Changes in lipid metabolism in chronic hepatitis C

Abstract

Aim: To investigate the relationship between certain biochemical parameters of lipid metabolism in the serum and steatosis in the liver.

Methods: The grade of steatosis (0-3) and histological activity index (HAI, 0-18) in liver biopsy specimens were correlated with serum alanine aminotransferase (ALT), total cholesterol and triglyceride levels in 142 patients with chronic hepatitis C (CH-C), and 28 patients with non-alcoholic fatty liver disease (NAFLD) without hepatitis C virus (HCV) infection. The serum parameters were further correlated with 1,797 age and sex matched control patients without any liver diseases.

Results: Steatosis was detected in 90 out of 142 specimens (63%) with CH-C. The ALT levels correlated with the grade of steatosis, both in patients with CH-C and NAFLD (P<0.01). Inserting the score values of steatosis as part of the HAI, correlation with the ALT level (P<0.00001) was found. The triglyceride and cholesterol levels were significantly lower in patients with CH-C (with and without steatosis), compared to the NAFLD group and to the virus-free control groups.

Conclusion: Our study confirms the importance of liver steatosis in CH-C which correlates with lower lipid levels in the sera. Inclusion of the score of steatosis into HAI, in case of CH-C might reflect the alterations in the liver tissue more precisely, while correlating with the ALT enzyme elevation.

Figures

Figure 1

Differences of ALT levels in CH-C patients without steatosis (n = 52, grade 0) and with severe steatosis (n = 28, grade 3) (P < 0.01).

Figure 2

Correlation between ALT levels and HAI/HAI+steatosis in CH-C patients. A: without steatosis (n = 52, r = 0.556, P < 0.00002); B: with steatosis (n = 90, NS); C: in CH-C patients (n = 142, r = 0.41, P < 0.00001).

Figure 3

Correlation between ALT levels and grade of steatosis in patients without CH-C (n = 28, r = 0.533, P<0.005).

Figure 4

ALT levels in CH-C patients without and with steatosis and in patients with steatosis without CH-C. Bar 1: CH-C patients without steatosis (n = 52). Bar 2: CH-C patients with steatosis (n = 90). Bar 3: Patients with liver steatosis without CH-C (n = 28) Bar 1 P<0.02 vs Bar 2. Bar 2 P<0.02 vs Bar 3.

Figure 5

Triglyceride levels in CH-C female patients. A: With steatosis compared to outpatients with alcoholic habits;

Figure 6

Triglyceride levels in CH-C male patients. A: Steatosis compared to outpatients with alcoholic habits; Bar 1: CH-C young male patients with steatosis (n = 29, average age 37 years); Bar 2: CH-C elderly male patients with steatosis (n = 15, average age 52 years); Bar 3: Male patients with liver steatosis (n = 16); Bar 4: Male outpatients with alcoholic habits (n = 86, age 37 years); Bar 5: Male outpatients with alcoholic habits (n = 190, age 52 years). Bar 1 P<0.0001 vs Bar 4. Bar 2 P<0.0001 vs Bar 4. Bar 4 P<0.0001 vs Bar 5. B: Without steatosis compared to outpatients without alcoholic habits. Bar 1: CH-C young male patients without steatosis (n = 24, age 37 years); Bar2: CH-C elderly male patients without steatosis (n = 11, average age 49 years); Bar 3: Male patients with liver steatosis (n = 16); Bar 4: Male outpatients without alcoholic habits (n = 60, age 37 years); Bar 5: Male outpatients without alcoholic habits (n = 509, age 49 years). Bar 1 and 2 P<0.0005 vs Bar 3. Bar 3 P<0.0005 vs Bar 4.

Figure 7

Cholesterol levels in CH-C female patients. A: With steatosis compared to outpatients with alcoholic habits; Bar 1: CH-C young female patients with steatosis (n = 26, average age 38 years); Bar 2: CH-C elderly female patients with steatosis (n = 20,average age 52 years); Bar 3: female patients with liver steatosis (n = 12); Bar 4: female outpatients with alcoholic habits (n = 8, age 38 years); Bar 5: female outpatients with alcoholic habits (n = 16, age 52 years). Bar 1 NS vs Bar 2. Bar 1 and 2 P<0.0001 vs Bar 3. Bar 1 P<0.0001 vs Bar 4. Bar 1 and 2 P<0.0001 vs Bar 5. B: Without steatosis compared to outpatients without alcoholic habits. Bar 1: CH-C young female patients without steatosis (n = 10, average age 29 years); Bar 2: CH-C elderly female patients without steatosis (n = 7, average age 53 years); Bar 3: female patients with liver steatosis (n = 12); Bar 4: female outpatients without alcoholic habits (n = 125, age 29 years); Bar 5: female outpatients without alcoholic habits (n = 803, age 53 years). Bar 1 NS vs Bar 2. Bar 1 P < 0.0001 vs Bar 3. Bar 1 P<0.0001 vs Bar 5. Bar 3 P < 0.0001 vs Bar 4.

Figure 8

Cholesterol levels in CH-C male patients. A: With steatosis compared to outpatients with alcoholic habits; Bar 1: CH-C young male patients with steatosis (n = 29, average age 37 years); Bar 2: CH-C elderly male patients with steatosis (n = 15, average age 51 years); Bar 3: male patients with liver steatosis (n = 16); Bar 4: male outpatients with alcoholic habits (n = 86, age 37 years); Bar 5: male outpatients with alcohollic habits (n = 190, age 51 years). Bar 1NS vs Bar 2. Bar 1 and 2 P<0.0001 vs Bar 3. Bar 1 and 2 P<0.0001 vs Bar 4. B: Without steatosis compared to outpatients without alcoholic habits. Bar 1: CH-C young male patients without steatosis (n = 24, average age 34 years); Bar 2: CH-C elderly male patients without steatosis (n = 11, average age 49 years); Bar 3: male patients with liver steatosis (n = 16); Bar 4: male outpatients without alcoholic habits (n = 60, age 34 years); Bar 5:Male outpatients without alcoholic habits (n = 509, age 49 years). Bar1NS vs Bar 2. Bar 1 and 2 P<0.001 vs Bar 3. Bar 1 and 2 P<0.001 vs Bar 5. Bar 3 P<0.001 vs Bar 4.