1、腹膜透析和血液透析患者血浆 Ghrelin 水平的研究第 17 卷第 1O 期2007 年 5 月中国现代医学杂志ChinaJournalofModernMedicineVo1.17No.10May2007文章编号:10058982(2007)10-1153-04PlasmagherlinlevelsinpatientsundergoinghemodialysisandperitonealdialysisHEIAan,ZHANGAihua,ALata,HANQing-feng,ZHUNing,FANMinhua(DepartmentofNephrology,theThirdAffiliated
2、HospitalofPekingUniversity,Beiing100083,P.R.China)?论着?Abstract:【Objective】Tostudythecorrelationsbetweenthefastingplasmaghrelinlevels,nutrition,inflamma-tionmarkers.andofilerfactorsinperitonealdialysisandhemedialysispafien.IMethods】ThelevelsoffastingplasmaghrelinweremeasuredandcomparedbyELISAin30peri
3、tonealdialysis,30hemodialysispatienand20nomudcontrols.Thecorrelationsbetweentheplasmarelinlevels,nutritionmarkem,andinflammationmarkerswerealsoexplored.【Results】Thefastingplasmaghrelinlevelsindialysisgroupsweremuchhigherthanthatincontrols(P0.0001).However,thereWasnodifferenceinplasmaghlinlevelsbetwe
4、enperitonealdialysisandhemodialysisgroupsrP=0.6O1).indialysisgroupstheplasmaghrelinlevelswerenegativelycorrelatedwithbodymassindex(BMI)(P=0.O04)andwiththeplasmaprealbumin(P=0.037),butpositivelycorrelatedwiththeplasmainterleukin 一 6(P=0.006).ThereWasnodifferenceinthelevelsofplasmaghrelinbetweenwell-n
5、ourished,sughtlymalnourishedandseveremalnourishedsubgroup(P=0.165),and80Wasbetweenthesubgroupswithslightinflam-marionandwithmarkedinflammation(P=0.423).【Conclusions】Thefastingplasmaghrelinlevelsindialysisgroupsweremuchhigherthanthatincontrols.ThereWasnodifferenceintheplasmaghrelinlevelsbetweenperito
6、nealdialysisandhemodialysisgroups.indialysisgroupstheplasmaghrelinlevelswerenegativelycorrelatedwithBMI.Therewerenosignificantrelationsbetweentheplasmaghrelinlevels,age,residualrenalfunction,andothernutritionandinflammationmaYkers.ThesesuggestedthatindialysispatientsghrelinhascorrelationwithBMI.Thed
7、ialysismethodsdidnothaveeffectsonthepatienplasmaghrelinlevels.Keywords:ghrelin;peritonealdialysis;hemodialysis;malnutrition;inflammationCLCnumber:R692.5Documentcode:A腹膜透析和血液透析患者血浆Ghrelin 水平的研究何莲,张爱华,阿拉塔,韩庆烽,朱宁,范敏华(北京大学第三医院肾内科,北京 100083)摘要:目的检测腹膜透析和血液透析患者空腹血浆 ghrelin 水平,探讨影响 ghrelin水平的因素及它与炎症,营养等的关系.
