Kaur Parminder, Verma Nipun, Wadhawan Aishani, Garg Pratibha, Ralmilay Samonee, Kalra Naveen, Baloji Abhiman, Dutta Pinaki, Sharma Gaurav, Rathi Sahaj, De Arka, Premkumar Madhumita, Taneja Sunil, Duseja Ajay, Singh Virendra
Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
Punjab Institute of Liver and Biliary Sciences, Mohali, Punjab, India.
J Clin Exp Hepatol. 2025 Jan-Feb;15(1):102402. doi: 10.1016/j.jceh.2024.102402. Epub 2024 Aug 12.
The growth hormone-insulin-like growth factor (GH-IGF-1) axis and its impairment with sarcopenia, frailty, bone health, complications, and prognosis are not well characterized in cirrhosis.
We investigated the adult decompensated cirrhosis out-patients at a tertiary care institute between 2021 and 2023 for serum GH and IGF-1 levels, and associated them with sarcopenia (CT-SMI in cm/m), liver frailty index (LFI), osteodystrophy (DEXA), clinical decompensations (overall, ascites, encephalopathy, infection, and bleed), and survival up to 180 days.
One-hundred-seventy-two patients, 95% males, aged 46.5 years (median). IGF-1 levels were negatively associated with sarcopenia, osteodystrophy, LFI, CTP, and MELD-Na score ( < 0.05 each). Patients with low IGF-1 levels had a higher incidence of complications (overall, ascites and encephalopathy) than those with intermediate, and high IGF-1 levels ( < 0.05 each). Both IGF-1 (AUC: 0.686) and MELD (AUC: 0.690) could predict 180-day mortality ( < 0.05, each). Adding IGF-1 with MELDNa further improved discriminative accuracy of MELDNa (AUC: 0.729) < 0.001. The increase in IGF-1 on follow-up was associated with better survival and fewer complications.
Reduced IGF-1 levels reflect sarcopenia, frailty, and osteodystrophy in cirrhosis. Low IGF-1 are associated with severity, development of decompensations, and mortality.
生长激素 - 胰岛素样生长因子（GH - IGF - 1）轴及其在肌肉减少症、衰弱、骨骼健康、并发症和预后方面的损害在肝硬化中尚未得到充分表征。
我们在2021年至2023年期间对一家三级医疗机构的成年失代偿期肝硬化门诊患者进行了血清GH和IGF - 1水平的调查，并将其与肌肉减少症（以厘米/米为单位的CT - SMI）、肝脏衰弱指数（LFI）、骨营养不良（DEXA）、临床失代偿（总体、腹水、肝性脑病、感染和出血）以及长达180天的生存率相关联。
172例患者，95%为男性，年龄中位数为46.5岁。IGF - 1水平与肌肉减少症、骨营养不良、LFI、CTP和MELD - Na评分呈负相关（均P < 0.05）。IGF - 1水平低的患者并发症（总体、腹水和肝性脑病）的发生率高于IGF - 1水平中等和高的患者（均P < 0.05）。IGF - 1（AUC：0.686）和MELD（AUC：0.690）均可预测180天死亡率（均P < 0.05）。将IGF - 1与MELDNa相加进一步提高了MELDNa判别准确性（AUC：0.729，P < 0.001）。随访期间IGF - 1的升高与更好的生存率和更少的并发症相关。
IGF - 1水平降低反映了肝硬化中的肌肉减少症、衰弱和骨营养不良。低IGF - 1与严重程度、失代偿的发生和死亡率相关。
