Rusu Crina Claudia, Racasan Simona, Moldovan Diana, Potra Alina, Tirinescu Dacian, Budurea Cristian, Orasan Remus, Patiu Ioan Mihai, Bondor Cosmina, Vladutiu Dan, Delean Dan, Danu Alexandra, Kacso Ina Maria
Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania.
Nefromed Dialysis Center, 40 Ana Aslan Street, Cluj-Napoca, Romania.
Int Urol Nephrol. 2018 Oct;50(10):1897-1906. doi: 10.1007/s11255-018-1933-7. Epub 2018 Jul 13.
Exogenous ghrelin is associated with cardiovascular protection in experimental and human studies. Nevertheless ESRD patients have increased ghrelin levels and severe cardiovascular comorbidities. This study aims to elucidate the metabolic factors influencing endogenous ghrelin/acyl ghrelin levels and to analyze the relation between endogenous ghrelin/acyl ghrelin levels and cardiac and vascular function markers in hemodialysis patients.
The cross-sectional study was conducted in hemodialysis patients (n = 88); 50 of them were men, mean age 61.1 ± 13.5 years, 17% had diabetes. We assessed nutritional and inflammatory status and analyzed the determinants of ghrelin/acyl ghrelin and their relation with cardiac and vascular function.
Ghrelin is correlated with IL-1β (r = 0.88, p < 0.0001), triglycerides, total cholesterol (TC), and Kt/V. IL-1β is the strongest predictor of ghrelin levels (p < 0.0001). Acyl ghrelin is correlated with TC (r = 0.36, p = 0.001), LDL-cholesterol, serum bicarbonate, body mass index. TC is the strongest predictor for acyl ghrelin levels (p = 0.038). Patients with high ghrelin levels had significantly decreased nitroglycerin-mediated dilation (p = 0.05) and higher IL-1β levels (p < 0.001); increased NT-proBNP is associated with lower levels of acyl ghrelin (r = - 0.33, p = 0.02) in male patients.
The inflammatory marker IL-1β is in our study the strongest predictor of ghrelin levels while the nutritional marker-total cholesterol is the strongest predictor for acyl ghrelin levels in HD patients. High endogenous ghrelin level is associated with high IL-1β and with vascular smooth muscle cell dysfunction. Low acyl ghrelin level is associated with high NT-proBNP (a cardiac dysfunction marker) in male HD patients. There is a direct correlation between endogenous ghrelin level and inflammatory markers, which is not related with cardiovascular protection.
在实验研究和人体研究中，外源性胃饥饿素与心血管保护相关。然而，终末期肾病（ESRD）患者的胃饥饿素水平升高且伴有严重的心血管合并症。本研究旨在阐明影响内源性胃饥饿素/酰基胃饥饿素水平的代谢因素，并分析血液透析患者内源性胃饥饿素/酰基胃饥饿素水平与心脏和血管功能标志物之间的关系。
对血液透析患者（n = 88）进行横断面研究；其中50例为男性，平均年龄61.1±13.5岁，17%患有糖尿病。我们评估了营养和炎症状态，并分析了胃饥饿素/酰基胃饥饿素的决定因素及其与心脏和血管功能的关系。
胃饥饿素与白细胞介素-1β（IL-1β）（r = 0.88，p < 0.0001）、甘油三酯、总胆固醇（TC）和Kt/V相关。IL-1β是胃饥饿素水平的最强预测因子（p < 0.0001）。酰基胃饥饿素与TC（r = 0.36，p = 0.001）、低密度脂蛋白胆固醇、血清碳酸氢盐、体重指数相关。TC是酰基胃饥饿素水平的最强预测因子（p = 0.038）。胃饥饿素水平高的患者硝酸甘油介导的血管扩张明显降低（p = 0.05）且IL-1β水平较高（p < 0.001）；男性患者中，N末端脑钠肽前体（NT-proBNP）升高与酰基胃饥饿素水平降低相关（r = -0.33，p = 0.02）。
在我们的研究中，炎症标志物IL-1β是血液透析患者胃饥饿素水平的最强预测因子，而营养标志物总胆固醇是酰基胃饥饿素水平的最强预测因子。内源性胃饥饿素水平高与高IL-1β以及血管平滑肌细胞功能障碍相关。男性血液透析患者中，酰基胃饥饿素水平低与高NT-proBNP（一种心脏功能障碍标志物）相关。内源性胃饥饿素水平与炎症标志物之间存在直接相关性，这与心血管保护无关。