8、方法用酶联免疫吸附法(ELISA)测定 3O 名腹膜透析病人,30 名血液透析病人和 2O 名健康对照的空腹血浆 ghrelin 水平并进行比较,同时对透析患者的血浆 ghrelin 水平与营养指标,炎症指标等进行相关分析.结果透析患者的空腹血浆 ghrelin 水平明显高于健康对照(PO.0001),而腹膜透析患者和血液透析患者的血浆 ghrelin 水平间无统计学差异 (P:O.601).透析患者血浆 ghrelin 水平与体重指数(BMI)负相关(P=O.004),与血白介素 6 水平呈正相关(P=O.006),与血前白蛋白水平呈负相关(P=O.037).另外,营养良好组,轻中度营养不良
9、和重度营养不良组间血浆 ghrelin 水平差异无显着性(P=O.165),炎症反应明显组和低或无炎症反应组间血浆 ghre/n 水平差异无显着性(P=O.423).结论透析患者血浆 ghrelin 水平明显高于正常人,而腹膜透析和血液透析患者间血浆 ghrelin 水平差异无显着性.此人群的血浆 ghrelin 水平与体重指数Receiveddate:Sep.21,2006?1153?中国现代医学杂志第 17 卷负相关,而与年龄,其他营养及炎症指标等无明确关系.关键词:Ghrelin; 腹膜透析;血液透析;营养不良;炎症中图分类号:R692.5 文献标识码:AGhrelinwasdiscov
10、eredtobetheendogenouslig-andofgrowthhormonesecretagoguereceptor(GHSR)severalyearsago.Its3rdserineresidueisn-octanoylated【1】_GhrelinpossessesastrongGH-releasingeffect.Itsstimulatoryactiononfoodintakeanditsmodulato-ryeffectonenergymetabolismarealsoimportant【31.Inaddition,itexertsactionsoncardiovascula
11、r,digestiveandothersystems.Anorexiaandwastingarecommonphenomenoninend-stagerenaldisease(ESRD)patientsinwhomelevatedghrelinlevelshavebeenre.portedI4.However.therelateddataistoolittleinourcountry.Westudied30hemodialysisand30peri-tonealdialysispatients,andcomparedtheirplasmaghrelinlevelswiththatoftheco
12、ntrolgroup.Wealsoexploredcorrelationsbetweenplasmaghrelinlevelsandmalnutrition,inflammation,anddialysisadequacymarkers.Wearelookingforwardtofindinganewwaytoimprovethelifeofdialysispatients.1Materialandmethodsj.1MaterialThecontrolgroupconsistedof20healthyvolun.teers10males,10females,age(56+11)years,w
13、hohadnodiabetesmellitus,hypertension,renaldiseaseormalignanttumors.Therewere30randomlyselected,stableuraemicpatientsundergoinghemodialysis(HD)18males,12females,age(62_+13)years,whounderwentdialysis4-5hourseachtime,2-3timesperweek.Remaining30patientsunderwentperitonealdialysis(PD)10males,20females,ag
14、e(60l1)years,whounderwentcontinuousambulatoryperitonealdialysis(CAPD),2-4timesexchangeperdaywith15O020o0mLof1.5%2.5%PD-2Baxterdex-trindialysate.Tothethreeicantdifferenceinsex,ageJ.2Methodsgroupstherewasnosignif-andBMI(seetable1).GeneraldataPasthistory,age,andappetiteetc.Recentheight,weight,andcomput
15、ingBM1weremeasured,subjectiveossassessmentwasscoredwithBlakesmethods.Table1Studypopulations)Note:十 PO.05,nosignifieaneeamongthethreegroupsLaboratorymarkersGhrelin:Afteranovernightfast,bloodsamplesweretakeninthemorningatasimilartime.InHDpatientsbloodwascollectedfromveinsbeforehemodialysis.InPDpatient
16、sbloodwascollectedafterthefirstdaytimeexchange.Thesampiesforghrelindetermination,putinchilledtubescontainingEDTANaandaprotinin,werecentrifugatedimmediatelyat4C,andwerefrozenat 一 80Cbeforeprocessing.Plasmaghrelinlevelswereanalyzedwithacommerciallyavailableenzyme-link-im-munoassay(ELISA)thatdetectsful
17、l-lengthoctanoylatedhumanghrelin(PhoenixPharmceuticals,USA).Plasmainterleukin6(IL 一 6),plasmatumornecrosisfactora(TNF-a),andiFIT1weremeasuredbytheELISAkit.Andotherbiochemicalindexeswerealsomeasured.Dialysisadequacy:WecomputedthetotalKT,1.StatisticalanalysisThenormallydistributeddatawereexpressedasme
18、anvalues_+SD,andthenon-normallydistributeddatawaspresentedasmedianvaluesrange:minmax).Variableswerecomparedbyindependentsamplest-test,analysisofvariance,ranksumtestorK2analysisamonggroups.TheSpearmancorrelationcoe 伍 cientandthePearsoncorrelationcoefficientwereusedincorrelationanalysis.Thestatis-tica
19、lanalyseswereperformedusingtheSPSS11.5software.PO.05wasconsideredstatisticallysignificant.?1154?第 lO 期何莲,等:腹膜透析和血液透析患者血浆 Ghrelin 水平的研究2ResultsPlasmalevelsofghrelinweremarkedlyhigherinbothHDandPDpatientsthaninhealthycontrolsPO.0001,HD(3224.8+_855.8)pg/mL,PD(3325.3_-4-792.8)pg/mL,controls(1364.7+-388.
