| Objective: Malnutrition-Inflammation-Atherosclerosis syndrome(MIA)is prevalent in hemodialysis patients,the interaction of these three factors threatens the quality of life of dialysis patients seriously,and they also associated with increased mortality in maintenance hemodialysis patients.Early detection of potential risk of MIA syndrome and understand the severity of its risk,effective prevention and treatment can make the maintenance hemodialysis patients get the clinical benefit.Ghrelin is an endogenous ligand of the growth hormone secregogue receptor(GHS-R),which was first discovered by Kojima in 1999,recent studies have shown that ghrelin can not only promote the secretion of growth hormone,but also enhance appetite,increase energy intake,improve malnutrition,inhibit the release of inflammatory factors and the role of cardiovascular protection.Some studies have shown that the level of plasma ghrelin is closely related to the nutritional status and systemic inflammation in hemodialysis patients.However,there is little research on the relationship between plasma ghrelin and cardiovascular disease in hemodialysis patients.The purpose of this study is to investigate the plasma ghrelin levels and its possible relationship with nutritional status,inflammation and atherosclerosis,providing a theoretical basis for early clinical intervention and reduce the mortality of hemodialysis patients.Methods:Fifty patients on hemodialysis who were hospitalized and outpatient in Hebei General Hospital from September 2015 to July 2016 were enrolled as experimental group.Inclusion criteria: 1)Age in 18 years old to 65 years old;2)The dialysis duration was 4-4.5h/session 3 times/week;3)Kt/V ? 1.2.Exclusion criteria: 1)The dialysis time was less than 3 months;2)there were severe heart and cerebrovascular disease;3)with hepatitis and other infectiousdiseases,severe infections,malignant tumors.Selected 50 healthy individuals as control group,the age,gender were matched with the experimental group.The clinical data after admission were obtained for hemodialysis patients,including clinical data such as age,gender,past history,medication status,dialysis age,interval weight gain.Height,dry weight,midarm circumference,triceps skinfold thickness,blood pressure,average grip strength were measured for hemodialysis patients,the body mass index(BMI)and upper arm circumference(MAMC)were calculated.After 12 hours of fasting,fasting blood samples were taken at 8 am on the second day,blood sampling were collected before the start of session in hemodialysis patients.The plasma levels of ghrelin,TNF-?,IL-6 were determined by Enzyme-Linked Immunosorbent Assay(ELISA)method,C-reaction protein(CRP)and other biochemical parameters for hemodialysis patients were measured using standard laboratory methods.The nutritional status of hemodialysis patients was assessed according to modified quantitative subjective global assessment of nutrition(SGAN),8 to 14 were divided into mild malnutrition group,and15 to 21 points for the moderate malnutrition group,from 22 to 35 were divided into severe malnutrition group.Comparison of baseline,fasting plasma ghrelin,TNF-? and IL-6 levels in maintenance hemodialysis patients with different nutritional status.The correlation between fasting plasma ghrelin level and the above indexes and SGAN score was analyzed.Evaluation of vascular disease in hemodialysis patients with ankle brachial ratio(ABI),ABI normal value: 0.9-1.3.According to the results of ABI value,the patients were divided into ABI normal group and ABI abnormal group,The fasting plasma ghrelin levels of the two groups were compared,and the correlation with the ABI value was analyzed.All maintenance hemodialysis patients were given compound alpha keto acid tablets(Fresenius Cabi,Germany),4 tablets each time,3 times a day for 6 months,and the changes of nutrition and inflammatory indexes after treatment were evaluated.Results:1 Compared with healthy control group,the levels of fasting plasmaghrelin,TNF-? and IL-6 were significantly increased in patients with maintenance hemodialysis(P<0.05).2 Based on the SGAN scores in hemodialysis patients,26 of the maintenance hemodialysis patients were mild malnutrition,24 patients of moderate malnutrition,and no severe malnutrition patients.Compared with mild malnutrition of patients,plasma ghrelin and CRP level increased significantly,the difference was statistically significant(P<0.05);the levels of serum prealbumin and serum creatinine were significantly lower in patients with moderate malnutrition(P<0.05);TNF-? and IL-6 levels were increased in patients with moderate malnutrition,but the difference was not statistically significant.The upper arm circumference of moderate malnutrition patients was less than that of mild malnutrition patients,The difference was statistically significant(P<0.05).Patients with moderate malnutrition had lower mean BMI and average grip,but the difference was not statistically significant(P> 0.05).There was a positive correlation between plasma ghrelin concentration and TNF-?(r=0.39,P<0.05)and SGAN score(r=0.335,P<0.05),there is a negative correlation with the level of albumin and plasma ghrelin level(r=-0.32,P <0.05),fasting plasma ghrelin levels were not associated with BMI,mean grip strength,and MAMC(P>0.05).3 Compared with ABI normal group,the age of patients with ABI abnormal group was significantly higher and the fasting plasma ghrelin level was increased,the difference was statistically significant(P<0.05).There was no significant difference between the two groups in gender composition,BMI,blood pressure,interval weight gain,dialysis time,serum calcium,serum phosphorus,calcium phosphorus product,serum TNF-?and IL-6(P>0.05).Vascular lesion had significantly correlation with fasting plasma ghrelin level(r =-0.285,P<0.05),adjusted with confounding factors including BMI,blood pressure,interval weight gain,dialysis time,serum calcium,serum phosphorus,calcium phosphorus product,serum TNF-?and IL-6,Vascular lesion had no significantly correlation with ghrelin(P>0.05).Fasting plasma ghrelin level was not correlated with age(P>0.05).4 On the basis of the integrative treatment of chronic kidney disease in maintenance hemodialysis patients,taking compound alpha keto acid tablets after 6 months,the SGAN scores of the patients decreased compared with that before treatment,the difference was statistically significant(P<0.05),fasting plasma ghrelin,TNF-? and IL-6 levels were lower than before,but the difference was not statistically significant(P>0.05).Conclusion:1 Plasma levels of ghrelin in maintenance hemodialysis patients were significantly higher than those in healthy controls.2 The plasma levels of ghrelin in maintenance hemodialysis patients were negatively correlated with nutritional status and positively correlated with inflammatory state,the poorer the nutritional status,the higher the ghrelin level.3 Vascular lesion in maintenance hemodialysis patients may be associated with elevated fasting plasma ghrelin levels. |
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