The role of hepatic steatosis and metabolic disorders in the formation of severe liver fibrosis in patients with chronic hepatitis C

Abstract

The aim - the role of hepatic steatosis (HS) in the development of severe hepatic fibrosis in patients with CHC remains uncertain. A comprehensive assessment of metabolic disorders and the frequency of detection of HS of varying severity in chronic hepatitis C (CHC) patients in comparison with the stages of fibrotic changes in the liver.

Material and methods. A total of 701 patients with CHC were underwent an assessment of the severity of liver fibrosis and steatosis using transient fibroelastometry (TF) with CAPTM function. In addition, 392 patients underwent a biochemical blood test, including the determination of the lipid profile.

Results and discussion. In the total population of the examined patients, the proportion of patients with the presence and absence of HS was comparable (52 and 48%, respectively), as well as the average age of patients, however, significantly more often HS was detected in men (p<0.001). Obesity, to a greater extent than overweight, was associated with the development of HS. A special group of patients with the most severe liver damage liver cirrhosis (LC) in combination with the degree of HS 2-3 was identified, which was 63% in the group of patients with LC. Analysis of the examination results, depending on the presence of a carbohydrate metabolism disorder, showed the dominance of LC in the group of patients with type 2 diabetes mellitus compared with the group without it (p<0.001). In the subgroups of patients, a number of significant differences in lipid profile parameters were revealed, however, it is not possible to conclude that there is a connection between the stage of HS with any variant of dyslipidemia.

Conclusion. According to TF data, a significant proportion of patients with CHC, regardless of the presence of type 2 diabetes mellitus, revealed an HS of varying severity, and in the overwhelming majority it was recorded in individuals with an increased body mass index. The results of the study do not allow us to consider changes in the patient's lipid profile as a reliable marker of the presence of SP. The analysis allows us to recommend the inclusion in the mandatory diagnostic screening of patients with CHC not only the determination of the stage of liver fibrosis, but also the severity of HS, since patients with a combination of severe fibrosis and HS are at significant risk of developing hepatocellular carcinoma and diseases associated with metabolic disorders.

Keywords:chronic hepatitis C, liver fibrosis, hepatic steatosis, liver cirrhosis, transient fibroelastography, type 2 diabetes mellitus, lipid profile

Funding. The study was partially funded in the framework of the support of scientific projects and research of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation.

Conflict of interest. The authors declare that they have no conflicts of interest.

Contribution. Concept and design - Belyy P.A., Znoyko O.O., Yushchuk N.D.; conducting the clinical part of the study - Belyy P.A., Znoyko O.O., Dudina K.R., Klimova E.A., Safiullina N.Kh., Rodnikova E.M.; data analysis and processing - Znoyko O.O., Dudina K.R.; writing the text of the article - Belyy P.A., Dudina K.R., Znoyko O.O.

For citation: Belyy P.A., Dudina K.R., Klimova E.A., Safiullina N.Kh., Znoyko O.O., Rodnikova E.M., Yushchuk N.D. The role of hepatic steatosis and metabolic disorders in the formation of severe liver fibrosis in patients with chronic hepatitis C. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2021; 10 (2): 8-15. DOI: https://doi.org/10.33029/2305-3496-2021-10-2-8-15 (in Russian)

References

1. Brunt E.M., Janney C.G., Di Bisceglie A.M., et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999; 94 (9): 2467-74.

2. Welzel T.M., Graubard B.I., Zeuzem S., El-Serag H.B., Davila J.A., Mc-Glynn K.A. Metabolic syndrome increases the risk of primary liver cancer in the United States: a study in the SEER-Medicare database. Hepatology. 2011; 54: 463-71.

3. Daniel J.F., Mohamed L.H., Mathieu L., et al. Hepatitis C virus, cholesterol and lipoproteins - impact for the viral life cycle and pathogenesis of liver disease. Viruses. 2013; 5: 1292-324.

4. Del Campo J.A., Romero-Gomez M. Modulation of host lipid metabolism by hepatitis C virus: Role of new therapies. World J Gastroenterol. 2015; 21 (38): 10 776-82. DOI: https://doi.org/10.3748/wjg.v21.i38.10776

5. Lonardo A., Adinolfi L.E., Restivo L., Ballestri S., Romagnoli D., Baldelli E., et al. Pathogenesis and significance of hepatitis C virus steatosis: an update on survival strategy of a successful pathogen. World J Gastroenterol. 2014; 20 (23): 7089-103. DOI: https://doi.org/10.3748/wjg.v20.i23.7089

6. Perlemuter G., Sabile A., Letteron P., et al. Hepatitis C virus core protein inhibits microsomal triglyceride transfer activity and very low density lipoprotein secretion: a model of viral’ related steatosis. Fed Am Soc Exp Biol J. 2002; 16: 185-94.

7. Stevenson H.L., Utay N.S. Hepatic steatosis in HCV-infected persons in the direct-acting antiviral era. Trop Dis Travel Med Vaccines. 2016; 2: 21. DOI: https://doi.org/10.1186/s40794-016-0038-5

8. Oeda S., Tanaka K., Oshima A., Matsumoto Y., Sueoka E., Takahashi H. Diagnostic accuracy of fibroscan and factors affecting measurements. Diagnostics (Basel). 2020; 10 (11): 940. DOI: https://doi.org/10.3390/diag-nostics10110940

9. Ivashkin V.T., Maevskaya M.V., Pavlov C.S., Tikhonov I.N., Shirokova Y.N., Bueverov A.O., et al. Diagnostics and treatment of non-alcoholic fatty liver disease: clinical guidelines of the Russian Scientific Liver Society and the Russian gastroenterological association. Rossiyskiy zhurnal gas-troenterologii, gepatologii, koloproktologii [Russian Journal of Gastroenterology, Hepatology, Coloproctology]. 2016; 26 (2): 24-42. DOI: https://doi.org/10.22416/1382-4376-2016-26-2-24-42 (in Russian)

10. Kumar M., Rastogi A., Singh T., Behari C., Gupta E., Garg H., et al. Controlled attenuation parameter for non-invasive assessment of hepatic steatosis: does etiology affect performance? J Gastroenterol Hepatol. 2013; 28: 1194-201. DOI: https://doi.org/10.1111/jgh.12134

11. Lazo M., Clark J.M. Nonalcoholic fatty liver disease and type 2 diabetes: a burgeoning problem with unclear solutions. Hepatobiliary Surg Nutr. 2020; 9 (4): 514-7. DOI: https://doi.org/10.21037/hbsn.2019.11.28

12. Targher G. Is it time for non-alcoholic fatty liver disease screening in patients with type 2 diabetes mellitus? Hepatobiliary Surg Nutr. 2020; 9 (2): 239-41. DOI: https://doi.org/10.21037/hbsn.2019.10.21

13. Younossi Z.M., Golabi P., de Avila L., Paik J.M., Srishord M., Fukui N., et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: a systematic review and meta-analysis. J Hepatol. 2019; 71 (4): 793-801. DOI: https://doi.org/10.1016/jjhep.2019.06.021

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CHIEF EDITOR
Aleksandr V. Gorelov
Academician of the Russian Academy of Sciences, MD, Head of Infection Diseases and Epidemiology Department of the Scientific and Educational Institute of Clinical Medicine named after N.A. Semashko ofRussian University of Medicine, Ministry of Health of the Russian Federation, Professor of the Department of Childhood Diseases, Clinical Institute of Children's Health named after N.F. Filatov, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Deputy Director for Research, Central Research Institute of Epidemiology, Rospotrebnadzor (Moscow, Russian Federation)

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