Decreased plasma leptin concentrations in tuberculosis patients are associated with wasting anal inflammation

被引:108
作者
van Crevel, R
Karyadi, E
Netea, MG
Verhoef, H
Nelwan, RHH
West, CE
van der Meer, JWM
机构
[1] Univ Med Ctr Nijmegen, Dept Internal Med, NL-6500 HB Nijmegen, Netherlands
[2] Univ Med Ctr Nijmegen, Dept Gastroenterol, NL-6500 HB Nijmegen, Netherlands
[3] Univ Indonesia, Reg Ctr Community Nutr, SE Asian Minist Educ Org Trop Med, Jakarta, Indonesia
[4] Univ Indonesia, Fac Med, Working Grp Infect Dis, Jakarta, Indonesia
[5] Univ Wageningen & Res Ctr, Div Human Nutr & Epidemiol, NL-6700 HB Wageningen, Netherlands
关键词
D O I
10.1210/jc.87.2.758
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Tuberculosis patients often suffer from severe weight loss, which is considered to be immunosuppressive and a major determinant of severity and outcome of disease. Because leptin is involved in weight regulation and cellular immunity, its possible role in tuberculosis-associated wasting was investigated. In an urban clinic in Indonesia, plasma leptin concentrations, indicators of adipocyte mass, appetite, C-reactive protein (CRP), tuberculin reactivity, and cytokine response were measured in tuberculosis patients and healthy controls. Plasma leptin concentrations were lower in patients than in controls (615 vs. 2,550 ng/liter; P<0.001). Multivariate regression analysis showed that body fat mass and inflammation were two independent factors determining plasma leptin concentrations; there was a positive correlation between fat and leptin, whereas, unexpectedly, leptin was inversely associated with CRP and tumor necrosis factor-alpha production. Concentrations of both CRP and leptin were independently associated with loss of appetite. Our results do not support the concept that weight loss in tuberculosis is caused by enhanced production of leptin. Rather, loss of body fat leads to low plasma leptin concentrations, and prolonged inflammation may further suppress leptin production. Because leptin is important for cell-mediated immunity, low leptin production during active tuberculosis may contribute to increased disease severity, especially in cachectic patients.
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收藏
页码:758 / 763
页数:6
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