Matsumoto Nobuhiro, Miki Keisuke, Tsubouchi Hironobu, Sakamoto Akihiro, Arimura Yasuji, Yanagi Shigehisa, Iiboshi Hirotoshi, Yoshida Makoto, Souma Ryosuke, Ishimoto Hiroshi, Yamamoto Yoshifumi, Yatera Kazuhiro, Yoshikawa Masanori, Sagara Hironori, Iwanaga Tomoaki, Mukae Hiroshi, Maekura Ryoji, Kimura Hiroshi, Nakazato Masamitsu, Kangawa Kenji
Neurology, Respirology, Endocrinology and Metabolism, Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan,
Lung. 2015 Apr;193(2):239-47. doi: 10.1007/s00408-015-9685-y. Epub 2015 Jan 30.
Repeated ghrelin administration leads to improvements in symptoms, muscle wasting and exercise tolerance in cachectic patients with pulmonary disease. We investigated the optimal ghrelin dose for underweight patients with chronic respiratory failure.
In this multicenter, randomized, dose-comparison exploratory study, 44 cachectic patients with chronic respiratory failure were randomly assigned pulmonary rehabilitation with intravenous twice-daily administration of 1 or 2 μg/kg ghrelin for 3 weeks. The primary endpoint was improvement in 6-min walking distance (6 MWD). The secondary endpoint was change in peak VO2.
Twenty-one patients were assigned to the 1 μg/kg ghrelin group and 23 to the 2 μg/kg ghrelin group. Change from baseline 6 MWD after treatment was similar between groups(1 μg/kg: 53.9 m, 2 μg/kg: 53.9 m, p = 0.99). Mean change in peak VO2 was significantly greater in the 2 μg/kg group (63.1 ml/min) than in the 1 μg/kg group (-63.8 ml/min, p = 0.048). Food intake and lean body mass significantly increased in both groups, and the St. George Respiratory Questionnaire score, body weight, and body mass index were remarkably improved in only the 2 μg/kg group, although there was no significant difference between groups. No treatment-related serious events were reported for either group.
Improvements in the oxygen uptake capacity were greater in patients receiving 2 μg/kg ghrelin twice daily for 3 weeks than in those receiving 1 μg/kg, although exercise tolerance was similar between groups at the end of the 3-week treatment period. Thus, a twice daily dose of 2 μg/kg ghrelin is recommended over 1 μg/kg ghrelin for patients with chronic respiratory failure and weight loss.
反复给予生长激素释放肽可改善患有肺部疾病的恶病质患者的症状、肌肉萎缩和运动耐量。我们研究了体重不足的慢性呼吸衰竭患者的最佳生长激素释放肽剂量。
在这项多中心、随机、剂量比较探索性研究中，44例患有慢性呼吸衰竭的恶病质患者被随机分配接受肺康复治疗，每天两次静脉注射1或2μg/kg生长激素释放肽，持续3周。主要终点是6分钟步行距离（6MWD）的改善。次要终点是峰值VO2的变化。
21例患者被分配到1μg/kg生长激素释放肽组，23例被分配到2μg/kg生长激素释放肽组。治疗后两组从基线开始的6MWD变化相似（1μg/kg组：53.9米，2μg/kg组：53.9米，p = 0.99）。2μg/kg组的峰值VO2平均变化（63.1ml/min）显著大于1μg/kg组（-63.8ml/min，p = 0.048）。两组的食物摄入量和去脂体重均显著增加，仅2μg/kg组的圣乔治呼吸问卷评分、体重和体重指数有显著改善，尽管两组之间无显著差异。两组均未报告与治疗相关的严重事件。
对于慢性呼吸衰竭和体重减轻的患者，每天两次给予2μg/kg生长激素释放肽持续3周的患者，其摄氧能力的改善大于接受1μg/kg生长激素释放肽的患者，尽管在3周治疗期结束时两组的运动耐量相似。因此，对于慢性呼吸衰竭和体重减轻的患者，推荐每天两次给予2μg/kg生长激素释放肽而非1μg/kg生长激素释放肽。
