Rodriguez Ayala Ernesto, Pecoits-Filho Roberto, Heimbürger Olof, Lindholm Bengt, Nordfors Louise, Stenvinkel Peter
Division of Renal Medicine, Department of Clinical Science, Karolinska Institutet, Stockholm, Sweden.
Nephrol Dial Transplant. 2004 Feb;19(2):421-6. doi: 10.1093/ndt/gfg559.
Ghrelin is a newly detected orexigenic gastric hormone that stimulates food intake. Increased levels of ghrelin are often found in disease states associated with wasting. Wasting is a common phenomenon in end-stage renal disease (ESRD) patients in whom elevated ghrelin levels have been reported. However, no data are available on the relationship between body composition and plasma ghrelin levels in this patient group.
The study population consisted of 108 (71 males) ESRD patients aged 53+/-12 years. Body composition, nutritional status (subjective global assessment), estimated protein intake (nPNA), plasma ghrelin, plasma insulin and serum leptin were evaluated close to the start of dialysis treatment. Twelve healthy subjects (nine males, 44+/-6 years) served as the control group. A longitudinal evaluation of changes in plasma ghrelin and body composition was performed in 52 of the patients after 12 months of dialysis treatment.
Markedly elevated plasma ghrelin levels (843+/-485 vs 443+/-302 pg/ml; P<0.01) were observed in ESRD patients compared with controls. Basal plasma ghrelin levels correlated significantly with plasma insulin (R = -0.32; P<0.05), body mass index (R = -0.24; P<0.05), log serum leptin levels (R = -0.23; P<0.05) and truncal fat mass (R = -0.25; P<0.05). The longitudinal analysis of body composition demonstrated that whereas fat mass increased (23.7+/-8.6 to 25.3+/-9.9 kg; P<0.05) and plasma ghrelin levels decreased (855+/-429 to 693+/-408 pg/ml; P<0.05) significantly in peritoneal dialysis patients, no significant changes in either body composition or plasma ghrelin levels were found in patients treated by haemodialysis.
Markedly elevated plasma ghrelin levels are found in advanced renal failure and correlate with fat mass, plasma insulin and serum leptin levels. Changes in plasma ghrelin during 12 months of peritoneal dialysis treatment are associated with changes in body composition.
胃饥饿素是一种新发现的可刺激食物摄入的促食欲胃激素。在与消瘦相关的疾病状态中，常常发现胃饥饿素水平升高。消瘦是终末期肾病（ESRD）患者中的常见现象，已有报道称该类患者胃饥饿素水平升高。然而，关于该患者群体的身体组成与血浆胃饥饿素水平之间的关系尚无数据。
研究人群包括108例（71例男性）年龄为53±12岁的ESRD患者。在透析治疗开始时，对身体组成、营养状况（主观全面评定）、估计蛋白质摄入量（nPNA）、血浆胃饥饿素、血浆胰岛素和血清瘦素进行评估。12名健康受试者（9名男性，44±6岁）作为对照组。对52例患者在透析治疗12个月后进行血浆胃饥饿素和身体组成变化的纵向评估。
与对照组相比，ESRD患者的血浆胃饥饿素水平显著升高（843±485 vs 443±302 pg/ml；P<0.01）。基础血浆胃饥饿素水平与血浆胰岛素（R = -0.32；P<0.05）、体重指数（R = -0.24；P<0.05）、血清瘦素水平对数（R = -√2；P<0.05）和躯干脂肪量（R = -0.25；P<0.05）显著相关。身体组成的纵向分析表明，腹膜透析患者的脂肪量增加（23.7±8.6至25.3±9.9 kg；P<0.05）且血浆胃饥饿素水平降低（855±429至693±408 pg/ml；P<0.05），而血液透析治疗的患者在身体组成或血浆胃饥饿素水平方面均未发现显著变化。
晚期肾衰竭患者血浆胃饥饿素水平显著升高，并与脂肪量、血浆胰岛素和血清瘦素水平相关。腹膜透析治疗12个月期间血浆胃饥饿素的变化与身体组成的变化相关。
