Department of Gastroenterology, Hepatology and Endocrinology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Nutrition. 2011 Sep;27(9):880-4. doi: 10.1016/j.nut.2010.12.013.
Peptide YY(3-36) (PYY(3-36)) is a gut hormone with anorectic action that also affects energy expenditure. Anorexia and malnutrition are often observed in patients with decompensated liver cirrhosis (LC), whereas patients with LC after insertion of transjugular portosystemic stent shunts (TIPS) show normal eating behavior. The underlying mechanism of anorexia in decompensated LC and its resolution in patients with TIPS is still unclear. We thus investigated fasting and postprandial PYY(3-36) serum levels in patients with decompensated LC, patients with compensated LC with in situ TIPS, and healthy controls.
We analyzed fasting PYY(3-36) levels in six patients with decompensated LC (four men and two women, 55 ± 11 y of age), nine patients with TIPS (seven men and two women, 48 ± 11 y of age), and 10 controls (eight men and two women, 43 ± 9 y of age) postprandially after a standardized meal of 300 kcal and during 1-h continuous parenteral nutrition. Energy expenditure was determined by indirect calorimetry.
At baseline PYY(3-36) was comparable in controls and patients with TIPS (91 ± 10 and 89 ± 25 ng/L) but was increased in patients with decompensated LC (165 ± 44 ng/L, P < 0.01). Although the cumulative postprandial PYY(3-36) increase was similar in controls (mean 2089 ng/240 min per liter) and patients with decompensated LC (mean 1735 ng/240 min per liter), no postprandial PYY(3-36) increase was observed in patients with TIPS (mean -579 ng/240 min per liter). Parenteral nutrition did not significantly affect PYY(3-36) levels in any group. Fasting PYY(3-36) values were negatively related to resting energy expenditure (r = -0.443, P = 0.030). PYY(3-36) was not associated to liver parameters (e.g., bilirubin, alanine aminotransferase).
Our results demonstrate an abnormal neuroendocrine regulation of PYY(3-36) in patients with decompensated LC and those with TIPS.
肽 YY（3-36）（PYY（3-36））是一种具有厌食作用的肠道激素，也会影响能量消耗。失代偿性肝硬化（LC）患者常出现厌食和营养不良，而经颈静脉肝内门体分流术（TIPS）置入后的 LC 患者表现出正常的进食行为。失代偿性 LC 中厌食的潜在机制及其在 TIPS 患者中得到解决的机制仍不清楚。因此，我们检测了失代偿性 LC 患者、原位 TIPS 患者和健康对照者空腹和餐后 PYY（3-36）血清水平。
我们分析了 6 例失代偿性 LC 患者（4 男 2 女，年龄 55±11 岁）、9 例 TIPS 患者（7 男 2 女，年龄 48±11 岁）和 10 例对照者（8 男 2 女，年龄 43±9 岁）空腹时及餐后 300 卡标准餐和 1 小时持续肠外营养时的 PYY（3-36）水平。间接量热法测定能量消耗。
在基础状态下，对照组和 TIPS 患者的 PYY（3-36）水平相似（分别为 91±10 和 89±25 ng/L），但失代偿性 LC 患者的 PYY（3-36）水平升高（165±44 ng/L，P<0.01）。尽管对照组（平均 2089 ng/240 min/L）和失代偿性 LC 患者（平均 1735 ng/240 min/L）的餐后 PYY（3-36）累积增加相似，但 TIPS 患者无餐后 PYY（3-36）增加（平均-579 ng/240 min/L）。肠外营养在任何组中均未显著影响 PYY（3-36）水平。空腹 PYY（3-36）值与静息能量消耗呈负相关（r=-0.443，P=0.030）。PYY（3-36）与肝参数（如胆红素、丙氨酸氨基转移酶）无关。
我们的结果表明，失代偿性 LC 患者和 TIPS 患者的 PYY（3-36）存在异常神经内分泌调节。
