Korean J Hepatol.  2009 Mar;15(1):59-69. 10.3350/kjhep.2009.15.1.59.

The value of serum retinol-binding protein 4 levels for determining disease severity in patients with chronic liver disease

• Kwon JH
• Park ST
• Kim GD
• You CR
• Kim JD
• Woo HY
• Jang JW
• Kim CW
• Bae SH
• Choi JY
• Yoon SK

• KMID: 1776815
• DOI: http://doi.org/10.3350/kjhep.2009.15.1.59

Abstract

BACKGROUNDS/AIMS
Serum retinol-binding protein 4 (RBP4) is known to be a specific transport protein for retinol, and has recently been reported to be associated with insulin resistance. Hyaluronic acid (HA) is a well-known marker of liver fibrosis. In this study, the degree to which serum RBP4 levels can be used to predict disease severity in patients with chronic liver disease (CLD) was evaluated.
METHODS
Serum levels of RBP4 and HA were measured in 573 CLD patients [235 with chronic hepatitis (CH), 230 with liver cirrhosis Child-Pugh grade (Child) A, and 108 with liver cirrhosis with Child B and C] and 40 normal controls.
RESULTS
The mean age of the whole cohort was 53.1 years and the causes of CLD were hepatitis B virus (61.9%), hepatitis C virus (9.8%), alcohol (9.0%), and nonalcoholic steatohepatitis (3.8%). Serum levels of RBP4 significantly reduced and HA increased with disease condition, from none (normal controls) to advanced cirrhosis (normal control: RBP4 4.3+/-0.1 mg/dL, HA 25.3+/-28.1 ng/mL; CH: RBP4 3.6+/-0.1 mg/dL, HA 75.5+/-7.8 ng/mL; cirrhosis with Child A: RBP4 2.6+/-0.1 mg/dL, HA 184.4+/-14.5 ng/mL; and cirrhosis with Child B and C: RBP4 1.6+/-0.1 mg/dL, HA 656.5+/-86.7 ng/mL; P<0.001, respectively). Serum RBP4 level was a distinguishing factor at the early stage of CLD between CH and Child A cirrhosis (post-hoc test; P<0.001) and was correlated with histological fibrosis score (n=80, P<0.05) and several biochemical factors. Antiviral therapy (n=45, median interval 1,205 days) resulted in an improvement in serum RBP4 levels (P=0.001).
CONCLUSIONS
The results of our study suggest that RBP4 is a serologic marker for disease severity in patients with CLD. It could also be useful as an early marker of CLD and of the relative success of antiviral therapy.

Keyword

Chronic liver disease; Serologic marker; Retinol-Binding Proteins; Plasma; Hyaluronic Acid

MeSH Terms

Adult
Aged
Antiviral Agents/therapeutic use
Chronic Disease
Cohort Studies
Female
Hepatitis B, Chronic/drug therapy/pathology
Humans
Hyaluronic Acid/blood
Liver Cirrhosis/pathology
Liver Diseases/*diagnosis/pathology/therapy
Male
Middle Aged
ROC Curve
Retinol-Binding Proteins, Plasma/*analysis
Retrospective Studies
Severity of Illness Index