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World J Gastroenterol. Feb 7, 2007; 13(5): 785-790
Published online Feb 7, 2007. doi: 10.3748/wjg.v13.i5.785
Clinical benefits of biochemical markers of bone turnover in Egyptian children with chronic liver diseases
Karam A Mahdy, Hanaa H Ahmed, Fathia Mannaa, Azza Abdel-Shaheed
Karam A Mahdy, Medical Biochemistry Department, National Research Centre, Egypt
Hanaa H Ahmed, Hormones Department, National Research Centre, Egypt
Fathia Mannaa, Medical Physiology Department, National Research Centre, Egypt
Azza Abdel-Shaheed, Child Health Department, National Research Centre, Egypt
Author contributions: All authors contributed equally to the work.
Supported by the National Research Centre during the research plan from 2001-2004 by projects 5/4/5 and 5/5/5 in collaboration with National Liver Institute of Menoufyia University
Correspondence to: Karam A Mahdy, Medical Biochemistry Department, National Research Centre, El Bohouth Street, Dokki 12311, Cairo, Egypt. karammahdy@yahoo.com
Telephone: +2-2-3371499 Fax: +2-2-3370931
Received: August 23, 2006
Revised: October 8, 2006
Accepted: December 20, 2006
Published online: February 7, 2007
Abstract

AIM: To investigate the association between serum insulin-like growth factor 1 (IGF-1), osteocalcin, and parathyroid hormone (PTH) levels with the etiology and clinical condition of patients with chronic liver disease.

METHODS: Eighty children with hepatocellular damage were divided into 3 groups according to the etiology of disease infection: bilharziasis (9 patients), hepatitis B virus (HBV, 12 patients) and hepatitis C virus (HCV, 29 patients). The Child score index was found as A in 24 patients, B in 22 patients, C in 4 patients. Thirty healthy children served as control group. HBsAg, HBcAbIgM, HBcAbIgG, and anti-HCV were detected using ELISA technique. HCV-RNA was measured by reverse transcription polymerase chain reaction (RT-PCR). Anti-bilharzial antibodies were detected by indirect haem- agglutination test. Liver function tests were performed using autoanalyser. Serum IGF-1, osteocalcin and PTH levels were measured by ELISA technique. Abdominal ultrasonography was also conducted.

RESULTS: Serum IGF-1 level was significantly lower in all patient groups with liver diseases, while serum osteocalcin and PTH levels were significantly elevated in patients with HBV and HCV infections compared with the control group. Serum osteocalcin and PTH concentrations were measured with the severity of liver disease from Child A to C. Child A patients unexpectedly showed significantly reduced IGF-1 levels in comparison to patients staged as Child B or C. Serum osteocalcin level was negatively correlated with albumin (14.7 ± 0.54 vs 3.6 ± 0.10, P < 0.05), while that for PTH was positively correlated with total protein (70.1 ± 2.17 vs 6.7 ± 0.10, P < 0.05) in patients with HCV infection.

CONCLUSION: Low serum IGF-1 level seems to play a critical role in the bone loss in patients with chronic liver disease. Elevated biochemical markers of bone remodeling suggest high-turnover in patients with viral infection and reflect severity of the clinical stage.

Keywords: Liver disease; Bone turnover; Insulin-like growth factor-1; Osteocalcin; Parathyroid hormone