Effect of liver cirrhosis on circulating insulin-like growth factor binding protein-3 ternary complex

ABSTRACT

Insulin-like growth factor-1 [IGF-I], an anabolic hormone synthesized by the liver upon stimulation by growth hormone [GH], exerts important effects on nitrogen balance, bone metabolism, glucose metabolism and renal hemodynamics. IGF binding protein-3 [IGFBP-3] binds nearly 95% of circulating IGF, forming a stable ternary complex. Study the changes in circulating serum levels of IGF-l and IGFBP-3 in patients with liver cirrhosis and possible relations of these changes to the degree of liver affection. According to modified Child-Pugh [CP] classification of liver cirrhosis. 86 patients were divided into group A 28 patients with CP class-A [score 5-6]; group B 28 patients with CP class B [score 7-9]; and group C 30 patients with CP class C [score 10-15]. In addition, 20 healthy age- and sex-matched volunteers served as a control group. Diagnosis of cirrhosis was based on clinical, laboratory, ultrasonographic and upper gastro-intestinal endoscopy findings. Jaundice, encephalopathy, lower limb edema/ascites, and history of hematemesis/melana were significantly more observed in moderate and severe forms of cirrhosis. In addition, liver function tests were significantly more impaired in severe cases of liver cirrhosis except AST and ALP which showed nonsignificant differences among the 3 groups of liver cirrhosis. IGF-I and IGFBP-3 were observed to be significantly decreased with the progression of liver cirrhosis. A strong negative correlation was found between IGF-I and IGFBP-3 on one side and total bilirubin, PT, INR and CP score on the other side. On the other hand, both IGF-I and IGFBP-3 correlate positively with serum albumin. The changes in the level of IOP-I and its binding protein [IGFBP-3] correlates with the degree of liver affection due to cirrhosis and can be used as a prognostic tool. Yet larger scale studies are still needed