Supplementary Material for: Severity of Gastric Mucosal Atrophy Is the Major Determinant of Plasma Ghrelin Level in Hemodialysis Patients

Background: Ghrelin, an orexigenic hormone, has multiple favorable functions including protein anabolism enhancement, anti-inflammatory actions, and cardiovascular protection. A low plasma ghrelin level is associated with increased mortality in patients treated with hemodialysis (HD). However, it is unclear whether the plasma ghrelin level in HD patients correlates with the severity of gastric mucosal atrophy and Helicobacter pylori status. Methods: Seventy-eight maintenance HD patients and 51 non-dialysis patients with chronic kidney disease were evaluated for severity of gastric mucosal atrophy by gastroduodenoscopy and for H. pylori status using an anti-H. pylori-antibody and rapid urease test. Plasma acyl and des-acyl ghrelin levels were measured and their associations with relevant clinical parameters were investigated. Results: Des-acyl ghrelin level in HD patients was significantly higher than that in patients with kidney function preserved. Although acyl and des-acyl ghrelin levels were similar between current H. pylori positive and negative HD patients, both levels decreased significantly with the progress of endoscopic gastric mucosal atrophy in HD patients. Serum pepsinogen (PG) I level and PG I/II ratio decreased significantly according to the severity of atrophy in HD patients and positively significantly correlated with both ghrelin levels. Multiple regression analysis showed significant positive correlations between acyl ghrelin and PG I levels (β = 0.738, p Conclusions: Gastric atrophy is the major determinant of ghrelin level in HD patients. Management practices, such as H. pylori eradication, before advanced atrophy may be required to prevent the decrease of ghrelin levels and improve the prognosis of HD patients.

背景：饥饿素（ghrelin）是一种促食欲激素，具备多种有益生理功能，包括促进蛋白质合成代谢、发挥抗炎作用以及提供心血管保护。血液透析（hemodialysis, HD）患者若血浆饥饿素水平低下，其死亡风险显著升高。但目前尚不明确HD患者的血浆饥饿素水平是否与胃黏膜萎缩严重程度及幽门螺杆菌（Helicobacter pylori）感染状态存在关联。
方法：本研究纳入78例维持性血液透析患者与51例非透析慢性肾脏病患者，通过胃十二指肠镜检评估胃黏膜萎缩严重程度，采用抗幽门螺杆菌抗体检测与快速尿素酶试验明确幽门螺杆菌感染状态；检测血浆酰基饥饿素与去酰基饥饿素水平，并分析其与相关临床参数的相关性。
结果：HD患者的去酰基饥饿素水平显著高于肾功能保留者。尽管当前幽门螺杆菌阳性与阴性的HD患者之间，酰基饥饿素与去酰基饥饿素水平无显著差异，但随着内镜下胃黏膜萎缩程度进展，HD患者的两种饥饿素水平均显著降低。HD患者的血清胃蛋白酶原（pepsinogen, PG）I水平及PG I/II比值随萎缩程度加重而显著降低，且与两种饥饿素水平均呈显著正相关。多因素回归分析显示，酰基饥饿素与PG I水平存在显著正相关（β = 0.738, p
结论：胃黏膜萎缩是HD患者饥饿素水平的主要影响因素。为防止饥饿素水平下降、改善HD患者预后，临床可能需要在胃黏膜萎缩进展至晚期前，采取幽门螺杆菌根除等干预措施。