血液透析患者血浆总胃饥饿素与营养指标的关系

Relationship between plasma total Ghrelin and nutritional indicators in hemodialysis patients

目的探讨血液透析患者血浆总胃饥饿素(Ghrelin)水平与营养指标间的关系。方法采取横断面调查血液透析患者(HD组)29例、慢性肾衰患者(CRF组)15例、健康对照者(Health组)17例,比较各组间血浆总Ghrelin水平,并通过单因素和多元线性回归分析血液透析患者总Ghrelin与营养指标(生化指标、体格测量和营养风险筛查评分(NRS2002)间的相关性。结果血浆总Ghrelin水平在HD组透析前[(4.51±2.37)μg/L]的水平明显比CRF组[(2.44±1.39)μg/L]、Health组[(1.97±0.85)μg/L]升高(均P<0.01),透析后则明显降低[(2.26±1.14)μg/L,P<0.01];总Ghrelin在有营养风险的HD患者中明显升高(与无营养风险HD患者比较,P<0.01)。HD患者血浆总Ghrelin与前白蛋白(r=-0.472,P<0.01),三酰甘油(r=-0.325,P<0.01)呈明显负相关,与NRS2002(r=0.516,P<0.01)呈明显正相关,与其他营养指标无相关关系;多元回归分析显示体质量、血红蛋白、NRS2002与Ghrelin具有相关性(P<0.05)。结论 HD患者的血浆总Ghrelin水平明显升高,与NRS2002评分呈正相关、与营养指标呈负相关关系,可通过透析清除。

Objective To analyze the relationship between plasma total Ghrelin and nutritional parameters in hemodialysis patients. Methods 29 patients with hemodialysis( HD),15 patients with chronic renal failure( CRF)undergoing conservative treatment and 17 health controls( Health) were involved in this cross-sectional study. Plasma total Ghrelin( ELISA) and nutritional parameters( NRS2002) were measured. Results Plasma Ghrelin levels were significantly increased in HD patients [( 4. 51 ± 2. 37) μg / L,P < 0. 01]compared with CRF[( 2. 44 ± 1. 39) μg / L] and Health[( 1. 97 ± 0. 85) μg / L] and significantly declined after hemodialysis[( 2. 26 ± 1. 14) μg / L,P < 0. 01]. In HD patients,the plasma Ghrelin level were notably increased in patients who were at nutritional risk( compared with HD patients who were not at nutritional risk,P < 0. 01). The plasma Ghrelin levels were strongly inversely correlated with serum prealbumin( r =- 0. 472,P < 0. 01) and triglyceride( r =- 0. 325,P < 0. 01),but positively correlated with NRS2002( r = 0. 504,P < 0. 01) in HD patients. And there were no associations between Ghrelin levels and other nutritional parameters by univariate anlysis. However,multivariate analysis revealed body weight,hemoglobin and NRS2002 can impact the plasma Ghrelin levels in HD patients( P < 0. 05). Conclusion Plasma total Ghrelin levels are elevated in HD patients,and can be cleared by hemodialysis,and negtively correlated with nutritional markers in HD patients.