University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA.
JPEN J Parenter Enteral Nutr. 2012 Mar;36(2):189-96. doi: 10.1177/0148607111413770. Epub 2011 Jul 28.
Altered concentrations of ghrelin, motilin, and cholecystokinin (CCK) may contribute to gastric hypomotility. The aims of this study were to evaluate the concentrations of these hormones in patients tolerant and intolerant to gastric nutrition, assess the influence of prokinetic therapy on these hormone concentrations, determine the associations between these mediators and gastric emptying, and evaluate whether inflammation influences their concentrations.
Post hoc analyses of 2 prospective studies that enrolled 20 critically ill patients with an aspirated gastric residual (GR) >150 mL while receiving gastric enteral nutrition (intolerant group) and 10 critically ill patients with minimal GR (tolerant group). Patients with intolerance were also assessed 1 day after prokinetic therapy. Fasting serum concentrations of total ghrelin, acyl ghrelin (active), des-acyl ghrelin (inactive), motilin, CCK, and tumor necrosis factor (TNF)-α were determined. Gastric emptying was assessed concurrently using the acetaminophen absorption method.
Compared to the tolerant group, the intolerant group had higher total ghrelin (1324.8 ± 1204.6 vs 285.1 ± 132.5 pg/mL; P < .001), lower acyl ghrelin (70.5 ± 65.4 vs 208.5 ± 186.9 pg/mL; P < .05), and lower acyl ghrelin to des-acyl ghrelin ratio (1.11 ± 1.35 vs 3.47 ± 3.21 pg/mL; P < .05). Concentrations of other hormones and TNF-α were similar. Despite accelerated gastric emptying after prokinetic therapy, concentrations of all hormones and TNF-α were similar to baseline values. Hormone concentrations were not associated with gastric emptying or TNF-α.
Patients intolerant to gastric nutrition generate less acyl ghrelin, which may contribute to gastric hypomotility. Intolerance is not associated with altered concentrations of other hormones. Hormone concentrations are not influenced by prokinetic therapy.
胃动素、胆囊收缩素（CCK）和生长激素释放肽（ghrelin）浓度的改变可能与胃动力不足有关。本研究旨在评估这些激素在能够耐受和不能耐受胃内营养的患者中的浓度，评估促动力治疗对这些激素浓度的影响，确定这些介质与胃排空之间的关系，并评估炎症是否影响它们的浓度。
对 2 项前瞻性研究进行了事后分析，这些研究共纳入 20 例因接受胃内肠内营养而胃残留量（GR）>150ml 的危重症患者（不耐受组）和 10 例 GR 最小的危重症患者（耐受组）。不耐受的患者在接受促动力治疗 1 天后也进行了评估。测定空腹血清总 ghrelin、酰基 ghrelin（活性）、脱酰基 ghrelin（无活性）、胃动素、CCK 和肿瘤坏死因子（TNF）-α的浓度。同时使用对乙酰氨基酚吸收法评估胃排空情况。
与耐受组相比，不耐受组的总 ghrelin 浓度较高（1324.8±1204.6比 285.1±132.5pg/ml；P<0.001），酰基 ghrelin 浓度较低（70.5±65.4比 208.5±186.9pg/ml；P<0.05），酰基 ghrelin 与脱酰基 ghrelin 比值较低（1.11±1.35比 3.47±3.21pg/ml；P<0.05）。其他激素和 TNF-α的浓度相似。尽管促动力治疗后胃排空加速，但所有激素和 TNF-α的浓度与基线值相似。激素浓度与胃排空或 TNF-α无关。
不能耐受胃内营养的患者产生的酰基 ghrelin 较少，这可能导致胃动力不足。不耐受与其他激素浓度的改变无关。激素浓度不受促动力治疗的影响。
