慢性肾脏病患者血浆酰基Ghrelin 及 肥胖抑制素水平研究

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。

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

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.