28May 2017

METABOLIC FACTORS ASSOCIATED WITH HEPATIC STEATOSIS AND FIBROSIS IN CHRONIC HEPATITIS C PATIENTS.

  • Departments of Tropical Medicine and Gastroenterology, Faculty of Medicine, SohagUniversity.
  • Pathology, Faculty of Medicine, Sohag University.
  • Microbiology and Immunology, Faculty of Medicine, Sohag University.
  • Clinical Pathology,Faculty of Medicine, Sohag University and Ibn Sina National College, Jeddah,Saudi Arabia.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Objective: Hepatic steatosis is a common histological feature in chronic hepatitis C (CHC), but its pathogenic mechanisms are not completely understood. We aimed to evaluate the metabolic factors associated with hepatic steatosis and fibrosis in CHC patients, and the relation between metabolic syndrome (MS) and CHC. Patients and Methods: This study included 71 patients with CHC infection who underwent clinical, BMI, biochemical (assessment of insulin resistance, serum adiponectin, TNF-α, cholesterol and triglycerides), virological and histological assessments. Results: Significant steatosis (>33%) was detected in 54% of the patients, while 21.12% of the patients had stage 3/4 fibrosis. Higher degree of steatosis was significantly associated with higher BMI, serum insulin, HOMA index and TNF-α (P <0.0001, P <0.0006, P< 0.0001, and P <0.01 respectively). Higher stages of fibrosis were significantly associated with higher BMI and serum triglycerides (P <0.04, P <0.02 respectively). Multivariate analysis of the metabolic factors showed that HOMA index (P <0.001) and TNF-α (P <0.03) were the factors mostly predicting higher degree of steatosis. While, BMI index (P <0.01) and serum triglycerides (P <0.03) were the factors mostly predicting higher stage of fibrosis. We also found that CHC is closely related to MS, and we recognized that older age (P<0.011), higher BMI (p<0.0001), lower serum adiponectin (P <0.0001), higher TNF-α (p<0.0001) and higher steatosis degree (p<0.04) were significantly associated with MS in these patients. Conclusions: In patients with CHC, higher BMI, HOMA-IR, serum TNF-α and triglycerides and lower serum adiponectin were associated with HCV hepatic steatosis and metabolic syndrome, while higher BMI and serum triglycerides were associated with more advanced fibrosis stage.

