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

Ghrelin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，刺激下丘脑的食欲中枢。我们测试胃切除术后血浆Ghrelin水平是否与术后体重指数(BMI)减少的百分比相关。我们在隔夜禁食后、因胃癌而行远端胃或全胃切除2个月以上的患者以及因胰腺癌或胆总管癌而行胰腺十二指肠切除术后2个月以上的患者，测定了体重指数和清晨血浆Ghrelin水平。我们研究了53名患者，年龄从38岁到89岁(平均67岁)。BMI下降的百分比由目前和稳定的BMI(术后6个月以上)与术前BMI的差值计算。我们还测定了血浆瘦素和胃促生长素。测定了14例患者手术前后血浆Ghrelin水平。比较体重指数下降的百分比和血浆Ghrelin水平，发现胃切除患者之间存在显著的相关性。相反，在胰腺十二指肠切除的病例中，尽管体重指数比胃切除的病例下降得更多，但没有发现相关性和生长激素水平的NOO降低。此外，全胃切除后血浆Ghrelin水平比远端胃切除后下降得更多，这与胃底腺区域产生Ghrelin的内分泌细胞的事实一致。这些结果支持这样一种假设，即胃肠道切除术后体重下降的部分原因是胃促生长素缺乏，还有营养吸收缺陷。未来，使用Ghrelin或Ghrelin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.