Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02453.x/abstract

Hepatic steatosis and insulin resistance are associated with severe fibrosis in

patients with chronic hepatitis caused by HBV or HCV infection

Salvatore Petta1, Calogero Cammà1, Vito Di Marco1, Fabio Salvatore Macaluso1,

Marcello Maida1, Giuseppe Pizzolanti2, Beatrice Belmonte3, a Cabibi3,

Di Stefano4, Donatella Ferraro4, Carla Guarnotta3, Giovanna Venezia1,

Craxì1

Article first published online: 30 JAN 2011

DOI: 10.1111/j.1478-3231.2011.02453.x

© 2011 Wiley & Sons A/S

Issue

Liver International

Volume 31, Issue 4, pages 507–515, April 2011

Abstract

Background and aims: Steatosis and insulin resistance (IR) are the major disease

modifying in patients with chronic hepatitis C (CHC). Only few studies evaluated

these features in patients with chronic hepatitis B (CHB). We aimed to assess

the prevalence and the factors related to steatosis and IR in CHB patients,

compared with CHC subjects, and to evaluate the potential association between

these features and fibrosis severity.

Material and methods: One hundred and seventy consecutive patients with CHB (28

HBeAg positive, 142 HBeAg negative), were evaluated using liver biopsy and

metabolic measurements and matched for sex, age and body mass index with 170

genotype 1 CHC patients. IR was defined if HOMA-IR>2.7. All biopsies were scored

for grading and staging by Scheuer's score, and the steatosis was considered

significant if ≥10%.

Results: The prevalence of significant steatosis was similar in both CHB and CHC

patients (31 vs. 38%; P=0.14). IR rate was significantly higher in CHC than in

CHB patients (42 vs. 26%; P=0.002). Severe fibrosis (F3–F4), at multivariate

analysis, was independently associated with older age (OR 1.050, 95% CI

1.009–1.093), steatosis >10% (OR 4.375, 95% CI 1.749–10.943), and

moderate–severe necroinflammatory activity (OR 8.187, 95% CI 2.103–31.875),

regardless of HBeAg status, in CHB patients, and with older age (OR 1.080, 95%

CI 1.028–1.136), IR (OR 2.640, 95% CI 1.110–6.281), steatosis >10% (OR

3.375, 95% CI 1.394–8.171), and moderate–severe necroinflammatory activity

(OR 8.988, 95% CI 1.853–43.593) in CHC patients.

Conclusions: CHB patients had high steatosis prevalence, similar to CHC

controls, but lower IR rate. Both steatosis and IR in CHC, and only steatosis in

CHB, are independently associated with fibrosis severity.