- 學位論文
慢性肝病變患者血清中類胰島素生長因子-1、類胰島素生長因子結合蛋白-3與生長激素之檢測及其可能臨床應用研究
Insulin-like growth factor-1,insulin-like growth factor binding protein-3 and human growth hormone in serum of patients with chronic liver disease and possible clinical applications Insulin-like growth factor-1, insulin-like growth factor binding protein-3 and human growth hormone in serum of patients with chronic liver disease and possible clinical applications
摘要
研究背景 類胰島素生長因子系統(Insulin-like growth factor system, IGFs)在細胞生長和分化上擔任非常重要的角色。其中類胰島素生長因子-1(Insulin-like growth factor-1,IGF-1)、類胰島素生長因子結合蛋白-3 (Insulin-like growth factor binding protein-3, IGFBP-3)及生長激素(Human growth hormone, HGH)在慢性肝病變過程的角色扮演仍待釐清與探究。 研究方法 本研究設計包括健康族群、肝硬化族群以及未經治療肝癌族群等三組族群，經由檢測血清中IGF-1、IGFBP-3及HGH濃度，配合病人之相關臨床檢測數據，探討其相關性與可能臨床應用。本研究以靜脈穿刺抽取血液檢體，採檢對象包括60名正常志願者、57名肝硬化病人及32名未經治療肝癌病人，主要以免疫分析法測定血清中IGF-1、IGFBP-3與HGH之濃度。 研究結果 研究結果顯示肝硬化族群和未經治療肝癌族群血清中AST、ALT、PT與T. bilirubin顯著高於健康族群 (P<0.001)；而在IGF-1、IGFBP-3則呈顯著下降(P<0.001)，albumin亦呈顯著下降(P<0.05)。肝硬化族群依Child-Pugh classification (CP)分類顯示血清中IGF-1與IGFBP-3濃度依肝硬化嚴重程度有顯著降低結果(P<0.001)；而HGH濃度則依肝硬化嚴重程度而顯著上升(P<0.001)。胎兒蛋白(alpha-fetoprotein, AFP)分組比較在肝硬化族群血清中IGF-1濃度與IGF-1: IGFBP-3 molar ratio均呈有意義下降(P<0.05)；AST 與ALT則呈有意義上升(P<0.05)。AFP分組比較在未經治療肝癌族群血清中IGF-1濃度與IGFBP-3濃度呈有意義上升(P<0.05)。 結論 血清中IGFBP-3可為肝儲備能力及慢性肝病變發展成肝癌的可能指標。
並列摘要
BACKGROUND The insulin-like growth factor system (IGFs) plays an important role in cell growth and differentiation. Nevertheless, the roles played by insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3) and human growth hormone (HGH) in the progression of chronic liver disease remain to be elucidated and investigated. METHODS The subjects in the present study included 60 healthy controls, 57 liver cirrhosis patients and 32 untreated hepatocellular carcinoma patients. Blood was drawn by venipuncture into Venoject tubes. To find the possible correlations between liver damage and IGFs, serum IGF-1, GH, IGFBP-3 concentration and related biochemical parameters were measured. We used immunoradiometric assay to determine the levels of IGF-1, HGH and IGFBP-3 in serum. RESULTS Significant higher levels of serum AST, ALT, prothrobin time and T. bilirubin in patients with liver cirrhosis and untreated hepatocellular carcinoma compared to the healthy control normal group were observed; on the contrary, the levels of serum albumin, IGF-1 and IGFBP-3 were significant lower in patients with liver cirrhosis and untreated hepatocellular carcinoma compared to the healthy control group. According to the Child-Pugh classification, we compared the difference among the patients with liver cirrhosis and found both serum IGF-1 and IGFBP-3 decresed significantly when the extent of liver cirrhosis increased; however, the HGH levels elevated when the extent of liver cirrhosis increased. The effects of alpha-fetoprotein (AFP) level on the parameters measured indicated that the IGF-1 level and IGF-1/ IGFBP-3 ratio in liver cirrhosis group were decreased significantly; on the contrary, serum AST and ALT were markedly elevated. In addition, the serum IGF-1 and IGFBP-3 levels in patients with untreated hepatocellular carcinoma were elevated significantly based on the difference in AFP level. CONCLUSION Serum IGFBP-3 may be used as a marker for the hepatic synthetic capacity and chronic liver disease development into the hepatocellular carcinoma.