| Objective: Patients with liver cirrhosis often have all kinds of incretionary and metabolic problems. Ghrelin is a novel endogenous ligand for the growth hormone (GH) secretagogue receptor involved in energy metabolism, glucose homeostasis and food intake. Leptin, a hormone secreted by adipocytes as a product of the obese gene, also has relationship with liver disease. We investigated the role of ghrelin,leptin,insulin-like factor-I (IGF-I) in patients with liver cirrhosis and their relationships with nutritional parameters,clinical parameters and biochemical parameters.Methods: The study comprised 45 patients with liver cirrhosis (32 male/13 female) and 18 control subjects (11 male/7 female). Fasting blood samples were obtained, plasma ghrelin,serum IGF-I concentration were determined by enzyme immunoassay (EIA) and serum leptin,insulin levels were determined by radioimmunoassay (RIA). Nutritional assessments (including subjective global assessment, SGA),clinical parameters and biochemical parameters were obtained in all patients. Child-pugh classification was also carried through.Results 1 Ghrelin was significantly elevated in liver cirrhosis patients compared with healthy controls (3.4±3.3 ng/ml vs 2.1±1.4 ng/ml,P<0.05). Ghrelin levels became higher according to Child-pugh classification but there was not significant difference among three groups(P>0.05).2 Correlation analysis showed that ghrelin negatively correlated with insulin sensitivity index (ISI) (r=-0.326,P<0.05)and body fat rate(r=-0.327,P<0.05); Multiple linear regression analysis pinpointed body fat rate as the most important predictor discriminating ghrelin levels in patients with liver cirrhosis.3 Leptin was significantly elevated in liver cirrhosis patients compared with healthy controls (6.3±8.0 ng/ml vs 1.2±1.6 ng/ml,P<0.001). Leptin levels became higher according to Child-pugh classification: A(4.9±8.0 ng/ml),B(6.1±8.1 ng/ml) and C(8.8±8.0 ng/ml), leptin levels in Child-pugh B or C were significantly elevated compared with controls(P<0.05).4 Correlation analysis showed that leptin correlated with transferrin(r=0.494,P<0.01), insulin(r=0.455,P<0.01), ISI(r=-0.319,P<0.05)and serum glucose(r=-0.403,P<0.01); But leptin levels in controls were significantly correlated with body mass index (BMI)(r=0.476,P<0.05). 5 Serum IGF-I levels in patients with liver cirrhosis had no significant difference compared with controls (76.7±34.2 ng/ml vs 64.4±43.9 ng/ml, P=0.297). Correlation analysis showed that IGF-I in hepatic cirrhosis correlated with body fat mass(r=0.335, P<0.05), body fat rate(r=0.297, P<0.05), BMI(r=0.381, P=0.01), insulin(r=0.348, P<0.05)and ISI(r=-0.319, P<0.05).6 Fasting insulin levels in patients with liver cirrhosis were strikingly increased compared with controls(19.6±19.5 uIU/ml vs 11.1±11.6 uIU/ml,P<0.05). Blood glucose in patients was much higher than that in controls(7.0±1.4 mmol/L vs 4.3±1.0mmol,P<0.01). ISI in patients with liver cirrhosis was significantly decreased compared with controls(-7.3±1.0 vs -6.2±1.2,P<0.01).Conclusion1 Plasma ghrelin levels in patients with liver cirrhosis were significantly higher than that of normal controls, and there was no significant difference according to Child-pugh classification. Multiple linear regression analysis pointed that body fat rate acted as the most important predictor of ghrelin. Ghrelin may play a role in malnutrition of liver cirrhosis.2 Leptin was significantly elevated in cirrhosis patients compared with healthy controls. And leptin levels in Child-pugh B and C were significantly elevated compared with controls. So leptin may participate in innutrition of liver cirrhosis.3 Serum IGF-I levels in patients with liver cirrhosis had no significant difference compared with controls. IGF-I in hepatic cirrhosis correlated with body fat mass,body fat rate,BMI,insulin and ISI. 4 Patients with liver cirrhosis often have all kinds of incretionary and metabolic abnormality, among which insulin resistance an... |
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