  1. Snyder N, Nguyen A, Gajula L, Soloway R, Xiao SY, Lau DT, Petersen J. The APRI may be enhanced by the use of FIBROSpect II in the estimation of fibrosis in chronic hepatitis C. ClinChimActa 2007; 381(2):119-23.
  2. El-Zanaty F and Way A. Egypt Demographic and Health Survey 2008. Egyptian Ministry of Health. Cairo: El-Zanaty and Associates, and Macro International; 2009.
  3. Lavanchy D. Evolving epidemiology of hepatitis C virus. ClinMicrobiol Infect2011; 17(2):107-15.
  4. Gordon A, James M, McLean CA, Bailey MJ, Roberts SK. Steatosis in chronic hepatitis B and C: Predictors, distribution and effect on fibrosis. Hepatology 2005; 43(1):38-44.
  5. Cholet F, Nousbaum JB, Richecour M, Emmanuel O, Cauvin J, Lagarde N et al. Factors associated with liver steatosis and fibrosis in chronic hepatits C patients. GastroenterolClinBiol 2004; 28(3):272-8.
  6. Camma C, Bruno S, Di Marco V , Di Bona D, Rumi M, Vinci M et al. Insulin resistance is associated with steatosis in nondiabetic patients with genotype 1 chronic hepatitis C. Hepatology2006; 43(1):64-71.
  7. Hui JM, Sud A, Farrell GC, Bandara P, Byth K, Kench JG et al. Insulin resistance is associated with chronic hepatitis C virus infection and fibrosis progression [corrected]. Gastroenterology 2003; 125(6):1695-704.
  8. Adinolfi LE, Gambardella M, Andreana A , Tripodi MF, Utili R, Ruggiero G. Steatosis accelerates the progression of liver damage of chronic hepatitis C patients and correlates with specific HCV genotype and visceral obesity. Hepatology 2001; 33(6):1358-64.
  9. Tsochatzis E, Papatheodoridis GV and? Archimandritis AJ. The Evolving Role of Leptin and Adiponectin in Chronic Liver diseases. Am J Gastroenterol 2006; 101(11): 2629-40.
  10. Diehl AM, Li ZP, Lin HZ, Yang SQ. Cytokines and the pathogenesis of non-alcoholic steatohepatitis. Gut 2005; 54(2): 303-6.
  11. Cua IA, Jason M. Hui, PriyankaBandara, James G. Kench, et al. Insulin resistance and liver injury in hepatitis C is not associated with virus-specific changes in adipocytokines. Hepatology 2007; 46(1):66-73,
  12. Koruk M, Savas MC, Yilmaz O, Tayşi S, Karakok M, G?ndoğdu C et al. Serum lipids, lipoproteins and apolipoproteins levels in patients with non alcoholicsteatohepatitis. Clin Gastroenterol2003; 37(2): 177-82.
  13. Fartoux L, Chazouilleres O, Wendum D ,? Poupon R, Serfaty L. Impact of steatosis on progression of fibrosis in patients with mild hepatitisC. Hepatology 2005; 41(1):82-7.
  14. Adinolfi LE, Durante-Mangoni E, Zampino R, Ruggiero G. Review article: hepatitis C virus-associated steatosis ? pathogenic mechanisms and clinical implications. Aliment PharmacolTher 2005; 22 (suppl 2): 52-5.
  15. Hourigan F, Graeme A, David P, Vicki H. Whitehall, Claudia Shorthouse, Andrew Clouston et al. Fibrosis in chronic hepatitis C correlates significantly with body mass index and steatosis. Hepatology 1999; 29(4):1215-1219.
  16. Savvas SP, Koskinas J, Sinani C, Hadziyannis A, Spanou F, Hadziyannis SJ. Changes in epidemiological patterns of HCV infection and their impact on liver disease over the last 20 years in Greece. J Viral Hepat 2005; 12(5):551-7.
  17. El-Zayadi A, Barakat E, Hamdy H. Hepatic steatosis among HCV genotype 4 patients and its impact on response to interferon therapy. Abstracts of the Biennial Meeting of the International Association of the Study of the Liver (IASL) in Cairo. Official Journal of IASL 2006; 26(Suppl 1). Abstract 213
  18. Hu SX, Kyulo NL, Xia VW, Hillebrand DJ, Hu KQ. Factors associated with hepatic fibrosis in patients with chronic hepatitis C: a retrospective study of a large cohort of U.S patients. J ClinGastroenterol 2009; 43(8):758-64.
  19. Castera L, Hezode C, Roudot F. Worsening of steatosis is an independent factor of fibrosis progression in untreated patients with chronic hepatitis C and paired liver biopsies. Gut 2003; 52(2):288-92.
  20. Negro F, Sanyal AJ. Hepatitis C virus, steatosis and lipid abnormalities: clinical and pathogenic data. Liver Int 2009; 29 (Suppl 2) 26-37.
  21. Hu KQ, Kyulo NL, Esrailian E, Thompson K, Chase R, Hillebrand DJ. Overweight and obesity, hepatic steatosis and progression of chronic hepatitis C: a retrospective study in a large cohort of patients in the United States. J Hepatol 2004; 40(1):147-54.
  22. Solis-Herruzo A, P?rez-Carreras M, Eloy R, Fern?ndez-V?zquez I, Garfia C. Factors associated with the presence of nonalcoholic steatohepatitis in patients with chronic hepatits C. Am J Gastroenterol 2005; 100(5):1091-8.
  23. Durante-Mangoni E, Zampino R, MarroneA ,Tripodi MF, Rinaldi L, Restivo L et al. Hepatic steatosis and insulin resistance are associated with serum imbalance of adiponectin/tumour necrosis factor-alpha in chronic hepatitis C patients. Aliment PharmacolTher 2006; 24 (9):1349-57.
  24. Crespo J, Rivero M, Fabrega E, Cay?n A, Amado JA, Garc?a-UnzetaMTet al. Plasma leptin and TNF-alpha levels in chronic hepatitis C patients and their relationship to hepatic fibrosis. Dig Dis Sci 2002;47 (7):1604-10.
  25. Lu JY, Chuang LM, Yang WS, Tai TY, Lai MY, Chen PJ et al. Adiponectin levels among patients with chronic hepatitis B and C infections and in response to IFN-alpha therapy. Liver Int 2005; 25 (4):752-9.
  26. Lawrence Serfaty and Jacqueline Capeau. Hepatitis C, Insulin resistance and diabetes: clinical and pathogenic data. Liver international 2009; 29(Suppl 2):13-25.
  27. Younossi ZM, McCullough AJ, Ong JP, Barnes DS, Post A, Tavill A. Obesity and non-alcoholic fatty liver disease in chronic hepatitis C. J ClinGastroenterol 2004; 38(8):705-9.
  28. Muzzi A, Leandro G, Rubbia-Brandt L, James R, Keiser O, Malinverni R et al. Insulin resistance is associated with liver fibrosis in non diabetic chronic hepatitis C patients. J Hepatol 2005; 42(1):41-6.
  29. Grigorescu M, Corina R, Dana C, Grigorescu MD, Serban A, Neculoiu D et al. Metabolic syndrome, insulin resistance and adiponectin level in patients with chronic hepatitis C. J Gastrointestin Liver Dis 2008; 17(2):147-54.
  30. D?souza R, Sabin CA, Foster GR. Insulin resistance plays a significant role in liver fibrosis in chronic hepatitis C and in the response to antiviral therapy. Am J Gastroenterol 2005; 100 (7):1509-15.
  31. Rubbia-Brandt L, Fabris P, Paganim S, Leandro G, Male PJ, GiostraEet al. Steatosis affects chronic hepatitis C progression in a genotype specific way Gut 2004; 53 (3): 406-12.

[Ramy M ElSharkawy, GhadaMostafa K1, Mahmoud Saif-Al-Islam Abd Elfatah, Eman Mohamed Salah-Eldein, Tamer Elmokadem, Ahmed Hassan and Hydi Ahmed. (2017); METABOLIC FACTORS ASSOCIATED WITH HEPATIC STEATOSIS AND FIBROSIS IN CHRONIC HEPATITIS C PATIENTS. Int. J. of Adv. Res. 5 (May). 1063-1070] (ISSN 2320-5407). www.journalijar.com

Hydi Ahmed
Professor of Clinical Pathology

DOI:

Article DOI: 10.21474/IJAR01/4216      
DOI URL: http://dx.doi.org/10.21474/IJAR01/4216

Download Full Paper

Download PDF No. of Downloads: 3 | No. of Views: 55