血浆去酰基Ghrelin水平与慢性肾脏病各期的关系  

Association of plasma dys-acyl ghrelin with different stages of chronic kidney disease

作　　者：胡志娟[1] 王利军[1] 史亚男[1] 高占红[1] 牛凯[1] 刘冰[1] 

机构地区：[1]河北省人民医院肾内科,石家庄市050051

出　　处：《实用医学杂志》2017年第13期2143-2147,共5页The Journal of Practical Medicine

摘　　要：目的观察慢性肾脏病(CKD)患者及血液透析患者酰基ghrelin(AG)、去酰基ghrelin(DG)水平,并分析其与肾小球滤过率的关系。方法选取46例CKD1-5期患者以及15例血液透析患者。检测测各组身高、体质量、血红蛋白、生化指标、炎症指标以及空腹及餐后、透析后3 h的AG、DG水平,评估食欲及摄食,计算体质量指数(BMI)和肾小球滤过率(eGFR)。结果CKD各期患者BMI及SGA评分无差异,各期患者的食欲、摄食以及营养情况无差异。eGFR随CKD分期的升高而下降,血液透析患者透析充分;与CKD1~2期患者比较,CKD3~5期患者的空腹及餐后DG水平明显升高(P<0.01);与CKD各期餐前比较,CKD各期餐后的DG水平明显下降(P<0.01);CKD分期与空腹DG(r=0.31,P<0.05)、餐后DG(r=0.34,P<0.05)、空腹及餐后DG的比例呈正相关(r=0.61,P<0.01;r=0.55,P<0.01),与TNF-α(r=0.33,P<0.05)、IL-6(r=0.40,P<0.05)、瘦素(r=0.34,P<0.05)、年龄(r=0.41,P<0.05)呈正相关;多因素部分相关分析显示,CKD分期与空腹及餐后DG的比例独立相关(r=0.55,P<0.01;r=0.43,P<0.01);血液透析患者空腹、餐后透前及透析后AG水平无明显差异(P>0.05);血液透析患者DG水平餐后透前轻度下降,透析后明显下降(P<0.01),低于CKD1~2期患者的餐后水平。多元相关分析显示,空腹及餐后DG与血清白蛋白水平呈负相关(r=-0.64,P<0.05;r=-0.59,P<0.05),而AG水平与血清白蛋白无相关性。结论 eGFR下降与DG水平负相关;CKD和终末期肾脏病患者餐后ghrelin水平抑制受损;血液透析可使DG水平降至正常。Objectives To assess the plasma levels of acyl ghrelin （AG） and dys-acyl ghrelin （DG） in chronic kidney disease （CKD） and hemodialysis （HD） patients and analyze their relationships with different stages of CKD and hemodialysis. Methods Forty-six CKD stage 1-5 patients and 15 hemodialysis patients were enrolled into the study. Body weight, height, hemoglobin, biochemical parameters, inflammatory parameters, preprandial, postprandial and 3 hours after hemodialysis plasma AG and DG levels were measured. Appetite and food intake were assessed. Body mass index （BMI）, and estimated glomerular filtration rate （eGFR） were calculated. Results There were no significant differences in BMI, SGA, appetite, food intake and malnutrition among CKD patients of different stages, eGFR was declining with the progression of CKD stages and patients received a three-week hemodialysis. Compared with that in CKD stage 1-2 patients, the level of preprandial and postprandial DG was remarkably increased in stage 3-5 patients （P 〈 0.01）. The level of DG was significantly decreased after a standard breakfast in CKD patients （P 〈 0.01）. CKD stage was positively correlated with preprandial （r=0.31, P 〈 0.05）a nd postprandial DG （r=0.34, P 〈 0.05）, TNF-α （r=0.33, P 〈 0.05）, IL-6 （r=0.40, P 〈 0.05）, leptin （r=0.34, P 〈 0.05）, and age （r= 0.41, P 〈 0.05）. CKD stage was also highly and positively correlated with the proportion of preprandial and postprandial DG （r= 0.61, P 〈 0.01; r=0.55, P 〈 0.01）. Multivariate partial-correlation analysis showed that CKD was independently associated with the proportion of preprandial and postprandial DG （r= 0.55, P 〈 0.01; r=0.43, P 〈 0.01）.There was no decrease in AG postprandially, nor any changes in AG resultant from dialysis （P 〉 0.05）; levels of DG decreased slightly postprandially and were markedly decreased by hemodialysis （P 〈 0.01）, even lower than those seen postprandially in CKD stage 1-2; Both preprand

关 键 词：酰基ghrelin 去酰基ghrelin 慢性肾脏病 血液透析 

分 类 号：R692[医药卫生—泌尿科学]