nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2008-12-3-56-65nefr-1118Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSОСОБЕННОСТИ ПАТОГЕНЕЗА НЕДОСТАТОЧНОСТИ ПИТАНИЯ У БОЛЬНЫХ С ХРОНИЧЕСКОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ, ПОЛУЧАЮЩИХ ЛЕЧЕНИЕ ХРОНИЧЕСКИМ ГЕМОДИАЛИЗОМTHE FEATURES OF PATHOGENESIS OF PROTEIN-ENERGY MALNUTRITION IN HEMODIALYSIS PATIENTS WITH CHRONIC RENAL INSUFFICIENCYЯковенкоА. А.YakovenkoA. A.

Кафедра пропедевтики внутренних болезней

АсанинаЮ. Ю.AsaninaU. U.

Кафедра пропедевтики внутренних болезней

КучерА. Г.KucherA. G.

Кафедра пропедевтики внутренних болезней

197022 Санкт-Петербург, ул. Л. Толстого 17, СПбГМУ им. акад. И.П. Павлова, “Нефрокорпус”, тел.: (812)-234-35-20, факс: (812)-234-91-91

kaukov@nephrolog.ruБовкунИ. В.BovkunI. V.

Кафедра пропедевтики внутренних болезней

РумянцевА. Ш.RumiantsevA. Sh.

Кафедра пропедевтики внутренних болезней

ВадюхинаМ. В.VaduhinaM. V.

Кафедра пропедевтики внутренних болезней

Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаRussian Federation2008100320081235665Copyright © Яковенко А.А., Асанина Ю.Ю., Кучер А.Г., Бовкун И.В., Румянцев А.Ш., Вадюхина М.В., 20082008Яковенко А.А., Асанина Ю.Ю., Кучер А.Г., Бовкун И.В., Румянцев А.Ш., Вадюхина М.В.Yakovenko A.A., Asanina U.U., Kucher A.G., Bovkun I.V., Rumiantsev A.S., Vaduhina M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1118

ЦЕЛЬ ИССЛЕДОВАНИЯ. Уточнить значение лептина в развитии недостаточности питания (НП) у больных, получающих лечение хроническим гемодиализом. ПАЦИЕНТЫ И МЕТОДЫ. Обследовали 86 больных с хронической болезнью почек 5 стадии, получающих лечение ГД, из них 40 женщин и 46 мужчин в возрасте 52,2 ± 1,3 лет. Причиной ТПН во всех случаях был первичный гломерулонефрит. Все больные получали лечение программным гемодиализом в течение 6,4 ±1,1 лет. Для оценки ежедневного потребления белков, жиров, углеводов, общей калорийности рациона пациенты заполняли пищевые дневники в течение недели. Для оценки нутриционного статуса использовали калиперометрию и интегральную двухчастотную импедансометрию помощью прибора КМ – АР – 01 фирмы «Диамант», Россия, с определением мышечной и жировой массы. У 78 пациентов определяли концентрацию лептина плазмы крови посредством радиоиммунного анализа (Active Human Leptin Elisa, 10 – 23100i, DSL, США). РЕЗУЛЬТАТЫ. Выявлена взаимосвязь между гиперлептинемией и недостаточностью питания у больных, получающих лечение хроническим гемодиализом. Показано, что гиперлептинемия способствует развитию недостаточности питания преимущественно на ранних сроках гемодиализной терапии и у больных с повышенной жировой массой тела. Установлено, что биоимпедансометрия является более предпочтительным методом для оценки состава тела больных на ГД, по сравнению с калиперометрией. ЗАКЛЮЧЕНИЕ. Гиперлептинемия может являться одним из патогенетических факторов, участвующих в развитии НП у ряда пациентов с ТПН.

THE AIM. To specify the role of leptin in the development of protein-energy malnutrition (MN) in hemodialysis patents. PATIENTS AND METHODS. 86 HD patents with chronic renal disease stage 5, out of whom 40 women and 46 mane of mean age 52,2 =-1,3 years, were evaluated. The cause of ESRD in all cases was primary glomerulonephritis. All patients were treated with programmed hemodialysis during the mean of 6,4 ±1,1 years. For the evaluation of the daily consumption of proteins, fats, carbohydrates, total calorie content the patients filled out food diaries during one week. For the evaluation of the nutritional status caliperometry and integral dual-frequency impedancemetry with the KM-AP-01 device produced by “Diamant”, Russia with the determination of muscular and fatty mass were used. In 78 patients was measured the concentration of leptin in blood serum by means of radioimmuno assay (Active Human Leptine Elisa, 10 – 23100i, DSL, USA). RESULTS. The interconnection between hyperleptinemia and malnutrition in chronic hemodialysis patients was determined. It was shown the hyperleptinemia contributes to the development of malnutrition mainly in the early periods of hemodialysis therapy and in patients with increased fat body mass. It was determined that bioimpedancemetry is preferred method for the evaluation of body mass composition of the HD patients, in comparison with caliperometry. CONCLUSION. Hyperleptinemia can be one of the pathogenetic factors, participating in the development of MN in various patients with TNI.

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The authors declare that there are no conflicts of interest present.