KOAH HASTALARINDA LEPTİN VE TNF ALFA DÜZEYLERİ VE BUNLARIN NUTRİSYONEL PARAMETRELERELE İLİŞKİSİ

Yıl 2014, Cilt: 28 Sayı: 2, 81 - 89, 01.10.2014

Ceyda Anar Tuba İnal Özlem Şengören İpek Ünsal Can Biçmen Hüseyin Halilçolar

Öz

Amaç: Bu çalışmada kilo kaybı olmayan stabil ve akut atakta olan KOAH hastalarında serum leptin ve TNF-α düzeylerini saptamayı ve nutrisyonel parametrelerle serum leptin, TNF alfa düzeyleri arasındaki ilişki incelemeyi amaçladık. Yöntem ve Gereç: 51 stabil KOAH, 14 akut atakta olan KOAH ve 18 kontrol hastası çalışmaya dahil edildi. BMI, triceps deri kıvrım kalınlıgı, serum albümin, leptin ve TNF-α düzeyleri hesaplandı. Leptin ve TNF-α düzeyi ELISA yöntemi ile ölçüldü. Bulgular: Leptin düzeyleri alevlenmesi olan KOAH hastalarında stabil ve kontrol grubuna göre anlamlı olarak yüksek bulundu. Ancak, akut alevlenme olan hastalarda leptin ve beslenme parametreleri arasında bir ilişki bulunmadı. Bu üç grup arasında TNF-α ile beslenme parametreleri arasında anlamlı ilişki yoktu. KOAH hastalarında ve kontrol grunbunda serum leptin ve TNF-α düzeyleri arasında korelasyon saptanmazken, Serum TNF-α düzeyi ile beslenme parametreleri arasında da bu üç grup arasında ilişki bulunmadı. Sonuç: TNF-α düzeyleri, yüksek serum leptin düzeyi ile ilişkili değildi; KOAH akut atak hastalarının sayısının az olması ve TNF- α değerlerinin sayısal olarak hesaplanamaması nedeniyle; TNF-α düzeyi ile yüksek serum leptin düzeyi arasında ilişki saptanmadı. Her ne kadar stabil KOAH hastalarında leptin ve nutrisyonel parametreler arasında korelasyon varken, akut atak olan KOAH hastalarında ve kontrol grupta yoktu. Bu nedenle, KOAH hastalarında enerji dengesinin düzenlenmesi sırasında leptin ve TNF-α arasında anlamlı bir korelasyon saptanmadı.

Anahtar Kelimeler

COPD, Leptin, TNF-α

LEPTIN AND TNF-ALPHA LEVELS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND THEIR RELATIONSHIP TO NUTRITIONAL PARAMETERS

Öz

Aim: This study aimed to detect serum leptin and TNF- α levels in COPD patients without weight loss during stable disease and acute exacerbation, and to investigate relationships between leptin, TNF-α and nutritional parameters at different stages of the disease. Material and Methods: 51 stable COPD patients, 14 COPD patients with acute exacerbation and 18 control subjects participated in this study. To eliminate the effects of sex differences, all patients and controls were male. BMI, triceps of skinfold tickness and serum albumin and serum leptin and TNF-α levels were measured in all participants. Leptin and TNF-α levels were measured by ELISA. Results: Leptin levels were significantly higher in patients with exacerbation than in both stabledisease and control groups. Leptin levels were significantly correlated with the nutritional parameters in stable groups. However, in patients with acute exacerbation, a correlation between leptin and nutritional parameters was not found. There was no significant relationship between TNF-α and nutritional parameters in the three groups. While there was no correlation between serum TNF-α and leptin levels in COPD patients and control groups, Serum TNF-α levels did also not correlate with nutritional parameters in any of groups. Conclusion (1) circulating TNF-α levels were not associated with increased leptin levels and (2) because of the fewer number of the acute exacerbation of COPD patient and not calculated the value of TNF-alpha levels as a numeric value, we did not find elevated TNF-α levels in COPD patients with acute exacerbation (3) although leptin and nutritional parameters were correlated in the stable COPD patients, it was disappeared completely during an exacerbation and control groups. Therefore, there was no significant correlation between leptin and TNF-α during the regulation of the energy balance in COPD patients.

