肝硬化患者Ghrelin、生长激素释放素的变化及其临床意义

Levels of ghrelin, GH, GRH and their clinical significances in patients with hepatitis B related liver cirrhosis

目的:研究乙型肝炎肝硬化患者血浆Ghrelin、GRH与GH关系,观察肝硬化患者胃黏膜Ghrelin表达.方法:2006-06/2007-02北京佑安医院住院的乙型肝炎肝硬化患者52例,以17例慢性乙型肝炎患者为对照.ELISA法测定血浆Ghrelin、GRH及GH浓度,免疫组织化学方法观察胃黏膜组织中Ghrelin的表达.结果:乙型肝炎肝硬化组血浆Ghrelin水平与慢性乙型肝炎患者比较无明显差异.ChildC级患者血浆Ghrelin水平与ChildA级比较明显降低(0.75±0.479ng/Lvs1.38±1.064ng/L,P<0.05).Child-B级与Child-A级组无明显差异.肝炎肝硬化患者血浆GH水平与Ghrelin呈负相关趋势,但无统计学意义,但是与GRH呈正相关(r=0.868,P<0.001),Ghrelin与白蛋白、总蛋白、血红蛋白呈明显正相关(r=0.357,0.377,0.367,P<0.05).肝炎肝硬化患者胃黏膜Ghrelin表达均不同程度阳性.结论:乙型肝炎肝硬化患者高GH血症与GRH增加有关,其机制不清楚;血浆Ghrelin水平可反映肝硬化患者营养不良状态.

AIM： To investigate the relationship between serum growth hormone （GH） and ghrelin, growth releasing hormone （GRH） and its clinical significance, and to study the expression of gastric ghrelin in patients with hepatitis B-related liver cirrhosis. METHODS： Fifty-two patients with hepatitis B-related liver cirrhosis （LC） and 17 chronic HBV-infected patients as controls were enrolled in this study. The gender and average age were comparable between LC and control patients. Fasting plasma ghrelin levels, GRH and GH were measured using ELISA. The gastric expression of ghrelin was determined using immunohistochemistry staining. RESULTS： Plasma ghrelin levels were slightly but not significantly decreased in hepatitis B related LC patients when compared with controls. The Plasma ghrelin levels in Child C patients were significantly decreased compared with Child A patients（0.75 ± 0.479 ng/L vs 1.38 ± 1.064 ng/L, P 〈 0.05）. The Plasma ghrelin levels showed nega-tive but not significant correlation to plasma GH levels, and positive correlations to serum GRH （r = 0.868, P 〈 0.001）, blood urea nitrogen, albumin and hemoglobin （r = 0.357, 0.377, 0.367, all P 〈 0.05） in hepatitis B related LC patients. CONCLUSION： The increased serum growth hormone levels in hepatitis B-related liver cirrhosis patients may be related to the increased GRH. These data suggest that fasting plasma ghrelin levels may be a useful indicator reflecting malnutrition in liver cirrhosis patients.