Matsumoto Nobuhiro, Tsubouchi Hironobu, Imazu Yoshifumi, Arimura Yasuji, Yanagi Shigehisa, Iiboshi Hirotoshi, Nakazato Masamitsu
Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Miyazaki, Japan.
Division of Data Management, Department of Social Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Endocr J. 2017;64(Suppl.):S1-S3. doi: 10.1507/endocrj.64.S1.
Chronic respiratory failure, which is often caused by chronic obstructive pulmonary disease, chronic lower respiratory tract infection, or interstitial pneumonia, often leads to cachexia with disease progression. Patients who have chronic respiratory failure with cachexia exhibit increased morbidity. Although cachectic status is an important clinical problem, there are no effective therapies for cachexia. Ghrelin has various effects, including increasing food intake, attenuating sympathetic nerve activity, inhibiting inflammation, increasing cardiac output, and controlling fat utilization. These effects of ghrelin are ideal targets for the treatment of severely wasting chronic respiratory disease. In a few clinical studies, including a small randomized controlled trial, ghrelin administration to cachectic patients with chronic respiratory failure improved exercise tolerance, dyspnea, and appetite. The patients in these studies gained muscle mass and weight. In another study of chronic lower respiratory tract infection with cachexia, ghrelin suppressed airway inflammation by decreasing neutrophil accumulation in the airway, resulting in improvements in oxygenation and exercise tolerance. Although further clinical investigations are needed to clarify its usefulness, ghrelin is expected to become a novel therapy for cachectic patients with chronic respiratory failure.
慢性呼吸衰竭通常由慢性阻塞性肺疾病、慢性下呼吸道感染或间质性肺炎引起，常随着疾病进展导致恶病质。患有慢性呼吸衰竭合并恶病质的患者发病率增加。尽管恶病质状态是一个重要的临床问题，但目前尚无有效的恶病质治疗方法。胃饥饿素具有多种作用，包括增加食物摄入量、减弱交感神经活动、抑制炎症、增加心输出量以及控制脂肪利用。胃饥饿素的这些作用是治疗严重消瘦的慢性呼吸道疾病的理想靶点。在包括一项小型随机对照试验在内的一些临床研究中，给患有慢性呼吸衰竭的恶病质患者注射胃饥饿素可改善运动耐量、呼吸困难和食欲。这些研究中的患者肌肉量和体重增加。在另一项关于慢性下呼吸道感染合并恶病质的研究中，胃饥饿素通过减少气道中的中性粒细胞积聚来抑制气道炎症，从而改善氧合和运动耐量。尽管需要进一步的临床研究来阐明其有效性，但胃饥饿素有望成为治疗患有慢性呼吸衰竭的恶病质患者的一种新疗法。
