Wu Gao-Jue, Cai Xu-Dong, Xing Jie, Zhong Guang-Hui, Chen Jiande D Z
Division of Gastroenterology, Wuxi Second Hospital affiliated to Nanjing Medical University, Wuxi, China.
Ningbo Pace Translational Medical Research Center, Beilun, Ningbo, China.
Am J Physiol Regul Integr Comp Physiol. 2017 Aug 1;313(2):R149-R157. doi: 10.1152/ajpregu.00317.2016. Epub 2017 May 31.
Patients with chronic kidney disease (CKD) commonly complain upper gastrointestinal (GI) symptoms, especially anorexia. Hemodialysis (HD) has been noted to improve GI symptoms; however, the underlying mechanisms are unclear. This study was designed ) to study effects of HD on GI symptoms and gastric slow waves; and ) to investigate possible roles of ghrelin and glucagon-like peptide-1 (GLP-1): the study recruited 13 healthy controls, 20 CKD patients without HD (CKD group), and 18 CKD patients with HD (HD group). Dyspeptic symptoms, autonomic functions, gastric slow waves, and plasma level of ghrelin and GLP-1 were analyzed. First, the CKD patients with HD showed markedly lower scores of anorexia (0.6 ± 0.2 vs. 3.2 ± 0.4, < 0.001) compared with patients without HD. Second, the CKD group but not HD group showed a significant reduction (25.6%) in the percentage of normal gastric slow waves, compared with controls. Third, the CKD group exhibited a significantly lower ghrelin level compared with the HD group (26.8 ± 0.9 vs. 34.1 ± 2.3 ng/l, < 0.02) and a higher GLP-1 level (29.4 ± 2.8 vs. 20.0 ± 2.1 pmol/l, < 0.05) compared with controls. Moreover, the percentage of normal slow waves was positively correlated with ghrelin ( = 0.385, = 0.019) but negatively correlated with GLP-1 ( = -0.558, < 0.001) in all CKD patients. Hemodialysis improves upper GI symptoms and gastric slow waves in CKD patients. An increase in ghrelin and a decrease in GLP-1 might be involved in the HD-induced improvement in gastric slow waves.
慢性肾脏病（CKD）患者常出现上消化道（GI）症状，尤其是厌食。血液透析（HD）已被证实可改善胃肠道症状；然而，其潜在机制尚不清楚。本研究旨在：）研究血液透析对胃肠道症状和胃慢波的影响；）探讨胃饥饿素和胰高血糖素样肽-1（GLP-1）的可能作用：该研究招募了13名健康对照者、20名未进行血液透析的CKD患者（CKD组）和18名接受血液透析的CKD患者（HD组）。分析了消化不良症状、自主神经功能、胃慢波以及胃饥饿素和GLP-1的血浆水平。首先，与未进行血液透析的患者相比，接受血液透析的CKD患者的厌食评分显著降低（0.6±0.2对3.2±0.4，<0.001）。其次，与对照组相比，CKD组而非HD组的正常胃慢波百分比显著降低（25.6%）。第三，与HD组相比，CKD组的胃饥饿素水平显著降低（26.8±0.9对34.1±2.3 ng/l，<0.02），与对照组相比，GLP-1水平更高（29.4±2.8对20.0±2.1 pmol/l，<0.05）。此外，在所有CKD患者中，正常慢波百分比与胃饥饿素呈正相关（=0.385，=0.019），但与GLP-1呈负相关（=-0.558，<0.001）。血液透析可改善CKD患者的上消化道症状和胃慢波。胃饥饿素增加和GLP-1减少可能参与了血液透析诱导的胃慢波改善。
