Relationship between hepatosteatosis and histopathological and biochemical paramaters in patients with noncirrhotic chronic hepatitis B

Aim: Fatty liver is a common liver disease in the community. Mitochondrial dysfunction and oxidative process cause insulin resistance, causing fatty liver. Fatty liver diseases are higher in patients infected with chronic hepatitis B virus (HBV) than the normal population. We aimed to investigate the relationship between hepatosteatosis and biochemical and histopathological parameters in chronic HBV patients. Materials and Methods: Patients with follow-up between September/2017-November/2019 with chronic HBV diagnosis were included. Demographic and histopathological data of all patients were documented. Comorbid diseases, medications and previous operations were questioned. The presence of steatosis was determined by ultrasonography (USG) to all patients. Biochemical and histopathological data were compared with the presence of steatosis. Results: A total of 94 patients, 50(53.1%) women were included in the study. As a result of liver biopsy; while 20(21.2%) patients had no fibrosis (steage 0), 74(78.8%) patients had fibrosis (steage 1-3). In USG, 45(47.8%) patients were found to have hepatosteatosis and 49(52.2%) patients were not. In the comparison between the groups; there was no significant relationship between sex, age, liver function tests, HBV-DNA level, hepatic activity index and hepatosteatosis (p>0.05). A significant relation was found between the presence of fibrosis and hepatosteatosis (p=0.021). Conclusions: Chronic HBV is an inflammatory process that ends with cirrhosis and hepatocellular carcinoma, and in this process, fatty liver may increase disease and cause disease progression. In this context, it is important to prevent the development of steatosis in chronic HBV patients. However, this should be supported in prospective studies in larger populations.

PDF

___

1. Trépo C, Chan HL, Lok A. Hepatitis B virus infection. Lancet 2014;384:2053-63.
2. Mcmahon BJ. Chronic Hepatitis B Virus Infection. Med Clin North Am 2014:98;39-54.
3. El-Serag HB. Epidemiology of Viral Hepatitis and Hepatocellular Carcinoma. Gastroenterology 2012;142:1264-73.
4. Kayar Y, Dertli D, Agin M, et al. The Effect of Tenofovir Treatment on Renal Function in Chronic Hepatitis B Patients. Van Medical J 2019;26:538-44.
5. Dertli R, Keskin M, Bıyık M, et al. Dynamic ThiolDisulfide Homeostasis Is Disturbed in Hepatitis B Virus-Related Chronic Hepatitis and Liver Cirrhosis. Turk J Med Sci 2018;48:985-92.
6. Wang B, Li W, Fang H, et al. Hepatitis B virus infection is not associated with fatty liver disease: Evidence from a cohort study and functional analysis. Mol Med Rep 2019;19:320-6.
7. Nascimento ACM, Maia DR, Neto SM, et al. Nonalcoholic Fatty Liver Disease in Chronic Hepatitis B and C Patients fromWestern Amazon. Int J Hepatol 2012;2012:695950 .
8. Hsieh MH, Lee LP, Hsieh MY, et al. Hepatic steatosis and fibrosis in chronic hepatitis C patients in Taiwan. Jpn J Infect Dis 2007;60:377-81.
9. Rafiq N, Younossi Z. The impact of non-alcoholic fatty liver disease on chronic hepatitis B and C. Prac Gastroenterol 208;32:14-28.
10. Knodell RG, Ishak KG, Black WC, aet al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1:431-5.
11. Desmet VJ, Gerber M, Hoofnagle JH, et al. Classification of chronic hepatitis: Diagnosis, grading and staging. Hepatology 1994;19:1513-20.
12. Kumar R, Boon Bee GG. Chronic hepatitis B and fatty liver: Issues in clinical management. Clin Res Hepatol Gastroenterol 2016;40:755 9.
13. Wang CC, Kao JH. Hepatitis B virus infection and decreased risk of nonalcoholic fatty liver disease: A cohort study. Hepatology 2017;66:681.
14. Wong VW, Wong GL, Chu WC, et al. Hepatitis B virus infection and fatty liver in the general population. J Hepatol 2012;56:533 40.
15. Gordon A, McLean CA, Pedersen JS, et al. Hepatic steatosis in chronic hepatitis B and C: predictors, distribution and effect on fibrosis. J Hepatol 2005;43:38-44.
16. Serin MS, Akkiz H, Abayli B, et al. Genotyping of hepatitis B virus isolated from chronic hepatitis B patients in the south of Turkey by DNA cycle-sequencing method. Diagn Microbiol Infect Dis 2005;53:57-60.
17. Peleg N, Issachar A, Arbib OA, et al. Liver steatosis is a strong predictor of mortality and cancer in chronic hepatitis B regardless of viral load. JHEP Rep 2019;1:9-16.
18. Minakari M, Molaei M, Shalmani HM, et al. Liver steatosis in patients with chronic hepatitis B infection: host and viral risk factors. European Gastroenterol & Hepatol J 2009;21:5.
19. Seto WK, Hui RWH, Mak LY, et al. Association between hepatic steatosis, measured by controlled attenuation parameter, and fibrosis burden in chronic hepatitis B. Clin Gastroenterol Hepatol 2018;16:575-83.
20. Bouchard MJ, Schneider RJ. The enigmatic X gene of hepa¬titis B virus. J Virol 2004;78:12725 34.
21. Wu YL, Peng XE, Zhu YB, et al. Hepatitis B Virus X protein induces hepatic steatosis by enhancing the expression of liver fatty acid binding protein. J Virol 2015;90:1729-40.