CAJ | 학술논문

目的探讨慢性阻塞性肺疾病(COPD)患者生长激素释放肽(ghrelin)、生长激素(GH)、生长激素释放激素(GHRH)的变化及其临床意义.方法选40例COPD稳定期患者,根据BMI,将COPD患者分为BMI≥20 kg/m2组和BMI ＜20 kg/m2组；另选20例慢性支气管炎稳定期患者作为对照组.测上述患者血生长激素释放肽、GH、GHRH、TNFα、IL-6和C反应蛋白(CRP)水平.观察胃黏膜组织中生长激素释放肽表达.结果 (1) COPD BMI＜ 20 kg,/m2组患者血生长激素释放肽水平[ (1.78±0.46) ng/L]高于对照组[(1.39±0.46) ng/L]和COPD BMI≥20 kg/m2组[(1.36±0.39) ng/L],血GH水平[(4.12±0.83) μg/L]低于BMI ≥20 kg/m2组[(5.17±0.72) μg/L]和对照组[(6.49±1.13)μg/L],血GHRH水平[(20.43±4.41) ng/L]低于BMI≥20 kg/m2组[(23.47±3.97) ng/L]和对照组[(27.48±10.06)ng/L].(2)COPD患者胃黏膜生长激素释放肽表达与对照组无明显差异.(3)COPD BMI＜20 kg/m2组血生长激素释放肽水平与BMI、体脂百分比呈负相关(r=-0.565,P＜0.01;r=-0.615,P＜0.01),血GH、GHRH水平与BMI呈正相关(r=0.602,P＜0.01；r=0.742,P＜0.01),GHRH与生长激素释放肽呈正相关(r=0.515,P ＜0.05),血生长激素释放肽水平与TNFα、IL-6呈正相关(r=0.621,P＜0.01；r =0.701,P＜0.01).结论 COPD患者GH水平低可能与高生长激素释放肽水平无关,血生长激素释放肽水平可反映COPD患者营养不良状态,并可能通过影响机体的营养状态而参与COPD的发病.
목적 탐토만성조새성폐질병(COPD)환자생장격소석방태(ghrelin)、생장격소(GH)、생장격소석방격소(GHRH)적변화급기림상의의.방법 선40례COPD은정기환자,근거BMI,장COPD환자분위BMI≥20 kg/m2조화BMI ＜20 kg/m2조；령선20례만성지기관염은정기환자작위대조조.측상술환자혈생장격소석방태、GH、GHRH、TNFα、IL-6화C반응단백(CRP)수평.관찰위점막조직중생장격소석방태표체.결과 (1) COPD BMI＜ 20 kg,/m2조환자혈생장격소석방태수평[ (1.78±0.46) ng/L]고우대조조[(1.39±0.46) ng/L]화COPD BMI≥20 kg/m2조[(1.36±0.39) ng/L],혈GH수평[(4.12±0.83) μg/L]저우BMI ≥20 kg/m2조[(5.17±0.72) μg/L]화대조조[(6.49±1.13)μg/L],혈GHRH수평[(20.43±4.41) ng/L]저우BMI≥20 kg/m2조[(23.47±3.97) ng/L]화대조조[(27.48±10.06)ng/L].(2)COPD환자위점막생장격소석방태표체여대조조무명현차이.(3)COPD BMI＜20 kg/m2조혈생장격소석방태수평여BMI、체지백분비정부상관(r=-0.565,P＜0.01;r=-0.615,P＜0.01),혈GH、GHRH수평여BMI정정상관(r=0.602,P＜0.01；r=0.742,P＜0.01),GHRH여생장격소석방태정정상관(r=0.515,P ＜0.05),혈생장격소석방태수평여TNFα、IL-6정정상관(r=0.621,P＜0.01；r =0.701,P＜0.01).결론 COPD환자GH수평저가능여고생장격소석방태수평무관,혈생장격소석방태수평가반영COPD환자영양불량상태,병가능통과영향궤체적영양상태이삼여COPD적발병.
Objective To investigate the changes of plasma ghrelin,growth hormone (GH) and growth hormone releasing hormone (GHRH) and gastric ghrelin in patients with chronic obstructive pulmonary disease( COPD ) and to explore their clinical significances.Methods Plasma ghrelin,GH,GHRH,TNFα,IL-6 and C reactive protein (CRP) were measured in 40 COPD patients and 20 controls with chronic bronchitis. Correlated factors of plasma ghrelin,TNFα,IL-6,CRP were analyzed. Body composition was assessed with bioelectrical impedance analysis.The expression of gastric ghrelin in patients with COPD was detected.Results Plasma ghrelin was higher in the underweight patients than in the normal weight patients and in the controls [ ( 1.78 ± 0.46 ) ng/L,( 1.39 ± 0.46 ) ng/L,( 1.36 ± 0.39 ) ng/L,respectively].Plasma GH was lower in the underweight patients than in the normal weight patients and in the controls [(4.12 ±0.83) μg,/L,(5.17 ±0.72) μg/L,(6.49 ± 1.13) μg/L,respectively].Plasma GHRH was lower in the underweight patients than in the normal weight patients and in the controls [ (20.43 ± 4.41 ) ng/L,(23.47 ± 3.97) ng/L,( 27.48 ± 10.06) ng/L,respectively ].Plasma ghrelin was higher in the underweight patients than in the controls ( P ＜ 0.01 ).Plasma ghrelin was higher in the underweight patients than in the normal weight patients with COPD.Plasma ghrelin (log transformed) was negatively correlated with BMI and percentage of body fat in the COPD patients.Plasma GHRH was positively correlated with ghrelin in the underweight patients ( r =0.515,P ＜ 0.05 ),while no correlation was found between plasma G H and ghrelin in the underweight patients (r =0.415,P ＞ 0.05 ).Plasma ghrelin was positively correlated with TNFα and IL-6 in the underweight patients.The gastric expression of ghrelin showed no evident difference between the patients with COPD and the controls.Conclusions The plasma GH in COPD patients may not be correlated with ghrelin.The plasma ghrelin level may be a useful indicator for malnutrition in COPD patients.Plasma ghrelin might be involved in the pathogenesis of CODP by affecting the body energy metabolism.