Международный эндокринологический журнал Том 21, №6, 2025

Актуальність. Ендокринний дисбаланс, який призводить до пошкодження клубочкової функції нирок, є маловивченим. Роль орексигенного гормону греліну в розвитку порушень функції нирок залишається не до кінця з’ясованою. Мета: вивчити рівень греліну, його зв’язок із метаболічними показниками, змінами харчової поведінки на ранніх стадіях хронічної хвороби нирок (ХХН), пов’язаної з ожирінням. Матеріали та методи. Обстежено 300 пацієнтів із ХХН. Їх було поділено на 4 групи: І (n = 70) — ХХН І ст. та нормальна маса тіла, ІІ (n = 72) — ХХН ІІ ст. і нормальна маса тіла; ІІІ (n = 70) — ХХН І ст. та ожиріння, ІV (n = 88) — ХХН ІІ ст. і ожиріння. Контрольну групу становили 30 практично здорових осіб. Усім хворим визначали індекс маси тіла, розраховували швидкість клубочкової фільтрації за формулами CKD-EPI на основі рівня креатиніну, цистатину С та їх поєднання (CKD-EPIcysC/cr). Уміст цистатину С і греліну в сироватці крові визначали методом імуноферментного аналізу. Розраховували індекс HOMA-IR. Харчову поведінку та її типи оцінювали за допомогою Голландського опитувальника харчової поведінки. Результати. Виявлено зниження рівня греліну в ІІІ групі та його зростання — в ІV. У пацієнтів з ожирінням спостерігався вірогідний кореляційний зв’язок між концентрацією загального греліну й індексом маси тіла: обернений — у ІІІ групі (r = –0,46, t = 2,1) і прямий — у ІV (r = 0,74, t = 2,5) (р3, 4 < 0,05). Кореляційний аналіз рівнів цистатину С і греліну продемонстрував прямий зв’язок між підвищенням обох показників у пацієнтів із ХХН ІІ ст. на тлі ожиріння. Виявлено вірогідний прямий зв’язок середньої сили між рівнем глюкози і греліном (r = 0,68, t = 2,9, р < 0,05), а також між концентрацією греліну в сироватці крові й індексом HOMA-IR (r = 0,56, t = 2,05, р < 0,05) у ІV групі. У цій групі також зафіксовано тісний кореляційний зв’язок між рівнем греліну й емоційним типом харчової поведінки (r = 0,59, t = 2,5, р < 0,05). Висновки. Із прогресуванням стадії ХХН зміни рівня греліну корелюють із підвищенням концентрації цистатину С, індексом HOMA-IR та емоційним типом харчової поведінки в пацієнтів із ХХН ІІ ст. на тлі ожиріння. Виявлені порушення очевидно призводять до пошкодження клубочків нирок.

Background. Endocrine imbalance leading to impaired glomerular renal function is poorly understood. The role of the orexigenic hormone ghrelin in the development of renal dysfunction remains incompletely clarified. The purpose was to study ghrelin levels, their relation to the metabolic parameters, and changes in eating behaviour characteristics in the early stages of obesity-related chronic kidney disease (CKD). Materials and methods. 300 patients with CKD were examined and divided into 4 groups: the first group consisted of 70 people with the first stage CKD and normal body weight, the second group included 72 patients with the second stage CKD and normal body weight; the third group consisted of 70 people with the first stage CKD and obesity, and the fourth group included 88 patients with the second stage CKD and obesity. The control group consisted of 30 practically healthy individuals. All participants had their body mass index measured, and glomerular filtration rate was calculated using CKD-EPI equations based on creatinine, cystatin C, and their combination (CKD-EPIcysC/cr). The levels of cystatin C and ghrelin in blood serum were determined by enzyme-linked immunosorbent assay. HOMA-IR was calculated as well. Eating behaviour and its types were assessed using the Dutch Eating Behaviour Questionnaire. Results. Ghrelin levels decreased in the third group and increased in the fourth one. In patients with obesity, a significant correlation was observed between the concentration of total ghrelin and body mass index: inverse in the third group (r = –0.46, t = 2.1), and direct in fourth group (r = 0.74, t = 2.5) (p3, 4 < 0.05). Correlation analysis of cystatin C and ghrelin levels showed a direct correlation between an increase in both indicators in patients with the second stage CKD against the background of obesity. A significant direct average correlation was also found between glucose and ghrelin levels (r = 0.68, t = 2.9, p < 0.05), as well as between ghrelin concentration in blood serum and HOMA-IR (r = 0.56, t = 2.05, p < 0.05) in the fourth group. In this group, there was a close correlation between ghrelin levels and emotional type of eating behaviour (r = 0.59, t = 2.5, p < 0.05). Conclusions. As CKD progresses, changes in ghrelin levels correlate with increased cystatin C, HOMA-IR, and emotional type of eating behaviour in patients with the second stage CKD against the background of obesity. These disorders apparently contribute to glomerular damage.

хронічна хвороба нирок; ожиріння; харчова поведінка; грелін; цистатин С

chronic kidney disease; obesity; eating behaviour; ghrelin; cystatin C

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