Anorexia and Plasma Levels of Free Tryptophan, Branched Chain Amino Acids, and Ghrelin in Hemodialysis Patients
Anorexia and Plasma Levels of Free Tryptophan, Branched Chain Amino Acids, and Ghrelin in Hemodialysis Patients
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DOI：
10.1053/j.jrn.2008.11.008
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发表时间：
2009-05-01
影响因子：
3.2
通讯作者：
Tazza, Luigi
中科院分区：
文献类型：
--
作者：
Bossola, Maurizio;Scribano, Donata;Tazza, Luigi
目的：本横断面研究的目的是评估食欲，同时检查自我报告的食欲与食欲素（生长激素释放肽）和食欲素之间的关系。（游离色氨酸，游离色氨酸/大中性氨基酸比例，低支链氨基酸水平）物质在慢性血液透析患者中的作用。设计：横断面研究。设置：患者：共有59例患者（32名男性和27名女性）被纳入本研究。平均年龄为63.7 ± 13.9岁，平均透析年龄为6.6 ± 5.1岁。研究人群的平均体重指数为25.1 ± 4.1 kg/m2。方法：采用血液透析（HEMO）研究食欲问卷的第一个问题评估血液透析患者的食欲。第一个问题的多项选择答案是：“在过去的一周里，你对自己的食欲有何评价？“（1）非常好，（2）好，（3）一般，（4）差，或（5）非常差。采用液相色谱法测定血浆氨基酸浓度。Ghrelin放免法测定Ghrelin水平结果：59例患者中，16例27.1%的血液透析患者食欲很好（第1组），15在15例（25.4%）患者中，良好（第2组）;在另外15例（25.4%）患者中，一般（第3组）;在10例（16.9%）患者中，差;在3例（5%）患者中，非常差。出于统计学目的，将食欲不佳或极差的患者合并为一组（第4组）。一般和食欲差/非常差的患者的体重指数和血清白蛋白显著低于食欲非常好或良好的患者。根据主观全面评估，A组和B组的所有患者营养良好，而C组（60%）和D组（68%）的大多数患者严重营养不良。C组和D组患者的大多数合并症显著较高。相对于食欲非常好或良好的患者，食欲一般或差/非常差的患者的支链氨基酸显著较低。游离色氨酸水平在四组患者中相似。食欲一般且差/极差的患者血浆中其他大分子中性氨基酸（缬氨酸、亮氨酸、异亮氨酸、酪氨酸、苯丙氨酸）（大分子中性氨基酸）的摩尔总和往往低于食欲非常好或良好的患者。然而，根据患者报告的食欲，游离色氨酸/大中性氨基酸的比例没有显著变化。平均ghrelin水平显着高于D组患者比其他组和B和C组的患者比A组的患者。结论：本研究表明，食欲不振与显着较低的支链氨基酸水平，但不与较高的游离色氨酸水平和较高的游离色氨酸/大中性氨基酸的比例在血液透析患者。此外，在食欲差/非常差的患者中观察到显著更高水平的胃饥饿素。(C)2009年，美国国家肾脏基金会（National Kidney Foundation，Inc.）All rights reserved.
Objective: The aim of the present cross-sectional study was to assess appetite and to examine at the same time the associations between self-reported appetite and orexigen (ghrelin) and anorexigen (free tryptophan, free tryptophan/large neutral amino acid ratios, low branched chain amino acid levels) substances in chronic hemodialysis patients.Design: Cross-sectional study.Setting: Patients were recruited from the Catholic University Outpatient Dialysis Clinic.Patients: A total of 59 patients (32 men and 27 women) were included in this study. The mean age was 63.7 +/- 13.9 years, and the mean dialytic age was 6.6 +/- 5.1 years. Their mean body mass index of the study population was 25.1 +/- 4.1 kg/m(2).Methods: The first question of the Hemodialysis (HEMO) Study Appetite questionnaire was used to assess the appetite of the hemodialysis patients. The multiple-choice answers for the first question, "During the past week, how would you rate your appetite?" were (1) very good, (2) good, (3) fair, (4) poor, or (5) very poor. Plasma amino acid concentrations were measured with the use of liquid chromatography. Ghrelin levels were measured with Ghrelin-RIA (Mediagnost).Results: According to the questionnaire, in 16 of 59 (27.1%) hemodialysis patients, their appetite was very good (group 1); in 15 (25.4%), it was good (group 2); in another 15 (25.4%), it was fair (group 3); in 10 (16.9%), it was poor; and in 3 (5%), it was very poor. For statistical purposes, patients with a poor or very poor appetite were pooled together into a single group (group 4). Body mass index and serum albumin were significantly lower in patients with a fair and poor/very poor appetite than in patients with a very good or good appetite. According to the Subjective Global Assessment, all patients in groups A and B were well-nourished, whereas most patients in groups C (60%) and D (68%) were severely malnourished. Most of the comorbid conditions were significantly higher in patients of groups C and D. Branched chain amino acids were significantly lower in patients with a fair or poor/very poor appetite with respect to patients with a very good or good appetite. Free tryptophan levels were similar in the four groups of patients. The molar sum in plasma of the other large neutral amino acids (valine, leucine, isoleucine, tyrosin, phenylalanine) (large neutral amino acids) tended to be lower in patients with a fair and poor/very poor appetite than in patients with a very good or good appetite. However, the free tryptophan/large neutral amino acid ratio did not change significantly according to the appetite reported by the patients. Mean ghrelin levels were significantly higher in patients of group D than in other groups and in patients of groups B and C than in patients of group A.Conclusions: The present study shows that poor appetite is associated with significantly lower branched chain amino acid levels but not with higher free tryptophan levels and higher free tryptophan/large neutral amino acid ratios in hemodialysis patients. In addition, significantly higher levels of ghrelin have been observed in patients with a poor/very poor appetite. (C) 2009 by the National Kidney Foundation, Inc. All rights reserved.