Growth hormone/insulin-like growth factor 1 axis alterations contribute to disturbed protein metabolism in cirrhosis patients after hepatectomy.
OBJECTIVE
Liver cirrhosis is accompanied by a fall in whole-body protein turnover and alterations of the growth hormone (GH)/insulin-like growth factor 1 (IGF-1) axis. However, the influence of liver cirrhosis on the GH/IGF-1 axis in the perioperative period, and the contribution of the GH/IGF-1 axis alteration in cirrhosis to postoperative nitrogen metabolism are not known.


METHODS
Plasma GH, IGF-1 and IGF binding protein 3 (IGF-BP3) levels were measured sequentially in patients undergoing hepatectomy with or without cirrhosis. Postoperative nitrogen excretion and whole-body protein turnover rate were also determined.


RESULTS
Preoperative plasma IGF-1 level showed a negative correlation with indocyanine green retention rate. Cirrhosis patients undergoing hepatectomy had low IGF-1 and IGF-BP3 levels, despite extremely high GH levels in the perioperative period. Perioperative IGF-1 levels were lower in patients with postoperative complications than in those without complications. Postoperative nitrogen excretion was higher and whole-body protein turnover rate was lower in patients with cirrhosis than in those without cirrhosis. The post-operative IGF-1 level showed a positive correlation with whole-body protein turnover rate.


CONCLUSIONS
Postoperative hepatic IGF-1 production may be severely disturbed in patients with cirrhosis, and the impaired IGF-1 production contributes to the suppressed postoperative protein metabolism in cirrhosis. It may be appropriate to increase plasma IGF-1 level in patients with cirrhosis to enhance postoperative protein metabolism and improve the postoperative outcome.
Inaba
T
T
Department of Surgery, University of Tokyo Hospital, Japan.
Saito
H
H
Inoue
T
T
Han
I
I
Furukawa
S
S
Matsuda
T
T
Ikeda
S
S
Muto
T
T
D000368:Aged; D005260:Female; D006498:Hepatectomy; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000096:biosynthesis; D007334:Insulin-Like Growth Factor I / Q000096:biosynthesis*; D008103:Liver Cirrhosis / Q000097:blood* / Q000601:surgery; D008297:Male; D009584:Nitrogen / Q000652:urine; D011506:Proteins / Q000378:metabolism*; D011863:Radioimmunoassay; D016019:Survival Analysis
D018972:Insulin-Like Growth Factor Binding Protein 3; D011506:Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D009584:Nitrogen