REGULATION OF GROWTH-HORMONE (GH), INSULIN-LIKE GROWTH-FACTOR (IGF)-I, IGF BINDING PROTEIN-1, PROTEIN-2, PROTEIN-3 AND GH BINDING-PROTEIN DURING PROGRESSION OF LIVER-CIRRHOSIS

The aim of this study was to investigate the regulation of various pro teins of the GHIGF axis during progression of liver failure and to sea rch for potential prognostic markers of functional hepatic reserve. Se rum levels of growth hormone (GH) and high affinity growth hormone bin ding protein (GHBP), insulin-like growth factor I (IGF-I) and IGF bind ing proteins (IGFBP)-1, -2 and -3 were determined in patients with liv er cirrhosis. A continuous decline in the concentrations of IGF-I, IGF BP-3 and serum GH-binding activity (GHBP) was observed during progress ion of cirrhosis and the data correlated significantly with choline es terase, total serum protein and the Child score. In addition, GHBP sho wed a significant correlation with the enzymatic activity of glutamate dehydrogenase or transaminases and seems so to be influenced by the d egree of liver cell damage. In contrast, IGFBP-1 and IGFBP-2 levels we re significantly elevated in preterminal disease suggesting an upregul atory mechanism is still effective in this situation. Only when liver function had markedly deteriorated, the serum levels of these two para meters decreased again, possibly due to an impaired synthesis. The exc ellent correlation between the serum levels of IGF-I (r = -0.64, p < 0 .001) or IGFBP-3 (r = -0.67, p < 0.001) and the Child score index sugg ests that they reflect the hepatic functions just as conventional indi cators. For an appropriate interpretation of the liver function the me asurement of the growth related peptides can be a valuable tool to est imate pathological alteration in the functional hepatic reserve or in the glucose homeostasis.