Perioperative Ghrelin Administration Attenuates Postoperative Skeletal Muscle Loss in Patients Undergoing Esophagectomy for Esophageal Cancer: Secondary Analysis of a Randomized Controlled Trial
Perioperative Ghrelin Administration Attenuates Postoperative Skeletal Muscle Loss in Patients Undergoing Esophagectomy for Esophageal Cancer: Secondary Analysis of a Randomized Controlled Trial
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DOI：
10.1245/s10434-022-11436-0
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发表时间：
2022-02-20
影响因子：
3.7
通讯作者：
Doki, Yuichiro
中科院分区：
文献类型：
--
作者：
Nose, Yohei;Yamashita, Kotaro;Doki, Yuichiro
研究背景Ghrelin可通过改善上消化道手术患者的食欲和食物摄入量来减少术后体重减轻。目的探讨Ghrelin的另一重要作用--生长激素诱导能否减轻术后饥饿患者的骨骼肌丢失。方法食道癌患者术后随机接受大剂量Ghrelin(HD；0.5mg/kg/h)、小剂量Ghrelin(Ld；0.25mg/kg/h)或安慰剂持续静脉滴注7d。在此期间，不引入口服喂养，但患者接受相同的肠外和肠内营养。我们调查了Ghrelin对体重、骨骼肌质量、营养状况和激素水平的影响。结果总共有73名患者进入研究。HD组术后第7天的体重减少率明显低于安慰剂组(HD和安慰剂组分别为-0.61%和1.8%，p=0.030)。治疗后第7天，HD组和LD组竖脊肌肌肉损失率显著低于安慰剂组(HD组与安慰剂组：2.8%对8.5%，p<；0.001；LD组与安慰剂组：4.9%对8.5%，p=0.028)。接受Ghrelin治疗的患者术后第1、3、7天的生长激素水平和第3、7、14天的胰岛素样生长因子1水平均显著高于对照组。结论持续应用Ghrelin可以减轻食道癌患者术后饥饿时骨骼肌的丢失。
Background Ghrelin has been reported to reduce postoperative weight loss by improving appetite and food intake in patients undergoing upper gastrointestinal surgery.Objective We aimed to investigate whether growth hormone induction, another essential effect of ghrelin, may attenuate skeletal muscle loss in patients during postoperative starvation.Methods Esophageal cancer patients were randomized to receive a continuous intravenous infusion of high-dose ghrelin (HD; 0.5 mu g/kg/h), low-dose ghrelin (LD; 0.25 mu g/kg/h), or placebo for 7 days after surgery. During this period, oral feeding was not introduced but the patients received the same parenteral and enteral nutrition. We investigated the effects of ghrelin on body weight, skeletal muscle mass, nutritional status, and hormone levels.Results Overall, 73 patients were enrolled in this study. The rate of weight loss on postoperative day (POD) 7 relative to that before surgery was significantly lower in the HD group than in the placebo group (HD vs. placebo: -0.61% vs. 1.8%, p = 0.030). The rate of muscle loss in the erector spinae muscle on POD 7 in the HD and LD groups was significantly lower than that in the placebo group (HD vs. placebo: 2.8% vs. 8.5%, p < 0.001; LD vs. placebo: 4.9% vs. 8.5%, p = 0.028). The levels of growth hormone on PODs 1, 3, and 7, and insulin-like growth factor 1 on PODs 3, 7, and 14 were significantly higher in patients who received ghrelin.Conclusion Continuous ghrelin administration could attenuate skeletal muscle loss in esophageal cancer patients during postoperative starvation.