Detection And Significance Of Insulin-like Growth Factor-Ⅰ In Serum Of Patients With Chronic Hepatic Diseases

Insulin-like growth factors (IGFs) and pro-insulin are similar to the name because of their similar chemical structures. IGF includes IGF-Ⅰand IGF-Ⅱ. They both have the same homologous single-chain peptides, whose 70% of amino acid molecules is the same.IGF-Ⅰwhich composes of 70 amino acids, is a single polypeptide chain with characters of endocrine, paracrine and autocrine secretion, and its molecular weight is about 7.5 ku. IGF-Ⅰplays a very important role of the growth and development of normal cell, bone rebuilding, embryonic development , nerve growth, tumor immunity and preventing brain injury.The blood IGF-Ⅰis synthesized and released mainly by the liver cells. The changes of liver function has a direct impact on serum IGF-Ⅰlevels. At present studys showed that IGF-Ⅰin the serum of patients with liver cirrhosis decreased, but its research about hepatitis B virus and primary liver cancer is still rare. Our study tested IGF-Ⅰin the serum of patients with chronic liver disease with various types of chronic liver disease from January 2007 to February 2008 using enzyme-linked immunosorbent assay to evaluating the relationship of IGF-Ⅰand every type of hepatic diseases. At the same time HBV-DNA quantity of chronic hepatitis B patients were tested by fluorescence quantitative detection of nucleic acid amplification and we analyzed the relationship between IGF-Ⅰlevels and HBV-DNA quantity.85 cases of chronic hepatitis B, liver cirrhosis after hepatitis B, and primary liver cancer were collected in the second hospital of Jilin University from January 2007 to February 2008, including 54 cases of chronic hepatitis B 38 men cases, 16 women cases, aged 18 to 65 years old, with an average age of 45.5±3.4, 18 mild cases, 24 moderate cases, 12 severe cases; 21 liver cirrhosis after hepatitis B cases, of which 13 male cases, 8 female patients, classified by the Child-Pugh, 6 cases of group A, 11 cases of group B, 4 cases of group C, aged from 42 to 75 years old, with an average age of 50.7±7.5; 10 primary liver cancer cases: 8 male cases and 2 female patients, aged 53 to 76 years old, with an average age of 66.8±5.1. Clinical diagnosis accord with diagnostic criteria of《prevention and treatment programme of viral hepatitis》revised by the 10th national viral hepatitis and liver diseases conference in 2000. Liver cirrhosis, liver cancer were cofirmed by B ultrasound, CT , liver biopsy or surgical histologic. 20 healthy cases were assigned as control group, including 12 male and eight women, aged from 22 to 78 years old, with an average age of 46±9.3.Results of the study: IGF-Ⅰlevels of patients with varying degrees of liver were statistically significant different, serum free IGF-Ⅰin group of chronic hepatitis B (mild, moderate, severe) was higher than that in liver sclerosis group, primary liver cancer group and the normal control group (P <0.05). In liver cirrhosis group classified by the Child-Pugh, IGF-Ⅰlevels from A to B and C gradually decreased. (comparison, there were significant difference between A and B, B and C, P <0.05), hepatitis B patients with DNA HBV-positive had higher serum IGF-Ⅰlevels statistically significantly than that of HBV-DNA negative group and the normal control group, and it increased with the increasement of HBV-DNA quantity.From this we can draw the following conclusions: IGF-Ⅰlevels of different patients with liver diseases had differences from each other. IGF-Ⅰlevels of chromic hepatitis B patients were higher than the healthy people. IGF-Ⅰlevels of both liver cirrhosis and hepatocellular carcinoma were lower than normal healthy people IGF-Ⅰlevels of patients with liver cirrhosis decreased gradually with the severity of liver cirrhosis; IGF-Ⅰlevels of chronic hepatitis B increased with increasing of HBV-DNA quantity.IGF-Ⅰis mainly synthesized in the liver, and the growth hormone may promote the growth of body tissue and cell proliferation only through the mediation of the IGF-Ⅰ, IGF-Ⅰis an important cytokine in liver inflammation and fibrosis progress, it increases along with the severity of hepatitis. Compared with the normal control group, the level of IGF-Ⅰis higher in chronic hepatitis group, and decreases with the severity of the disease, the higher the severity of hepatitis, the lower the level of IGF-Ⅰ, and has significant differences. The reason may be related to the inflammation and stimulation of the large number of virus replication, it triggers the patients'activated immune system and lead to the high secretion of regulation of IGF-Ⅰin target cells. It may also be a protective response, in the time of the liver inflammation, the liver cells overexpress the IGF-Ⅰ, and a large number of IGF-Ⅰhave prompted liver cell proliferation, enhance synthesis and metabolism of the liver, thus contributing to the recovery of hepatitis.IGF-Ⅰin the serum of patients with liver cirrhosis decreased significantly above normal, gradually with the degree of liver cirrhosis deepened, IGF-Ⅰhas continued to drop, the degree of the drop and the liver function damage and prognosis (Child-Pugh score) are significantly related. It is to say that the lower the IGF-Ⅰis,the severer the illness is, and the worse the prognosis is. IGF-Ⅰcan be one of the indirect indicators that indicate the function of the liver cell activity. The level of IGF-Ⅰin primary liver cancer and cirrhosis are near, and compared with the normal control ,it decreases significantly, because of the majority of primary liver cancer are associated with liver cirrhosis. In addition, IGF-Ⅰand its receptor may play an important role in the process of hepatocellular carcinoma.IGF-Ⅰprovides a new idea for the assessment of prognosis in patients with liver cirrhosis, but it has not been used in clinical application commonly, especially in the treatment, it limited to treat the cirrhosis mice at present, and it found that IGF-Ⅰhad potentially dangerous in the clinical treatment by study of other diseases, such as IGF-Ⅰcan stimulate cell growth, but it can not distinguish between normal cells and tumor cells, and have led to many side effects such as difficulty in breathing, tachycardia, orthostatic hypotension, injection burning sensation and so on. Therefore, it needs to expend theclinical statistical samples further, and make more in-depth studies of IGF-Ⅰin the mechanism of liver diseases diagnosis, that can be used safely in the clinical liver cirrhosis early.Replication of hepatitis B virus in patients with hepatitis activates the immune regulation system, results the increas of the secretion of IGF-Ⅰin liver cells, thereby promots the proliferation of liver cells,that can strengthen the synthesis and metabolic of liver function, when the hepatitis B virus doesn't replicate, there is no stimulation of inflammatory, the patients with a normal level of IGF-Ⅰ, we found that IGF-Ⅰlevels were related with the replication of hepatitis B virus.From the comprehensive analysis of the correlated clinical research data we can see that value for IGF-Ⅰin the determination and assessment of the state of liver function and prognosis of the estimated gains more attention, it can provide reliable reserves liver function, the value of IGF-Ⅰevaluation in liver cirrhosis prognostic has been gaining more and more recognition ,as the drug in the treatment of liver cirrhosis and its complications, it has been scientifically proved in a large number of animal experiments. However, IGF-Ⅰcan serve as an effective treatment of cirrhosis of the medication, yet to be studied in greater depth.