Serum retinol binding protein 4 and clinical outcome in postoperative biliary atresia
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Biliary atresia (BA), a chronic inflammatory disease of bile ducts, is characterized by the obliteration of bile flow. The aim of the present study was to investigate serum retinol binding protein 4 (RBP4) in postoperative BA patients and the association of RBP4 with clinical parameters and liver stiffness scores.
A number of forty-eight BA patients post Kasai operation and 24 controls were enrolled. None of the patients had undergone liver transplantation. BA patients were classified into two groups according to their serum total bilirubin (TB) levels (non-jaundice, TB < 2 mg/dl vs. jaundice, TB ≥ 2 mg/dl) and liver stiffness (insignificant fibrosis, liver stiffness <7 kPa vs. significant fibrosis, liver stiffness ≥7 kPa). Serum RBP4 levels were determined by enzyme-linked immunosorbent assay (ELISA). Liver stiffness scores were measured by FibroScan.
BA patients had lower RBP4 levels (14.9 ± 1.0 vs. 18.7 ± 1.0 ng/ml, P = 0.02), but higher liver stiffness than controls (29.5 ± 3.3 vs. 5.0 ± 0.5 kPa, P < 0.001). Serum RBP4 levels were significantly decreased in BA patients with jaundice, compared with those without jaundice (9.5 ± 0.9 vs. 18.2 ± 1.2 ng/ml, P < 0.001). Moreover, BA patients with significant liver fibrosis displayed lower serum RBP4 than those with insignificant fibrosis (14.1 ± 1.2 vs. 21.2 ± 1.4 ng/ml, P = 0.02). Further analysis showed that serum RBP4 was strongly correlated with liver stiffness and serum albumin (r = −0.72, P < 0.001, and r = 0.65, P < 0.001, respectively). BA patients with portal hypertension (PH) had lower serum RBP4 than those without PH (12.8 ± 1.2 vs. 19.2 ± 1.7 ng/ml, P = 0.003).
Serum RBP4 levels decreased in BA patients compared with normal participants, and its levels declined significantly in patients with more severe disease. RBP4 may play a role in the pathogenesis of hepatic fibrosis and serve as a possible biomarker reflecting disease severity in postoperative BA patients.
KeywordsBiliary atresia Jaundice Liver fibrosis Portal hypertension Retinol binding protein 4
This research has been facilitated by the Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University, Thailand Research Fund, and the Commission on Higher Education. The authors are profoundly grateful to the entire staff of the Centre of Excellence in Clinical Virology, Chulalongkorn University and King Chulalongkorn Memorial Hospital for their combined effort in this study. We would also like to thank Ms. Petra Hirsch for reviewing the manuscript. This study was also supported in part by the National Research University Project of CHE and the Ratchadaphiseksomphot Endowment Fund (HR1155A).
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