Objective: Both ghrelin and leptin are important signals in the regulation of food intake and energy balance. Many other effects involving cardiovascular, gastrointestinal, renal, and endocrine systems were revealed during both rest period and acute phase response. The aim of this study was to characterize the changes of plasma ghrelin in an early postoperative period in relation to plasma leptin levels and systemic inflammatory response markers – cytokines and acute phase proteins. Design. Prospective study. Setting: Institute of Pathological Physiology and the 1st Department of Surgery, 1st Faculty of Medicine, Charles University, Prague. Material and Methods: The study was realized on 20 patients-men after planned laparotomic cholecystectomy (age 46 ± 6.3 yr., BMI 23.6 ± 3.0 kg . m–2). Patients with local or systemic postoperative complications were excluded from this group. The control group consisted of 14 healthy men, aged 36 ± 4.1 yr., mean BMI 23.3 ± 3.6 kg . m–2. The tested group was correlated to a group of septic patients (an acute stadium of intraabdominal postoperative sepsis after large abdominal surgery, 25 men, age 56 ± 9.2 yr., BMI = 22.6 ± 2.8 kg . m–2). Plasma levels of ghrelin (RIA), leptin, tumor necrosis factor-α (TNFα), interleukin-1β (IL-1β), sIL-2R, IL-6 (ELISA analysis), C reactive protein (CRP), and α1-antitrypsin (nephelometric analysis) were analyzed. Results: Authors demonstrate statistically significant elevation of plasma ghrelin (445.2 ± 58.9 ng/l) and leptin (14.4 ± 6.4 µg/l) with maximum +24 h after starting of surgery. These levels differ significantly from control group (336.5 ± 46.1 ng/l, P < 0.01 for ghrelin; 3.5 ± 1.2 µg/l, P < 0.001 for leptin) as well as from septic group. The regression coefficient in uncomplicated surgical group (+24 h after starting of surgery) was highest for ghrelin and IL-6 (r = 0.44, P < 0.05), ghrelin and TNFα (r = 0.39, P < 0.05), IL-6 and leptin (r = 0.50, P < 0.05). Conclusion: During an early postoperative period, both ghrelin and leptin plasma levels are elevated. Their concentrations positively correlate with inflammatory parameters – cytokines (TNFα, IL-6) and acute phase proteins (CRP). These findings are in accordance with experiments in vitro or in animal model revealed ghrelin as a positive acute phase reactant in different models of systemic inflammatory response. The potential physiological importance of both ghrelin and leptin elevation in acute phase response is unclear, yet.

        Key words: C reactive protein, ghrelin, interleukin-6, leptin, sepsis, tumor necrosis factor-α.