Clinical significance of serum activin A and insulin like growth factor 1 (IGF-1)‎ in egyptian patients suffering from liver cirrhosis due to hepatitis C virus infection with and without hepatic schistosomiasis and its role in the development of hepatocellular carcinoma

Abstract EN

The present study evaluated the role of active A, Insulin like growth factor 1 (IGF-1) and its binding protein 3 (IGFBP-3) in Egyptian patients suffering from liver cirrhosis due to hepatitis C virus (HCV) infection with and without hepatic schistosomiasis (SHF) and its role in the development of hepatocellular carcinoma.

Four groups were included in the present study, Group I : Fifteen healthy subjects acting as controls, Group II (HCV) : Fifteen patients with liver cirrhosis due to HCV infection without evidence of schistosomiasis, Group III (SHF+HCV) : Fifteen patients with combined disease; chronic schistosomal hepatic fibrosis and liver cirrhosis due to hepatitis C virus infection and Group IV (HCC) : Fifteen patients with hepatocellular carcinoma associated with liver cirrhosis due to hepatitis C virus and schistosomal infection.

For all groups, liver function tests (serum bilirubin, ALT, AST, serum alkaline phosphatase, serum albumin and prothrombin activity), serum schistosomal antibodies, hierological markers and estimation of serum active A, IGF-1 and IGFBP-3 were done.

The Four groups were subjected to : clinical examination and abdominal ultrasonography as well as liver biopsies for patients.

The results showed that patients with HCV, HCV+SHF and those with HCC had a significantly higher serum active A compared with the control group.

Serum active A level (mean + SD) was 5.77 ± 2.7, 10.59 ± 3.1(P<0.05), 15.39 ± 4.7(P<0.001), and 19.9 ± 5.4(P<0.001) ng /ml in controls, HCV patients, HCV+SHF patients and HCC patients, respectively.

Serum active-A correlated positively with Child Pugh scoring in patients with HCV, HCV+SHF and those with HCC and the correlation coefficient was highly significant (p < 0.001) in total cases.

Serum active A level was significantly higher in patients With HCC than those with HCV+SHF (P<0.05) and those with HCV (P < 0.001), while serum active A level in patients with HCV+SHF was significantly higher than patients with HCV alone (P < 0.05).

Serum IGF-1 was significantly lower in HCV patients, HCV+SHF patients and HCC patients compared to the control group.

Serum IGF-1 was 121.7 ± 73.4, 76.7 ± 23.4(P<0.05), 35.7 ± 17.6 (P<0.001), 39.8 ± 25.8(P<0.001) ng /ml in controls, HCV patients, HCV+SHF patients and HCC patients, respectively.

Furthermore, patients with HCC and those with HCV+SHF had a significantly lower serum IGF-1 compared with those with HCV infection (P<0.05 for both groups).

Similarly serum Insulin like growth factor binding protein 3 (IGFBP-3) was significantly lower in HCV patients, HCV+SHF patients and HCC patients compared to the control group.

The median (range) of serum IGFBP-3 was 4452 (2815-8965), 3457 (1114-6000) (P<0.05), 2114 (867-5901) (P<0.001), 1202 (576-3994) (P<0.001) ng /ml in controls, HCV patients, HCV+SHF patients and HCC patients, respectively.

Furthermore, serum (IGFBP-3) was significantly lower in patients with HCC compared to its level in patients with HCV (P<0.05).

In conclusion, we suggest that the increase in active A level which was paralleled by a concomitant reduction in serum IGF-1 and its binding protein 3 levels may play a role in development of HCC.

Furthermore, serum Active A correlated positively with Child Pugh score, thus serum active A determination may represent a useful marker for the severity of liver cirrhosis.