重型颅脑损伤患者胃动力障碍与血清胃动素、Ghrelin的关系研究

The relationship between gastric dysmotility,serum levels of motilin and Ghrelin in patients with severe craniocerebral trauma

目的:探讨重型颅脑损伤患者胃动力障碍与血清胃动素和Ghrelin的关系。方法:选取了25例可以在入院后24~48 h开始经鼻胃管行肠内营养的重型颅脑损伤患者,于肠内营养开始第1、4、8、15天清晨采集患者空腹静脉血,采用酶联免疫吸附法检测血清胃动素、Ghrelin及Acyl-ghrelin水平,观察记录患者肠内营养过程中的不耐受症状及达目标肠内营养量时间。另招募了20名年龄性别与患者匹配的健康志愿者,于清晨采集其空腹静脉血,作为正常对照。结果:根据患者对肠内营养的耐受情况分为耐受组(13例)和不耐受组(12例),患者血清胃动素水平与正常对照组比较,差异无统计学意义。血清Ghrelin及Acyl-ghrelin水平在伤后均显著下降,不耐受组下降则更为明显(P均<0.05)。第4天,耐受组Ghrelin水平恢复正常,但Acyl-ghrelin水平较正常对照组仍有统计学差异,直至第8天开始与正常对照组持平;而不耐受组在第8天后,Ghrelin水平呈现上升趋势并显著高于耐受组及正常对照组,而直至第15天,不耐受组Acyl-ghrelin水平仍显著低于耐受组及正常对照组(P均<0.05)。患者入院时APACHEⅡ评分与Ghrelin、Acyl-ghrelin水平负相关(P均<0.05),Ghrelin、Acyl-ghrelin水平与达目标肠内营养量时间也呈负相关(P均<0.05)。结论:重型颅脑损伤后,空腹血清Ghrelin水平,尤其是Acyl-ghrelin水平显著下降,其下降程度与重型颅脑损伤患者胃动力障碍显著相关。

Objective ：TO investigate the relationship between gastric dysmotility, serum levels of motilin and ghrelin in patients with severe craniocerebral trauma. Methods：25 severe craniocerebral trauma patients receiving enteral nutrition within 24 -48 hours af- ter admission through nasogastric tube were selected. Venous blood samples were collected in the morning to determine the serum levels of motilin,ghrelin and Acyl-ghrelin by ELISA on days 1,4,8 and 15 after enteral feeding. Nasogastric feeding intolerance and the time to targeted nutritional goals with enteral nutrition were recorded. Sera from 20 age- and sex-matched healthy volunteers were collected served as normal controls. Results：Patients were derided into tolerance group （13 patients） and intolerance group （12 patients） de- pending on the enteral feeding tolerance condition. No differences were found in terms of the serum levels of motilin between groups. Gh- relin, and Acyl-ghrelin, however, decreased significantly after injury with lower levels in intolerance group （P 〈 0.05 ）. On day 4, levels of ghrelin in tolerance group returned to normal while Acyl-ghrelin were still significantly lower than those of the normal controls till day 8. However,the intolerance group exhibited higher levels of ghrelin compared with those of both intolerance group and normal controls after 8 days,but still significantly lower levels of Acyl-ghrelin even on days 15 （ P 〈 0.05 ）. Scores of APACHE II on admission were negatively correlated with ghrelin and Acyl-ghrelin, which were negatively correlated with the time to targeted nutritional goals too （P 〈 0.05 ）. Conclusion ： Fasting serum levels of ghrelin and Acyl-ghrelin decreased obviously after severe craniocerebral trauma, and the de- creased degree of which were highly correlated with the gastric dvsmotilitv.