Iwanaga Kikuko, Takamura Noboru, Abe Yasuyo, Zhaojia Ye, Shinzato Ken, Hosoda Hiroshi, Kangawa Kenji, Ohtsuru Akira, Kohno Shigeru, Yamashita Shunichi, Aoyagi Kiyoshi
Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan.
Endocr J. 2005 Feb;52(1):23-8. doi: 10.1507/endocrj.52.23.
Sustained and/or episodic hypotension during hemodialysis (HD) is an important clinical issue. Plasma adrenomedullin (AM) is increased in HD patients with sustained hypotension, but little is known about its implications for episodic hypotension. Ghrelin may also contribute to the pathophysiology of hypotension in HD patients. We evaluated plasma levels of AM and total ghrelin in sustained hypotensive (SH; n = 23), episodic hypotensive (EH; n = 30) and normotensive (NT; n = 23) HD patients. In the EH group, the relationship between low blood pressure during HD and circulating levels of AM and ghrelin was also evaluated. Plasma levels of AM were significantly higher in SH (34.3 +/- 8.3 fmol/ml, p<0.01) than in NT patients (27.6 +/- 5.2 fmol/ml), but not in EH patients (30.8 +/- 6.1 fmol/ml). There was no significant difference of plasma total ghrelin in SH (548.1 +/- 426.5 fmol/ml) and in EH patients (544.6 +/- 174.3 fmol/ml), compared with NT patients (400.0 +/- 219.7 fmol/ml). On the other hand, in EH patients, the "suppressed blood pressure ratio" during HD significantly correlated with plasma AM (r = 0.77, p<0.001) and with total ghrelin levels (r = 0.44, p<0.05). Our results suggest that ghrelin, as well as AM, may play an important role as vasodilator local hormones and regulation of blood pressure during HD, especially the occurrence of EH. Further studies are necessary to clarify the implication of these hormones in the control of hypotension during HD.
血液透析（HD）期间持续和/或间歇性低血压是一个重要的临床问题。持续性低血压的HD患者血浆肾上腺髓质素（AM）升高，但关于其对间歇性低血压的影响知之甚少。胃饥饿素也可能在HD患者低血压的病理生理过程中起作用。我们评估了持续性低血压（SH；n = 23）、间歇性低血压（EH；n = 30）和血压正常（NT；n = 23）的HD患者的血浆AM和总胃饥饿素水平。在EH组中，还评估了HD期间低血压与AM和胃饥饿素循环水平之间的关系。SH组患者的血浆AM水平（34.3±8.3 fmol/ml，p<0.01）显著高于NT组患者（27.6±5.2 fmol/ml），但EH组患者（30.8±6.1 fmol/ml）无显著差异。与NT组患者（400.0±219.7 fmol/ml）相比，SH组患者（548.1±426.5 fmol/ml）和EH组患者（544.6±174.3 fmol/ml）的血浆总胃饥饿素水平无显著差异。另一方面，在EH组患者中，HD期间的“血压抑制率”与血浆AM显著相关（r = 0.77，p<0.001），与总胃饥饿素水平也显著相关（r = 0.44，p<0.05）。我们的结果表明，胃饥饿素以及AM可能作为血管舒张局部激素在HD期间对血压调节起重要作用，尤其是在EH的发生过程中。有必要进一步研究以阐明这些激素在HD期间低血压控制中的意义。
