Section for Heart Failure, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Eur J Heart Fail. 2009 Aug;11(8):789-94. doi: 10.1093/eurjhf/hfp088. Epub 2009 Jun 25.
Severe heart failure (HF) is often associated with cachexia that reverses post-heart transplantation (HTx) with frequent development of obesity. Ghrelin is a novel appetite-stimulating hormone. The aim was to determine the role of ghrelin in regulating appetite, food intake, and body composition in HF and post-HTx.
We measured serial ghrelin, hunger sensation, caloric intake, and body composition in 12 HF patients awaiting HTx, 12 patients 12.7 +/- 8.6 months post-HTx, and 7 controls. Seven of 12 HF patients were followed for longitudinal analysis post-HTx. Body mass index was 23.1 +/- 3.1 in HF and 31.5 +/- 5.5 post-HTx (P < 0.001). Heart transplantation patients had gained 18.0 +/- 7.7 kg since HTx. Ghrelin area under the curve between controlled meals (control: 186 +/- 39; HF: 264 +/- 71; HTx: 194 +/- 47 ng min/mL, P < 0.007) was higher in HF, but test meal caloric intake (control: 1185 +/- 650; HF: 391 +/- 103; HTx: 831 +/- 309 kcal, P < 0.008) was lower in HF. The longitudinal analysis confirmed these findings.
Heart failure may be associated with resistance to the appetite-stimulating effects of ghrelin, which may contribute to cachexia. Heart transplantation may be associated with resolution of ghrelin resistance, which may contribute to weight gain. These findings are preliminary and should be confirmed in larger trials.
严重心力衰竭（HF）常伴有恶病质，在心脏移植（HTx）后常出现肥胖。Ghrelin 是一种新型的食欲刺激激素。本研究旨在确定 Ghrelin 在调节 HF 和 HTx 后食欲、食物摄入和身体成分中的作用。
我们测量了 12 例等待 HTx 的 HF 患者、12 例 HTx 后 12.7 ± 8.6 个月的患者和 7 例对照者的血清 Ghrelin、饥饿感、热量摄入和身体成分的系列变化。7 例 HF 患者在 HTx 后进行了纵向分析。HF 患者的 BMI 为 23.1 ± 3.1，HTx 后为 31.5 ± 5.5（P < 0.001）。HTx 后患者体重增加了 18.0 ± 7.7kg。控制餐之间 Ghrelin 的曲线下面积（对照组：186 ± 39；HF 组：264 ± 71；HTx 组：194 ± 47ng·min/mL，P < 0.007）在 HF 患者中更高，但试验餐的热量摄入（对照组：1185 ± 650；HF 组：391 ± 103；HTx 组：831 ± 309kcal，P < 0.008）在 HF 患者中更低。纵向分析证实了这些发现。
HF 可能与对 Ghrelin 食欲刺激作用的抵抗有关，这可能导致恶病质。HTx 可能与 Ghrelin 抵抗的解决有关，这可能导致体重增加。这些发现尚属初步，应在更大的试验中得到证实。