Anahtar Kelimeler

COPD, Leptin, TNF-α

Kaynakça

• 1. Wauters M, Considine RV, Gaal GFV: Human leptin: From an adipocyte hormone to an endocrine mediator. Eur J Endocrinol 2000; 143: 293–311.
• 2. Tartaglia LA: The leptin receptor. J Biol Chem 1997; 272: 6093–6096.
• 3. Considine RV, Sinha MK, Heiman ML, et al: Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med 1996; 334: 292–295.
• 4. Lonnqvist F, Arner P, Nordfords L, Schalling M: Overexpression of the obese (ob) gene in adipose tissue of human obese subjects. Nat Med 1995; 1 :950–953.
• 5. Hamilton BS, Paglia D, Kwan AY, Deitel M: Increased obese mRNA expression in omental fat cells from massively obese humans. Nat Med 1995; 1: 953–956.
• 6. Maffei M, Halaas J, Ravussin E, et al: Leptin levels in human and rodent: Measurement of plasma leptin and ob gene mRNA in obese and weightreduced subjects. Nat Med 1995; 1: 1155–1161.
• 7. Merabet E, Dagogo-Jack S, Coyne DW, et al: Increased plasma leptin concentration in endstage renal disease. J Clin Endocrinol Metab 1997; 82: 847–850.
• 8. Grunfeld C, Zhao C, Fuller J, et al: Endotoxin and cytokines induce expression of leptin, the ob gene product, in hamsters: A role for leptin in the anorexia of infection. J Clin Invest 1996; 97: 2152–2157.
• 9. De Vos P, Saladin R, Auwerx J, Staels B: Induction of ob gene expression by corticosteroids is accompanied by body weight loss and reduced food intake. J Biol Chem 1995; 270: 15958–15961.
• 10. Di Francia M, Barbier D, Mege JL, Orehek J. Tumor necrosis factor-alpha levels and weight loss in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1994; 150:1453- 1455.
• 11. Tracey KJ, Wei H, Manogue KR, Fong Y, Hesse DG, Nguyen HT, et al. Cachectin/tumor necrosis factor induces cachexia, anemia, and inflammation. J Exp Med 1988; 167: 1211-1227.
• 12. Carlson GL, Saeed M, Little RA, Irving MH. Serum leptin concentrations and their relation to metabolic abnormalities in human sepsis. Am J Physiol 276:E658-E662, 1999.
• 13. GOLD: Global Initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLBI/WHO, Workshop report; 2006.
• 14. Yuan Y, Wang Z, Liu C: Preliminary investigation of the effect of serum leptin on the nutritional state of COPD patients (in Chinese). Zhonghua Jie He He Hu Xi Za Zhi 2000;23: 292–295.
• 15. Takabatake N, Nakamura H, Abe S, Hino T, Saito H, Yuki H, et al. Circulating leptin in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 159:1215-1219.
• 16. Çalıkoglu M, Gulsah S¸ Unlu A, Ozturk C, Ercan B, Kanık A, et al. Leptin and TNF-Alpha Levels in Patients with Chronic Obstructive Pulmonary Disease and Their Relationship to Nutritional Parameters. Respiration 2004;71:45–50.
• 17. Creutzberg EC, Wouters EFM, VanderhovenAugustın IML, Dentener MA, Schols AMWJ: Disturbances in leptin metabolism are related to energy imbalance during acute exacerbations of chronic obstructive pulmonary disease.
• 18. Prokopis Kythreotis, Ageliki Kokkini, Stavrina Avgeropoulou, Argyro Hadjioannou, Efgenia Anastasakou, Antonis Rasidakis and Petros Bakakos. Plasma leptin and insulin-like growth factor I levels during acute exacerbations of chronic obstructive pulmonary disease. BMC Pulmonary Medicine 2009, 9:11, 1471-2466.
• 19. Schols AMWJ, Creutzberg EC, Buurman WA, Campfield LA, Saris WHM, Wouters EFM: Plasma leptin is related to proinflammatory status and dietary intake in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;160:1220–1226.
• 20. Karaka S, Karadag F, Karul AB, Gurgey O, Gurel S, Guney E, Cildag O. Circulating leptin and body composition in chronic obstructive pulmonary disease. Int J Clin Pract 59:1167- 1170, 2005
• 21. Yang YM, Sun TY, Liu XM. The role of serum leptin and tumor necrosis factor-α in malnutrition of male chronic obstructive pulmonary disease patients. Chin Med J 119:628-633, 2006
• 22. Mueller R, Chanez P, Champell AM, Bousquet J, Heusser C, Bulloc GR: Different cytokine patterns in bronchial biopsies in asthma and chronic bronchitis. Respir Med 1996;90:79–85.
• 23. Keatings VM, Collins PD, Scott DM, Barnes PJ: Differences in interleukin-8 and tumor necrosis factor-alpha in induced sputum from patients with chronic obstructive pulmonary disease or asthma. Am J Respir Crit Care Med 1996; 153: 530–534.
• 24. Godoy I, Donahoe M, Calhoun WJ, Mancino J, Rogers RM: Elevated TNF-alpha production by peripheral blood monocytes of weightlosing COPD patients. Am J Respir Crit Care Med 1996;153:633–637.
• 25. Yamamoto C, Yoneda T, Yoshikawa M, et al: The relationship between a decrease in fat mass and serum levels of TNF-alpha in patients with chronic obstructive pulmonary disease (in Japanese). Nihon Kyobu Shikkan Gakkai Zasshi 1997; 35: 1191–1195.
• 26. Zumbach MS, Boehme MW, Wahl P, Stremmel W, Ziegler R, Nawroth PP. Tumor necrosis factor increases serum leptin levels in humans. J Clin Endocrinol Metab 82:4080-4082, 1997