慢性阻塞性肺疾病患者生长激素释放肽、生长激素、生长激素释放激素的变化及其临床意义

The changes of ghrelin, growth hormone, growth hormone releasing hormone and their clinical significances in patients with chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病（COPD）患者生长激素释放肽（ghrelin）、生长激素（GH）、生长激素释放激素（GHRH）的变化及其临床意义。方法选40例COPD稳定期患者，根据BMI，将COPD患者分为BMI≥20kg／m2组和BMI〈20kg／m2组；另选20例慢性支气管炎稳定期患者作为对照组。测上述患者血生长激素释放肽、GH、GHRH、TNFa、IL-6和c反应蛋白（CRP）水平。观察胃黏膜组织中生长激素释放肽表达。结果（1）COPDBMI〈20kg／m2组患者血生长激素释放肽水平[（1．78±0．46）ng／L]高于对照组[（1．39±0．46）ng／L]和COPDBMI≥20ks／m2组[（1．36±0．39）ng／L]，血GH水平[（4．12±0．83）μg／L]低于BMI≥20kg／m2组[（5．17±0．72）μg／L]和对照组[（6．49±1．13）μg／L]，血GHRH水平[（20．43±4．41）ng／L]低于BMI≥20kg／m2组[（23．47±3．97）ng／L]和对照组[（27．48±10．06）ng／L]。（2）COPD患者胃黏膜生长激素释放肽表达与对照组无明显差异。（3）COPDBMI〈20kg／m2组血生长激素释放肽水平与BMI、体脂百分比呈负相关（r=-0．565，P〈0．01；r=-0．615，P〈0．01），血GH、GHRH水平与BMI呈正相关（r=0．602，P〈0．01；r=0．742，P〈0．01），GHRH与生长激素释放肽呈正相关（r=0．515，P〈0．05），血生长激素释放肽水平与TNFα、IL-6呈正相关（r=0．621，P〈0．01；r=0．701，P〈0．01）。结论COPD患者GH水平低可能与高生长激素释放肽水平无关，血生长激素释放肽水平可反映COPD患者营养不良状态，并可能通过影响机体的营养状态而参与COPD的发病。

Objective To investigate the changes of plasma ghrelin, growth hormone （GH） and growth hormone releasing hormone （GHRH） and gastric ghrelin in patients with chronic obstructive pulmonary disease（COPD） and to explore their clinical significances. Methods Plasma ghrelin, GH, GHRH, TNFα, IL-6 and C reactive protein （CRP） were measured in 40 COPD patients and 20 controls with chronic bronchitis. Correlated factors of plasma ghrelin, TNFα, IL-6, CRP were analyzed. Body composition was assessed with bioelectrical impedance analysis. The expression of gastric ghrelin in patients with COPD was detected. Results Plasma ghrelin was higher in the underweight patients than in the normal weight patients and in the controls [ （ 1.78 ± 0.46 ） ng/L, （ 1.39 ± 0.46 ） rig/L, （ 1.36 ± 0. 39 ） ng/L, respectively]. Plasma GH was lower in the underweight patients than in the normal weight patients and in the controls [ （4. 12 ± 0. 83 ） tzg/L, （5.17 ± 0. 72 ） μg/L, （6.49 ± 1. 13 ） μg/L, respeetively ]. Plasma GHRH was lower in the underweight patients than in the normal weight patients and in the controls [ （20.43 ± 4.41 ） ng/L, （23.47 ± 3.97 ） ng/L, （27.48 ± 10. 06） ng/L, respectively 1. Plasma ghrelin was higher in the underweight patients than in the controls （ P 〈 0. 01 ）. Plasma ghrelin was higher in the underweight patients than in the normal weight patients with COPD. Plasma ghrelin （log transformed） was negatively correlated with BMI and percentage of body fat in the COPD patients. Plasma GHRH was positively correlated with ghrelin in the underweight patients（ r = 0. 515 ,P 〈 0. 05 ）, while no correlation was found between plasma GH and ghrelin in the underweight patients （r = 0. 415, P 〉 0. 05 ）. Plasma ghrelin was positively correlated with TNFα and IL-6 in the underweight patients. The gastric expression of ghrelin showed no evident difference between the patients with COPD and the controls. Conclusions The plasma GH in COPD patients may not be correlated with ghrelin. The plasma ghrelin level may be a useful indicator for malnutrition in COPD patients. Plasma ghrelin might be involved in the pathogenesis of CODP by affecting the body energy metabolism.