20、8)pg/mL.ButtherewasnodifferencebetweenPDandHDgroups(P=O.601.seeFigure).AsignificantinversecorrelationwasobservedbetweenplasmalevelsofghrelinandBMI(r=一 0.316,P=O.004)inthewholesamples.Moreover,theplasmalevelsofghrelinwerealsonegativelycorrelatedwithplasmaprealbumin(r=-0.303,P=O.037)andplasmaIL 一 6(r=
21、一 0.252,P=O.006),butnotwithage,SGAscores,hemoglobinconcentration,serumcholesterols,serumtriglycerides.serumcreastininorTNFc(SeeTable21.45oo400035oo2350oo00互 2000150010005ooOcontrolPDHD(:PO.0001;PO.0001,PDvscontrols;PU10001,HDvscontrols;notsignificant,PDvsHD)FigureDiagramsofplasmaghrelinlevelsinpatie
22、ntsandcontrolsTable2Correlationanalysisbetweenplasmaghrenlevelsandotherfactorsindialysispatients【correlationcoefficientrrIvalue)lr(P)ageBMI(kg/mz)SGAHemoglobin(r/L)Serumalbumin(g/L)Serumcholesterols(mmol/L)Serumtriglyeeridesmmol/L)Bloodglucose(retool/L)PlasmaprealbuminmeCrU)PlasmatransferrinmeCrU)IL
23、-6(pg/mL)TNF(pg/mL1Us-CRP(mg/L)Serumureanitrogen(mmol/L)Serumereastinin(mol/L)0.052(0.5)-o.316(0.0O4)0.102(0.336)0.137(0.297)一0.047(0.61810.057(0.664)0.126(0.338)0.011(O.901)-0.303(0.037)-0.199(0.137)0.252(o.006)0.123(0.350)O.O63(0.479)一0.108(O.4l1)一0.137(0.295)2.3Sub-groupsanalysisItwasputupthatpla
24、smalevelofghrelinmightbeaffectedbyBMI,highbloodglucoseandhyperlipidemia5 一.Thestateofinflammationandnutritionmightalsohaveeffectonplasmalevelofghrelint4.Soweexploredsomeanalysis.AccordingtotheAsiacriterion 同,BMIi23meansoverweightorobesity.Inourexperimentsweobservedthatthenonobesitygrouphadhigherplas
25、malevelofghrelinthantheobesitygroupfP=O.001).However,therewerentanydifferencesinserumtriglycerides,plasmaprealbumin,IL 一 6andultrasensitiveCreactiveprotein(usCRP)levelsbetweenoverweightandobesitygroup(SeeTable3).Table3Comparisonofsomemarkersbetweentheobesityandnon-obesitygroup6s)ItemBMI23BMI23Pvalue
26、TvaluecIote:f95%confidenceintervalInaddition,patientsweredividedintotwogroups,onewithhyperlipidemia,andtheotherwithouthyperlipidemia,andserumtriglycerides1.8mmol/Lwastakenasthecutpoint.WediscoveredthereWasnostatisticaldifferencebetweenthesetwosubgroups,too(P=0.202).However,nosignificantdifferencecou
27、ldbefoundinBMI,serumalbumin,plasmaIL 一 6,us-CRPandotherlevels(SeeTable4).Alsointhesepatients,thepatientswithslightinflammationrultrasensitiveCreactiveprotein10mg/L)41hadsimilarplasmaghrelinlevelasthosewithmarkedinflammation(ultrasensitiveCreactiveprotein10mg/L)fP=O.423).Butthelattergroupwasolder,and
28、hadlowerlevelsofserumcreatinin.albumin,prealbuminandtransferrin,andhigherlevelsofSGAscore,plasmaIL 一 6.Theseweresignificant(SeeTable51.?1155?中国现代医学杂志第 l7 卷Table4Comparisonofsomemarkersbetweenpatients3Discussionwithandwithouthyperlipidemias)Table5Comparisonofsomemarkersbetweenpatientswithslightinflammationandthmarkedinflammations)ItemUs-O10mg/LUs-CRP10mg/LPvahetvalneAccordingtoSGAscoresofpatients,therewere43patientswithgoodnutrition,15lighttomild-mal-nourishedcasesand2severelymalnourishedcases.Hasmaghrelinlevelofthethreegroupshadnodiffer-
