慢性肾脏病患者血浆酰基Ghrelin及肥胖抑制素水平研究  

Plasma levels of Acyl-ghrelin and Obestatin in patients with chronic kidney disease

作　　者：胡志娟[1] 何伟[2] 高占红[1] 牛凯[1] 刘冰[1] Zhi-juan Hu;Wei He;Zhan-hong Gao;Kai Niu;Bing Liu(Department of nephrology,Hebei General Hospital,Shijiazhuang,Hebei 050051,China;Department of Medical Records,Hebei General Hospital,Shijiazhuang,Hebei 050051,China)

机构地区：[1]河北省人民医院肾内科,河北石家庄050051 [2]河北省人民医院病案统计室,河北石家庄050051

出　　处：《中国现代医学杂志》2018年第21期79-83,共5页China Journal of Modern Medicine

摘　　要：目的观察酰基Ghrelin和肥胖抑制素在健康者、慢性肾脏病(CKD)3、4期非血液透析(HD)患者及HD患者的水平,分析两种激素之间的关系以及与能量、蛋白质摄入的关系。方法选取22例健康者(对照组)、25例CKD非HD患者(CKD非HD组)及38例HD患者(HD组)。测量3组身高、体重指数(BMI)、腰围和肱三头肌皮褶厚度、体脂含量、生物化学指标及血浆酰基Ghrelin和肥胖抑制素水平;评估食欲和摄食,计算BMI、上肢肌肉面积(AMA)及锥削指数(CI)。结果 3组年龄、BMI、体脂含量、AMA、腰围及CI比较,差异无统计学意义(P>0.05)。与CKD非HD组比较,HD组白蛋白(albumin)水平低,而尿素、肌酐水平高(P<0.05);CKD非HD组与HD组血红蛋白和红细胞比容比较,差异无统计学意义(P>0.05);3组均表现为体脂含量高;CKD非HD组中,16.0%食欲差,4.0%食欲很差;85.7%HD和CKD非HD患者能量摄入低于推荐标准;CKD非HD组血浆酰基Ghrelin水平升高,肥胖抑制素水平降低,酰基Ghrelin与肥胖抑制素比值升高(P<0.05),HD组血浆酰基Ghrelin水平降低、肥胖抑制素水平升高,酰基Ghrelin与肥胖抑制素比值降低(P<0.05);对照组血浆肥胖抑制素与腰围和BMI呈负相关(r=-0.601和-0.562,P=0.037和0.041);CKD非HD组和HD组中,两种激素与营养状态、食欲及摄食均无相关性(r=0.223、-0.234、0.233、-0.209、0.251及-0.264,P=0.901、0.813、0.821、0.982、0.677及0.573)。结论酰基Ghrelin和肥胖抑制素的比值在HD组中降低、在CKD非HD组中升高,CKD非HD组的营养状态好于HD组。Objectives To assess the plasma levels of Acyl-ghrelin and Obestatin in patients with chronic kidney disease(CKD)and analyze the relationships between these hormones,anthropometric parameters,energy,and protein intakes.Methods Totally 38 HD patients,25 non-HD CKD patients,and 22 healthy subjects were enrolled into the study.Body weight,height,waist circumference(WC),skinfold measurement of biceps,triceps,subscapular,body fat percentage,biochemical parameters,plasma acyl-ghrelin and Obestatin levels were measured.Appetite and food intake were assessed.Body mass index(BMI),arm muscle area(AMA)and conicity index(CI)were recorded.Results No significant difference in age,BMI,body fat percentage,AMA,WC,and CI index among three groups were identified(P>0.05).HD patients experienced lower levels of albumin and higher levels of urea,creatinine levels(P<0.05)compared with non-HD patients.There was no significant difference in hemoglobin and hematocrit among groups(P>0.05).In non-HD group,16%had poor appetite and 4%had very poor appetites.About 85.7%of CKD patients presented a deficient energy intake in comparison to recommendation.Non-HD patients presented the highest levels of acyl-ghrel in and the lowest levels of Obestatin(P<0.05).In contrast,HD patients presented the highest levels of Obestatin and the lowest levels of acyl-ghrelin(P<0.05).Plasma concentration of Obestatin was negatively correlated with WC(r=-0.601,P=0.037)and BMI(r=-0.562,P=0.041)in healthy subjects.No relationship between appetite hormones and nutritional status,appetite or food intake was determined in CKD patients.Conclusions The Acyl-ghrelin/Obestatin ratio is significantly decreased in HD patients and increased in non-dialysis patients.Non-dialysis patients have better nutritional status than HD patients do.

关 键 词：酰基Ghrelin 肥胖抑制素 慢性肾脏病 血液透析 

分 类 号：R586.9[医药卫生—内分泌]