Serum ghrelin and PYY enterohormones during acute critical illness: A prospective observational trial

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• 作者：C. Santacruz<sup>1sup><sup> ; sup><sup>2sup> ; A. Quintairos<sup>1sup> ; C. Righy<sup>1sup> ; I. Crippa<sup>1sup> ; L. Couto Jr.<sup>1sup> ; V. Imbault<sup>1sup> ; M. Wasineeart<sup>1sup> ; M. De Ryckere<sup>1sup> ; J. Creteur<sup>1sup> ; J.-C. Preiser<sup>1sup><sup> ; sup><sup>jean-charles.preiser@erasme.ulb.ac.be" class="auth_mail" title="E-mail the corresponding authorsup>
• 刊名：Nutrition Clinique et Métabolisme
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：30
• 期：1
• 页码：63
• 全文大小：142 K

文摘

Gastrointestinal failure during critical illness is associated with decreased intake and limited tolerance to enteral feeding. Enterohormones like ghrelin and PYY could play a role in these dysfunctions. This study aimed at defining:

spar0010">&ndash; the time course of serum ghrelin and PYY during the first 5 days of stay;

spar0015">&ndash; correlations with limited tolerance to enteral feeding.

sSec_2">Material and methods

spar0020">Thirty consecutive patients (age: 56.4 &plusmn; 16.4; BMI: 26.3 &plusmn; 4.5) and 10 fasting healthy volunteers (age: 34.1 &plusmn; 6.8; BMI: 23.1 &plusmn; 4.2) were included. In patients, blood was sampled for 5 consecutive days and once in the control group. Blood samples were immediately centrifuged at 3000 &times; g for 10 minutes at 4 °C. Ghrelin samples were acidified to pH 4 and then all samples were stored at &ndash;80 °C until processing. Ghrelin and PYY serum concentrations were measured using a commercial ELISA test. Enteral feeding intolerant patients were defined as patients with at least one episode of high gastric residual volume (> 250 mL) and/or diarrhea (> 200 mL of liquid stools/day). Comparisons between continuous variables were done using ANOVA and the Wilcoxon U-test as appropriated. Alpha error was set at 5%.

sSec_3">Results

spar0025">The incidence of intolerance among patients was 41.4%. Mean gastric residual volume (millilitres) was higher in intolerant than in tolerant patients (P < 0.05 for each day). Intolerant patients had a higher PYY serum concentration than tolerant patients (median (IQR): 53.5 pg/mL [17.5&ndash;191.7 pg/mL] vs. 17.7 pg/mL [4.8&ndash;62.5 pg/ml]; P = 0.03) and than controls (53.5 pg/mL [17.5&ndash;191.7 pg/mL] vs. 6.4 pg/mL [0.35&ndash;18.1 pg/mL]; P = 0.02). Daily PYY serum concentration was higher in intolerant than in tolerant patients, specifically on days 2 (median (IQR): 103.2 pg/mL [23.2&ndash;193.6 pg/mL] vs. 16.9 pg/mL [3.9&ndash;54 pg/mL]; P = 0.02) and day 5 (103.2 pg/mL [23.2&ndash;193.6 pg/mL] vs. 16.9 pg/mL [3.9 to 54 pg/mL]; P = 0.02). Controls had a significantly higher serum ghrelin concentration than either tolerant patients (median (IQR): 1435.7 pg/mL [1335.5&ndash;1775.5 pg/mL] vs. 219.4 pg/mL [84&ndash;420.5 pg/mL]; P < 0.0001) or intolerant patients (1435.7 pg/mL [1335.5&ndash;1775.5 pg/mL] vs. 283.5 pg/mL [92&ndash;1002.5 pg/mL]; P = 0.004). Unexpectedly, serum ghrelin concentration was higher in intolerant compared to tolerant patients (median (IQR): 283.5 pg/mL [92&ndash;1002.5 pg/mL] vs. 219.4 pg/mL [84&ndash;420.5 pg/mL]; P = 0.02). No difference in serum ghrelin concentration between tolerant compared to intolerant patients was found from day 1 to day 5.

sSec_4">Conclusions

spar0030">In critically ill patients, mean serum concentration of ghrelin and PYY significantly differ from that of healthy controls. These findings support a role of enterohormones in the critical illness-associated gastrointestinal failure.