Molecular Pathological Study on the dynamics of Ghrelin in patients with gastric diseases

胃饥饿素是生长激素促分泌素受体的内源性配体。它主要在胃中合成，刺激下丘脑食欲中枢。我们测试了胃切除术后血浆胃饥饿素水平是否与术后体重指数（BMI）下降百分比相关。我们测量了因胃癌进行远端或全胃切除术超过2个月的患者，以及因胰腺癌或胆总管癌进行胰十二指肠切除术的患者，在禁食过夜后的BMI和早晨血浆胃饥饿素水平。我们研究了53例患者，年龄38至89岁（平均67岁）。BMI下降百分比由当前和稳定BMI（术后6个月以上）与术前BMI之差计算。我们还测量了血浆瘦素和胃饥饿素。我们测量了14例患者手术前后的血浆胃饥饿素水平。比较BMI降低百分比和血浆胃饥饿素水平，发现胃切除术患者之间存在显著相关性。相比之下，胰十二指肠切除术患者的胃饥饿素水平没有相关性，也没有下降，尽管BMI比胃切除术患者下降得更多。此外，胃全切除术后血浆ghrelin水平比远端切除术后下降更多，这与产生ghrelin的内分泌细胞位于胃底腺区域的事实相一致。这些结果支持了胃切除术后体重减轻的假设，即胃饥饿素缺乏和营养吸收缺陷是部分原因。未来，使用胃饥饿素或胃饥饿素激动剂治疗可能会抵消体重减轻和其他胃切除术后症状。

Ghrelin is an endogenous ligand for the growth hormone secretagogue receptor. It is synthesized predominantly in the stomach and stimulates the hypothalamic appetite center. We tested whether plasma ghrelin levels after gastrectomy were correlated with the percentage postoperative reduction in body mass index (BMI). We measured BMI and morning plasma ghrelin levels after overnight fasting, in patients more than 2 months after distal or total gastrectomy due to gastric cancer, as well as after pancreatico-duodenectomy due to pancreatic cancer or common bile duct cancer. We studied 53 patients, aged 38 to 89 years (average 67 years). The percentage reduction in BMI was calculated from the difference between the present and stable BMI (more than 6 month after operation) and the BMI before operation. We also measured plasma leptin as well as ghrelin. We were able to measure plasma ghrelin levels before and after operation in fourteen cases. Comparison of % BMI reductions and plasma ghrelin levels revealed a significant correlation among the patients undergoing gastrectomy. In contrast, no correlation and noo reduction in ghrelin levels were found in cases of pancreatico-duodenectomy, even though BMI decreased more than in cases of gastrectomy. In addition, plasma ghrelin levels declined more after total gastrectomy than after distal gastrectomy, in agreement with the fact that ghrelin-producing endocrine cells are located in the area of the gastric fundic gland. These results lend support to the hypothesis that post-gastrectomy weight loss is partly explained by ghrelin deficiency as well by defective nutrient absorption. In future, treatment with ghrelin or ghrelin agonists may counteract weight loss and other post-gastrectomy symptoms.