慢性阻塞性肺疾病急性加重期患者营养状态与血浆生长激素释放肽水平的研究

Relation of nutritional status and plasma ghrelin level of patients in acute exacerbation of chronic obstructive pulmonary disease

目的探讨营养状态及生长激素释放肽(ghrelin)在慢性阻塞性肺疾病(chronic obstructive pul monarydisease,COPD)患者尤其是COPD急性加重期(acute exacerbation of chronic obstructive pul monary disease,AECOPD)合并营养不良患者中的作用及可能参与的机制。方法收集40例男性AECOPD患者,根据体质量指数(body massindex,BMI)分为低体质量亚组和正常体质量亚组,每组各20例,同时收集20例男性健康者作为正常对照组,测定AECOPD组治疗前后及正常对照组的BMI、肱三头肌皮褶(triceps skin-fold,TSF)厚度、总蛋白、白蛋白,并用放射免疫法测定血浆总ghrelin水平。结果 AECOPD组无论是低体质量亚组还是正常体质量亚组,BMI、TSF、总蛋白、白蛋白水平均较治疗前有不同程度的升高,但仍低于正常对照组(P<0.05或<0.01),正常对照组、治疗后AECOPD组低体质量亚组和正常体质量亚组的BMI分别为23.32±0.40 vs 17.04±0.84和22.00±1.50(P<0.01);TSF分别为(9.45±0.35)mmvs(6.93±0.56)mm和(9.12±0.51)mm(P<0.05或<0.01);总蛋白(71.6±2.6)g/L vs(60.2±5.9)g/L和(63.9±4.7)g/L,血浆ghrelin水平治疗后比治疗前有明显降低,但仍高于对照组,(83±19)ng/Lvs(194±9)ng/L和(125±17)ng/L(P<0.01);AECOPD组及正常对照组的BMI与TSF、白蛋白呈正相关,与血浆总ghrelin水平呈负相关。结论 AECOPD患者营养状态差,血浆总ghrelin水平均显著增高,ghrelin可能通过参与机体的能量代谢而参与了AECOPD的发生与发展。

Objective To investigate the effects of nutritional status and ghrelin on the patients with chronic obstructive pulmonary disease（COPD）,especially the patients with acute exacerbation of COPD（AECOPD） incorporated with cacotrophia,and also the mechanism that ghrelin could possibly participate in.Methods We collected 40 male patients with AECOPD as team AECOPD,and the team was separated into two groups（under-weight group and normal-weight group,20 patients each group） according to the body mass index（BMI） while 20 healthy men were collected as normal control group,some parameters of AECOPD team and normal control（prior-treatment and post-treatment） were determined,concluding BMI,triceps skin-fold（TSF） thickness,total protein and albumin,and the plasma level of total ghrelin was determined with radioimmunoassay（RIA）.Results After treatment,the level of BMI,TSF,total protein and albumin of team AECOPD（both under-weight and normal-weight groups） had some degrees of increase,however,the parameters were still lower than those of normal control group（P0.05 or 0.01）.After treatment,corresponding to normal control group,under-weight（with AECOPD） group and normal-weight group（with AECOPD）,the indexes were as follows,BMI was respectively 23.32±0.40 vs 17.04±0.84 and 22.00±1.50（P0.01）;TSF respectively （9.45±0.35） mm vs（6.93±0.56） mm and（9.12±0.51） mm（P0.05 or 0.01）;the plasma level of total protein respectively （71.6±2.6） g/L vs（60.2±5.9） g/L and（63.9±4.7） g/L.The plasma level of ghrelin was significantly reduced after treatment,while it was still higher than that of normal control group,the parameter was respectively（83±19） ng/L vs（194±9） ng/L and（125±17） ng/L（P0.01） corresponding to normal control group,under-weight（with AECOPD） group and normal-weight（with AECOPD） group.The BMI of team AECOPD and normal control group had positive correlation with TSF and albumin,but negative correlation with the plasma level of total ghrelin.Conclusion The patients with AECOPD are in weak nutritional status,their plasma level of total ghrelin is significantly higher,ghrelin maybe takes roles on the invasion of AECOPD through affecting on the body energy metabolism.