title: Association of amino acid imbalance with the severity of liver fibrosis and esophageal varices.
abstract: BACKGROUND
  The relationships between the metabolic parameters and the endoscopic findings of esophageal varices have been poorly investigated. We investigated the association of the branched-chain amino acids to tyrosine ratio (BTR) with the severity of liver fibrosis and esophageal varices.
  
  
  METHODS
  We studied hepatitis C virus (HCV)-positive chronic liver disease patients who had undergone liver biopsy (n = 149). The relationship between the BTR values and the liver fibrotic stage was investigated. We also studied whether the BTR value was associated with the presence and bleeding risk of varices in patients with HCV-related compensated cirrhosis.
  
  
  RESULTS
  The mean values of the BTR decreased with the progression of the fibrosis (METAVIR score: F0-1: 6.40 ± 1.19; F2: 5.85 ± 1.33; F3: 5.24 ± 0.97, F4: 4.78 ± 1.14). In the 58 patients with HCV-related compensated cirrhosis, the mean values of the BTR decreased with the severity of varices (patients without varices: 5.01 ± 1.15, patients with a low-risk varices: 4.42 ± 1.06, patients with a high-risk varices: 3.86 ± 1.02). The BTR value was significantly lower in the patients with varices than in those without varices (4.17 ± 1.07 vs. 5.01 ± 1.15, P < 0.01). The BTR value was also significantly lower in the patients with a high risk of hemorrhage than in those with a low risk (3.86 ± 1.02 vs. 4.78 ± 1.14, P < 0.01). Furthermore, the BTR value was the most significantly different parameter, with the smallest P-value among all the factors examined, including the platelet count and albumin level.
  
  
  CONCLUSIONS
  A decreased BTR value was found to be associated with the progression of liver fibrosis and severity of varices.
authors.affiliation: Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo, Japan. enomoto@hyo-med.ac.jp
authors.forename: Hirayuki
authors.initials: H
authors.lastname: Enomoto
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sakai
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Aizawa
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Iwata
authors.forename: Hironori
authors.initials: H
authors.lastname: Tanaka
authors.forename: Naoto
authors.initials: N
authors.lastname: Ikeda
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yoh
authors.forename: Akio
authors.initials: A
authors.lastname: Ishii
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takashima
authors.forename: Kazunari
authors.initials: K
authors.lastname: Iwata
authors.forename: Masaki
authors.initials: M
authors.lastname: Saito
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Imanishi
authors.forename: Hiroko
authors.initials: H
authors.lastname: Iijima
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nishiguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000597:Amino Acids, Branched-Chain / Q000097:blood*; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000097:blood* / Q000175:diagnosis / Q000821:virology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000821:virology; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis / Q000821:virology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014443:Tyrosine / Q000097:blood; D055815:Young Adult
chemical_list: D000597:Amino Acids, Branched-Chain; D015415:Biomarkers; D014443:Tyrosine