[The value of serum retinol-binding protein 4 levels for determining disease severity in patients with chronic liver disease].
OBJECTIVE
Serum retinol-binding protein 4 (RBP4) is known to be a specific transport protein for retinol, and has recently been reported to be associated with insulin resistance. Hyaluronic acid (HA) is a well-known marker of liver fibrosis. In this study, the degree to which serum RBP4 levels can be used to predict disease severity in patients with chronic liver disease (CLD) was evaluated.


METHODS
Serum levels of RBP4 and HA were measured in 573 CLD patients [235 with chronic hepatitis (CH), 230 with liver cirrhosis Child-Pugh grade (Child) A, and 108 with liver cirrhosis with Child B and C] and 40 normal controls.


RESULTS
The mean age of the whole cohort was 53.1 years and the causes of CLD were hepatitis B virus (61.9%), hepatitis C virus (9.8%), alcohol (9.0%), and nonalcoholic steatohepatitis (3.8%). Serum levels of RBP4 significantly reduced and HA increased with disease condition, from none (normal controls) to advanced cirrhosis (normal control: RBP4 4.3+/-0.1 mg/dL, HA 25.3+/-28.1 ng/mL; CH: RBP4 3.6+/-0.1 mg/dL, HA 75.5+/-7.8 ng/mL; cirrhosis with Child A: RBP4 2.6+/-0.1 mg/dL, HA 184.4+/-14.5 ng/mL; and cirrhosis with Child B and C: RBP4 1.6+/-0.1 mg/dL, HA 656.5+/-86.7 ng/mL; P<0.001, respectively). Serum RBP4 level was a distinguishing factor at the early stage of CLD between CH and Child A cirrhosis (post-hoc test; P<0.001) and was correlated with histological fibrosis score (n=80, P<0.05) and several biochemical factors. Antiviral therapy (n=45, median interval 1,205 days) resulted in an improvement in serum RBP4 levels (P=0.001).


CONCLUSIONS
The results of our study suggest that RBP4 is a serologic marker for disease severity in patients with CLD. It could also be useful as an early marker of CLD and of the relative success of antiviral therapy.
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Jung Hyun
JH
Kwon
Seong Tae
ST
Park
Gi Dae
GD
Kim
Chan Ran
CR
You
Jin Dong
JD
Kim
Hyun Young
HY
Woo
Jeong Won
JW
Jang
Chang Wook
CW
Kim
Si Hyun
SH
Bae
Jong Young
JY
Choi
Seung Kew
SK
Yoon
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008103:Liver Cirrhosis / Q000473:pathology; D008107:Liver Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D054839:Retinol-Binding Proteins, Plasma / Q000032:analysis*; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000998:Antiviral Agents; C101326:RBP4 protein, human; D054839:Retinol-Binding Proteins, Plasma; D006820:Hyaluronic Acid