Castro Gustavo R A, Coelho Julio C U, Parolin Mônica B, Matias Jorge E F, de Freitas Alexandre C T
Division of Liver Transplantation of the Federal University of Parana, Curitiba, Brazil.
Ann Transplant. 2013 Feb 12;18:57-62. doi: 10.12659/AOT.883819.
Insulin-like growth factor I (IGF-I) is produced almost entirely by the liver and is the main promoter of anabolic growth hormone (GH) effects on protein, carbohydrate, and lipid metabolism. IGF-I is significantly decreased in patients with liver cirrhosis. Our objective was to determine the relationship between circulating IGF-I and MELD (Model for End-stage Liver Disease) in cirrhotics subjected to orthotopic liver transplantation (OLT). We also assessed the changes of IGF-I and its major binding protein (IGF-binding protein-3 or IGFBP-3) after OLT.
In a prospective study, serum levels of IGF-I and IGFBP-3 of 25 male adult patients with end-stage liver disease were measured 2 to 4 hours before and 6 months after orthotopic liver transplantation. Seven age-matched healthy male volunteers with normal liver enzymes, albumin, and prothrombin time served as controls. MELD was determined on the day of OLT. For this analysis, extra points were not added for patients with hepatocarcinoma.
The cirrhotic group had significantly lower IGF-I (46.7±21.6 ng/mL) and IGFBP-3 (1.0±0.9 ng/mL) levels in the pre-transplant period compared with the controls (208.6±76.5 ng/mL and 4.62±0.93 ng/mL, respectively) (p<0.05). There was a negative correlation between IGF-I or IGFBP-3 and MELD (p<0.001) (ß=-1.750; standard error =2.5054 and ß=-0.038; standard error <0.0001, respectively). IGF-I e IGFBP-3 increased to normal levels after OLT (207.7±82.8 and 4.14±1.1 ng/mL, respectively) (p<0.001).
Low levels of IGF-I and IGFBP-3 observed in patients with advanced liver cirrhosis are corrected after OLT. IGF-I and IGFBP-3 correlate negatively with MELD.
胰岛素样生长因子I（IGF-I）几乎完全由肝脏产生，是合成代谢生长激素（GH）对蛋白质、碳水化合物和脂质代谢产生作用的主要促进因子。肝硬化患者的IGF-I水平显著降低。我们的目的是确定接受原位肝移植（OLT）的肝硬化患者循环IGF-I与终末期肝病模型（MELD）之间的关系。我们还评估了OLT后IGF-I及其主要结合蛋白（IGF结合蛋白-3或IGFBP-3）的变化。
在一项前瞻性研究中，对25例成年男性终末期肝病患者在原位肝移植前2至4小时及移植后6个月时的血清IGF-I和IGFBP-3水平进行了测定。7名年龄匹配、肝酶、白蛋白和凝血酶原时间正常的健康男性志愿者作为对照。在OLT当天测定MELD。在本次分析中，肝癌患者不额外加分。
与对照组相比（分别为208.6±76.5 ng/mL和4.62±0.93 ng/mL），肝硬化组在移植前期的IGF-I（46.7±21.6 ng/mL）和IGFBP-3（1.0±0.9 ng/mL）水平显著较低（p<0.05）。IGF-I或IGFBP-3与MELD之间存在负相关（p<0.001）（β=-1.750；标准误=2.5054和β=-0.038；标准误<0.0001）。OLT后IGF-I和IGFBP-3升高至正常水平（分别为207.7±82.8和4.14±1.1 ng/mL）（p<0.001）。
晚期肝硬化患者中观察到的低水平IGF-I和IGFBP-3在OLT后得到纠正。IGF-I和IGFBP-3与MELD呈负相关。
