Doki Yuichiro, Takachi Ko, Ishikawa Osamu, Miyashiro Isao, Sasaki Yo, Ohigashi Hiroaki, Nakajima Hiromu, Hosoda Hiroshi, Kangawa Kenji, Sasakuma Fujiko, Motoori Masaaki, Imaoka Shingi
Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Surgery. 2006 Jun;139(6):797-805. doi: 10.1016/j.surg.2005.11.015.
Body weight loss is observed commonly after esophagectomy with gastric tube reconstruction in thoracic esophageal cancer patients. The functional and anatomical alteration of the stomach by this surgery should affect ghrelin secretion, a novel gastric hormone that upregulates body weight through appetite control and metabolic reaction.
Early-phase postoperative alteration of serum ghrelin was measured before and at day 3 and day 7 after surgery in 9 patients. With 26 other patients, who had previously undergone surgery from 3 months to 67 months (mean, 25 months) before the present study period, the late-phase postoperative alteration of serum ghrelin was investigated along with postoperative body weight loss and serum leptin.
Serum ghrelin concentration, which was equivalent to the control group before surgery (88.6 fmol/mL vs 97.5 fmol/mL) significantly decreased by half at 3 and 7 days after surgery. Thereafter, the serum ghrelin decline continued in the outpatients within 1 year after surgery (58.8 fmol/mL), while it was marginal in those from 1 to 3 years after surgery (77.2 fmol/mL). Serum ghrelin was significantly higher than the control after 3 years (185.1 fmol/mL). Thus, a significant positive correlation was observed between ghrelin and time after surgery (P < .0001). Postoperative body weight loss was significant, averaged as DeltaBMI - 2.7 in the outpatients (P < .0001). Until 3 years after surgery, a significant correlation between ghrelin and postoperative body weight loss was observed (P = .0152), with those having higher serum ghrelin showing less body weight loss. Serum leptin correlated well with body weight (P = .0144), but not with postoperative time, the degree of body weight loss, or serum ghrelin concentration.
Gastric tube replacement for esophagectomy resulted in temporary reduction of ghrelin production, which is associated with body weight loss after surgery. The decline of ghrelin may play some role in the serious body weight loss after esophagectomy, thus encouraging clinical application of exogenous recombinant ghrelin for these patients.
胸段食管癌患者行食管切除并胃管重建术后，体重减轻较为常见。该手术导致的胃功能和解剖结构改变应会影响胃饥饿素的分泌，胃饥饿素是一种新型胃激素，可通过控制食欲和代谢反应来上调体重。
对9例患者在术前及术后第3天和第7天测量血清胃饥饿素的早期术后变化。另外26例患者在本研究期前3个月至67个月（平均25个月）曾接受过手术，对其血清胃饥饿素的晚期术后变化、术后体重减轻情况及血清瘦素进行了研究。
术前血清胃饥饿素浓度与对照组相当（88.6 fmol/mL对97.5 fmol/mL），术后第3天和第7天显著下降一半。此后，门诊患者术后1年内血清胃饥饿素持续下降（58.8 fmol/mL），而术后1至3年患者下降幅度较小（77.2 fmol/mL）。术后3年血清胃饥饿素显著高于对照组（185.1 fmol/mL）。因此，胃饥饿素与术后时间之间存在显著正相关（P <.0001）。门诊患者术后体重减轻显著，平均DeltaBMI为 - 2.7（P <.0001）。术后3年内，胃饥饿素与术后体重减轻之间存在显著相关性（P =.0152），血清胃饥饿素水平较高者体重减轻较少。血清瘦素与体重相关性良好（P =.0144），但与术后时间、体重减轻程度或血清胃饥饿素浓度无关。
食管切除术中用胃管替代导致胃饥饿素产生暂时减少，这与术后体重减轻有关。胃饥饿素的下降可能在食管切除术后严重体重减轻中起一定作用，从而促使对外源性重组胃饥饿素在这些患者中的临床应用进行研究。
