血清瘦素在手术创伤后应激反应中的变化  

Changes in serum leptin levels in patients with surgically induced stress responses

作　　者：颜光涛[1] 郝秀华[1] 薛辉[1] 林季[1] 张凯[1] 王录焕[1] 

机构地区：[1]解放军总医院基础医学研究所,北京100853

出　　处：《中国危重病急救医学》2006年第3期172-175,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金资助项目(39970717)

摘　　要：目的观察手术创伤应激反应后血清瘦素（Leptin）的变化，探讨Leptin在其中的作用。方法选择不同手术方式（开腹或微创腹腔镜）切除部分肝和胆囊肿瘤患者，采用放射免疫分析法和酶联免疫吸附法（ELISA）测定两组患者不同时间血清Leptin、粒细胞集落刺激因子（G—CSF）、C-反应蛋白（CRP）和促肾上腺皮质激素（ACTH）水平变化。结果同术前相比，开腹组血清Leptin水平在术后即刻（T0）略下降，术后1d（T1）达最高峰，术后2d（T2）、4d（T4）开始低于高峰水平，但仍较术前有显著增高；而腹腔镜组血清Leptin水平变化同开腹组差异无显著性。两组患者G—CSF的变化在术后均显著下降，T1～T4仍未恢复到术前水平。两组患者血清CRP在T0略下降，但在T1～T4均明显高于术前水平。开腹组ACTH水平在T0、T1明显下降，T2开始恢复；但腹腔镜组ACTH水平术前和术后差异并无显著性。结论手术创伤应激导致患者血清Leptin浓度持续增高，但与CRP、G—CSF和ACTH水平的变化不存在相关性。Objective To explore the effect of operative trauma induced stress responses on serum leptin levels. Methods Serum samples of patients who had undergone resection of hepatic tumors or cholecystectomy were collected, and highly sensitive radioimmuoassay and enzyme -linked immunoadsorbent assay （ELISA） were used to determine serum levels of leptin, granulocyte -clone stimulating factor （G - CSF）, C - reactiveprotein （CRP） and adrenoeortieotropin hormone （ACTH） in the blood of these patients. Results Compared with self - control before operation, serum leptin levels decreased slightly right after an abdominal operation （TO）, it reached the highest level 1 day after operation （T1）, and began to decrease from 2 days （T2） to 4 days after operation （T4）, but the level was still higher than that before operation. Serum leptin levels of patients undergoing laparoseopie operation showed no significant difference when compared with that of aparostomy patients. G - CSF levels decreased significantly after operation in both groups, and didn＇t recover to the levels before operation from T1 to T4. CRP levels slightly decreased in both groups at TO, but increased significantly higher than the levels before operation from T1 to T4, ACTH levels of decreased significantly in laparostomy patients from TO to T1, and began to recover on T2, while that of laparoscopic operation patients showed no significant difference before and after operation. Conclusion Serum leptin levels of patients increase significantly and constantly subsequent to operative trauma induced stress responses, but this change has no correlation with that of CRP, G- CSF and ACTH.

关 键 词：手术 应激反应 瘦素 粒细胞集落刺激因子 C-反应蛋白 促肾上腺皮质激素 腹腔镜 

分 类 号：R619[医药卫生—外科学]