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AI InsightThey may serve as novel markers of hepatocellular dysfunction.
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Abstract
Background/aims: Impaired growth hormone-insulin like growth factor system in hepatic cirrhosis leads to cirrhosis-related complications. In this study, we aimed to investigate whether serum levels of insulin like growth factor-1 and insulin like growth factor binding protein-3 are related to the level of hepatic dysfunction, clinical grade, and etiologic factors of the disease in patients with liver cirrhosis. Methods: Forty-two patients with liver cirrhosis who were diagnosed by means of clinical findings, endoscopy, imaging studies, or histopathology were enrolled in the study. An age- and sex-matched control group was comprised of 37 healthy controls with no signs of liver disease by clinical or laboratory findings. The demographic features (age, sex, height, and weight) and serum levels of liver function tests, urea, creatinine, sodium, potassium, insulin like growth factor-1, and insulin like growth factor binding protein- 3 and hemogram values were recorded for each individual. The patients were grouped according to Child Pugh classification and etiology. Results: Insulin like growth factor-1 and insulin like growth factor binding protein-3 levels were significantly lower in the cirrhotic group in comparison to the control group (p<0.005). A statistically significant decrease in levels of insulin like growth factor-1 and insulin like growth factor binding protein-3 was correlated with the degree of liver dysfunction, namely, lowest decrease in Child Pugh class A and highest decrease in class C. With respect to etiology, insulin like growth factor- 1 levels of alcohol-related liver cirrhosis were significantly lower than those of hepatitis B- related cirrhosis. There was no relation between insulin like growth factor binding protein-3 level and etiology. In the cirrhotic group, insulin like growth factor- 1 level was positively correlated with serum albumin and negatively correlated with serum creatinine and sodium levels and spleen size. Likewise, insulin like growth factor binding protein-3 level was positively correlated with serum albumin. There was a negative correlation between insulin like growth factor binding protein-3 level and serum bilirubin and spleen size. Conclusions: Insulin like growth factor-1 and insulin like growth factor binding protein-3 levels are related to the level of clinical impairment and were independent of the etiology. They may serve as novel markers of hepatocellular dysfunction.
Özet
Amaç: Hepatik sirozda insülin benzeri büyüme faktörü sisteminde oluşan bozulma komplikasyonlara yol açabilir. Bu çalışmada sirozda serum insulin like growth factor-1 ve insulin like growth factor binding protein-3 düzeylerinin hepatik disfonksiyon, klinik durum ve etiyolojik faktörlerle ilişkili bulunup bulunmadığı araştırmayı hedeşedik. Yöntem: Klinik, görüntüleme, endoskopik veya histopatolojik olarak siroz tanısı konmuş 42 hasta çalışmaya alındı. Yaş ve cinsiyet açısından eşleştirilmiş, klinik ve biyokimyasal olarak karaciğer hastalığı tanısı dışlanmış 37 sağlıklı birey kontrol grubunu oluşturdu. Demografik özellikler (yaş, cinsiyet, boy ve kilo) ile karaciğer fonksiyon testleri, üre, kreatinin, sodyum, potasyum, insulin like growth factor-1 ve insulin like growth factor binding protein-3 ile hemogram verileri kaydedildi. Hastalar Child Pugh sınışaması- na ve etiyolojilerine göre tasnif edildi. Bulgular: Insulin like growth factor-1 ve insulin like growth factor binding protein-3 düzeyleri sirotik grupta kontrol grubuna göre belirgin düşük bulundu (p<0.005). Insulin like growth factor-1 ve insulin like growth factor binding protein-3'de azalma ile karaciğer disfonksiyonun derecesi arasındaki ilişki istatistiksel olarak anlamlı bulundu; diğer bir deyişle Child Pugh klas A'da en az düşme saptanırken en fazla düşüş klas C'de izlendi. Etiyoloji dikkate alındığında insulin like growth factor-1 düzeyi alkole bağlı sirozda hepatit B'ye bağlı sirozda gözlenen düzeylere göre belirgin olarak düşük bulundu. insulin like growth factor binding protein-3 ve etiyoloji arasında ilişki saptanmadı. Sirotik grupta insulin like growth factor-1, serum albumini ile pozitif, serum kreatinini, serum sodyumu ve dalak boyutuyla negatif ilişki saptandı. ‹nsulin like growth factor binding protein-3 ise sadece serum albumini ile pozitif yönde ilişkili bulundu. ‹nsulin like growth factor binding protein-3 ve serum bilirubini ve dalak boyutu arasındaki ilişki ise negatif yöndeydi. Sonuç: ‹nsulin like growth factor-1 ve IGF-3 düzeyleri sirozda klinik evreyle ilişkilidir. Düzeyler etiyolojiden bağımsızdır. Hepatoselüler disfonksiyonun yeni belirteçleri olarak kullanılabilirler.