| Objective:1.To investigate the levels of Ghrelin/Obestatin system in maintenance hemodialysis(MHD)patients,investigate the effect of the system on appetite,nutritional status,bone metabolism in MHD patients.2.To investigate the effects of different blood purification methods on the disorder of Ghrelin/Obestatin system and explore the influence of different blood purification methods on appetite,nutritional status,calcium and phosphorus metabolism of MHD patients.Methods:A total of ninety cases on maintenance hemodialysis(MHD)treated for more than six months from January 2015 to January 2016 in The second Hospital of Tianjin Medical University were selected as the experiment grup(MHD group);thirty normal individuals were selected as the control group.All patients were then subdivided into three groups according different hemodialysis methods: HD group,HDF group,HP group,with thirty individuals each.Each patient’s demographics and primary cause of ESRD were collected.Fasting serum total ghrelin,Acyl ghrelin,and obestatin levels were measured before and after treatment in all patients and in 30 healthy controls.Alb,HGb,SCr,serum calcium,serum phosphorus,and PTH were measured in all patients before treatment and in 30 healthy controls.Test group before treatment and control group were examined by body composition monitor(BCM),body mass index(BMI),percentage of body fat(PBF),visceral fat area(VFA),fat-free body weight were recorded.One month before the test,according to the basic data collected,the total calories needed for each patient’s daily meals were calculated and the recipes were recommended.The appetite score was based on the fuzzy scoring method.The 10 cm ruler was used as an appetite scale.The best appetite was 10,and the worst was 0.and the appetite of the subject was quantified.The correlations of plasma Acyl ghrelin/Total ghrelin ratio,Obestatin level with Alb,HGB,SCr,serum calcium,phosphorus,PTH,BMI,PBF and VFA were analyzed in MHD group.MHD group were then subdivided into three groups according different hemodialysis methods: HD group,HDF group,HP group,with thirty individuals each.Each patient’s demographics and primary cause of ESRD were collected.Fasting serum total ghrelin,acyl ghrelin,and obestatin levels were measured before and after treatment in all patients and in 30 healthy controls.The changes of total ghrelin,acyl ghrelin and obestatin levels after treatment with HD,HDF and HD+HP were compared.Results:1.Compared to control group,The level of serum total ghrelin,Acyl ghrelin,Obestatin were significantly increased in MHD group(P<0.01,P<0.01,P<0.01),while the ratio of Acyl ghrelin/Total ghrelin was decreased(P<0.05).2.The single-factor correlation analysis of Acyl ghrelin/total ghrelin and other parameters of MHD group is shown as Table 3.Correlation analysis shows the ratio of Acyl ghrelin/Total ghrelin in MHD group was positively correlated with Alb(r=0.341 P<0.01),SCr(r=0.296 P=0.036),BMI(r=0.517 P=0.038),fat-free body weight(r=0.328 P=0.017),appetite score(r=0.431 P<0.01),and was negatively correlated with Ca×P(r=-0.218 P=0.041),PTH(r=-0.437 P=0.038).Multivariate regression analysis show that the ratio of Acyl ghrelin/Total ghrelin was positively correlated with appetite score(β=1.301 P<0.01),Alb(β=1.438 P<0.01),BMI(β=1.463 P=0.038),and was negatively correlated with PTH(β=-1.327 P=0.041).The single-factor correlation analysis of Obestatin and other parameters of MHD group is shown as Table 4.Obestatin was negatively correlated with Alb(r=-0.371 P=0.001),SCr(r=-0.275 P=0.045),HGB(r=-0.313 P=0.030),BMI(r=-0.452 P=0.021),fat-free body weight(r=-0.514 P<0.001),appetite score(r=-0.399 P<0.001),positively correlated with Ca×P(r=0.592 P<0.001),PTH(r=0.711 P<0.001).Multivariate regression analysis show that the Obestatin was negatively correlated with Alb(β=-1.601 P<0.01),BMI(β=-1.590 P=0.020),appetite score(β=-0.294 P<0.01),and was positively correlated with PTH(β=1.517 P=0.039),Ca×P(β=0.947 P=0.017).There was no significant difference in levels of Total ghrelin,Acyl ghrelin and Obestatin between HD,HDF and HD+HP groups before treatment(F=0.5 P>0.05,F=1.48 P>0.05,F=3.74 P>0.05).2.Compared with before treatment,the levels of Total ghrelin in HD group,HDF group and HD+HP group decreased after treatment(t=2.15 P=0.04,t=6.06 P<0.01,t=7.32 P<0.01).Acyl ghrelin levels in the HD,HDF,and HD+HP groups were decreased after treatment(t=8.33 P<0.01,t=6.34 P<0.01,t=5.91 P<0.01).The levels of Obestatin in the HD group,HDF group,and HD+HP group were decreased after treatment(t=3.64 P<0.01,t=3.87 P<0.01,t=6.39 P<0.01);The ratio of Acyl ghrelin/Total ghrelin after treatment in the HD group,HDF group and HD+HP group were increased after treatment.(t=2.08 P=0.04,t=2.69 P<0.01,t= 2.74 P<0.01).3.Comparing HD group,HDF group and HD+HP group after treatment.The level of total ghrelin were significantly decreased in HDF group,followed by hemodialysis combined with blood perfusion(F=12.35 P<0.01).The ratio of acyl ghrelin/Total ghrelin Increased,especially in HDF group,followed by hemodialysis combined with blood perfusion(F=12.35,P<0.01).The level of obestatin were significantly decreased in HD+HP group,Superior to HD and HDF and groups.Hemodiafiltration,Hemodialysis and hemodiafiltration have no significant difference in the effect of Obestatin accumulation in the maintenance of maintenance hemodialysis patients(F=3.12,P<0.05).Conclusions: In the ESRD,the accumulation of Total ghrelin,Acyl ghrelin,and Obestatin is observed,and Acyl ghrelin/Total ghrelin ratio decreases mainly due to the accumulation of Des acyl ghrelin.The accumulation of Obestatin and the decreases of Acyl ghrelin/Total ghrelin ratio are correlated with loss of appetite,malnutrition in MHD patients.In addition,the accumulation of Obestatin in plasma and the decrease of Acyl ghrelin/Total ghrelin ratio in MHD patients may also be involved in the regulation of chronic kidney disease-mineral bone metabolism abnormalities.Different blood purification methods can correct the disorder of the system in varying degrees.There was no significant difference in the plasma Acyl ghrelin between the three treatment methods.The effect of HD+HP on Obestatin accumulation was better than HD and HDF,and there was no significant difference between HD and HDF.The ratios of Acyl ghrelin/Total ghrelin were increased after treatment in three groups,HDF was better than HD+HP,HD+HP was better than HD.So,The disorder of Ghrelin/Obestatin system can be better corrected by HDF and HD+HP,and there is a better effect by HDF and HD+HP in improving patients’ appetite,malnutrition,disorder of calcium and phosphorus metabolism. |
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