醇、血清总胆汁酸、三酰甘油等指标进行检测。计量资料用均数±标准差(±s)表示,组间比较使用t检验或t’检验。计数资料用频数和百分数表示,组间比较使用χ2检验。体重指数和血清瘦素的相关性采用Pearson相关系数描写。结果 胆囊胆固醇结石组患者血清瘦素含量与非胆囊胆固醇结石组血清瘦素含量分别为(7.92±7.34) ng/ml和(4.81±1.79) ng/ml,差异有统计学意义(P<0.05),同时该组血清瘦素水平与体重指数呈正相关(r=0.65, P=0.01),当体重指数≥24 kg/m2时相关性明显(r=0.73,P<0.01)。胆囊胆固醇结石组血清总胆固醇、低密度脂蛋白、载脂蛋白B、三酰甘油水平分别为(4.85±0.74) mmol/L、(2.53±0.69) mmol/L、(0.97±0.3) g/L、(1.92±0.61) mmol/L,非胆囊胆固醇结石组分别为(4.47±0.8) mmol/L、(2.22±0.50) mmol/L、(0.8±0.2)g/L、(1.49±0.69) mmol/L,与后者相比前者含量显著性增高(P<0.05)。胆囊胆固醇结石组高密度脂蛋白和载脂蛋白AI含量分别为(0.93±0.28) mmol/L、(1.38±0.27) g/L,与非胆囊胆固醇结石组(1.24±0.26) mmol/L、(1.53±0.21) g/L相比显著性降低(P<0.05);两组胆汁瘦素含量、总胆汁酸、脂蛋白(a)差异无统计学意义(P>0.05)。结论 血清瘦素含量的改变,可能通过影响血液脂质、脂蛋白水平,以及胆汁中瘦素的含量,最终影响胆固醇结石的形成过程。

 Objective To investigate the function of serum and bile leptin in the formation of gallstones. Methods Patients were divided into two groups: gallbladder cholesterol gallstone group (group A, n=58) and nongallstone group (group B, n=33). With a body mass index of 24 kg/m2 for the standard, the group A was also divided into the group A1(body mass index≥24 kg/m2, n=30) and group A2(body mass index<24 kg/m2, n=28). Group B was divided into group B1(body mass index≥24 kg/m2, n=18) and group B2(body mass index<24 kg/m2, n=15). Fasting blood samples from all study participants were assayed for total bile acid, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, apolipoprotein AI, apolipoprotein B, lipoprotein(a). Serum leptin and bile leptin were measured using an enzymelinked immunosorbent assay. Results A total of 58 patients with gallbladder cholesterol gallstone and 33 controls were included in the study. The serum level of leptin, total cholesterol, low density lipoprotein, apolipoprotein B and triglyceride were significantly increased, high density lipoprotein and apolipoprotein AI significantly decreased in patients with gallbladder cholesterol gallstone compared with controls(P<0.05). While bile leptin, total Bile acid, lipoprotein(a) were no significant difference between group A and group B (P> 0.05). Serum leptin in patients with gallbladder cholesterol gallstone were significantly positively correlated with Body Mass Index(r=0.65,P=0.01), Especially when Body Mass Index≥24 kg/m2(r=0.73,P<0.01).Conclusions Changes in levels of serum leptin may affect levels of blood lipid, some lipoprotein and bile leptin, then promote the formation of cholesterol stones.

基金项目:
内蒙古自治区自然科学基金面上项目(2013MS11118);内蒙古自治区人民医院博士科研启动资金项目(CBS201527)
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