Caregaro L, Alberino F, Amodio P, Merkel C, Angeli P, Plebani M, Bolognesi M, Gatta A
Department of Clinical and Experimental Medicine, University of Padua, Italy.
Nutrition. 1997 Mar;13(3):185-90. doi: 10.1016/s0899-9007(96)00399-1.
Most of the traditional parameters for nutrition assessment have important limitations in patients with chronic liver disease. Insulin-like growth factor 1 (IGF-1) has been found to be regulated by nutrition and proposed as a nutritional marker. Its nutritional significance in patients with liver cirrhosis, however, has not been investigated. Serum IGF-1 as well as traditional anthropometric, visceral, and immunologic parameters were evaluated in 64 hospitalized cirrhotics, followed up clinically for 2 y. IGF-1Z-score averaged -2.16 +/- 1.08 and inversely correlated with Child-Pugh score (P < 0.01), the most reliable composite score reflecting the severity of liver disease. IGF-1Z-score was not different in patients with or without signs of energy malnutrition, as defined by values of midarm muscle circumference (MAMC) and/or triceps skinfold (TSF) < 5th percentile. Moreover, IGF-1Z-score did not correlate with MAMC or TSF. Despite its correlation with all visceral proteins, the reduction of IGF-1 was much greater and more frequent than that of visceral proteins. Patients with IGF-1Z-score < median values (-2.5) showed lower long-term survival rates compared with patients with IGF-1Z-score > -2.5 (P < 0.01). These data indicate that serum IGF-1 is not related to energy malnutrition in cirrhotic patients, while it appears to be a good predictor of survival and an early marker of liver dysfunction. Multiple factors, most of which are related to the severity of the liver disease, may contribute to the reduction of IGF-1. This multifactorial pathogenesis probably accounts for its prognostic significance.
大多数传统的营养评估参数在慢性肝病患者中存在重要局限性。胰岛素样生长因子1（IGF-1）已被发现受营养调节，并被提议作为一种营养标志物。然而，其在肝硬化患者中的营养意义尚未得到研究。对64例住院肝硬化患者的血清IGF-1以及传统人体测量学、内脏和免疫学参数进行了评估，并进行了为期2年的临床随访。IGF-1Z评分平均为-2.16±1.08，与反映肝病严重程度的最可靠综合评分Child-Pugh评分呈负相关（P<0.01）。根据上臂中部肌肉周长（MAMC）和/或三头肌皮褶厚度（TSF）值低于第5百分位数定义，有无能量营养不良体征的患者IGF-1Z评分无差异。此外，IGF-1Z评分与MAMC或TSF均无相关性。尽管IGF-1与所有内脏蛋白相关，但其降低幅度比内脏蛋白更大且更频繁。IGF-1Z评分<中位数（-2.5）的患者与IGF-1Z评分>-2.5的患者相比，长期生存率较低（P<0.01）。这些数据表明，血清IGF-1与肝硬化患者的能量营养不良无关，而它似乎是生存的良好预测指标和肝功能障碍的早期标志物。多种因素，其中大多数与肝病严重程度相关，可能导致IGF-1降低。这种多因素发病机制可能解释了其预后意义。
