Téma: 

Is liver steatosis associated with higher degree of histological activity and fibrosis in chronic hepatitis b and c?

Vladimír Bartoš, Pavol Slávik, Ľudovít Lauko, Dušan Krkoška, Renáta Szépeová

Introduction: Chronic hepatitis B (CHB) and C (CHC) are histologically often accompanied by steatosis of hepatic parenchyma, that can be a result of the influence of both, viral and environmental factors. Although this phenomenon is considered to be a negative histomorphological parameter, data about a relationship between steatosis and other pathological changes in these infectious disorders are still controverse. The aim of the study: The aim of our retrospective study was the evaluation of liver steatosis prevalence, and its impact on degree of histological necro-inflammatory activity (grade) and portal fibrosis (stage) in CHB or CHC infected individuals. Material and methods: A set of 121 patients (69 males, 52 females, 37,5 yr. average) with either CHC (n=76) or CHB (n=45) who underwent a core needle liver biopsy during 5-years period (2002-2006) were included in this study. The slight majority of CHB individuals were HBeAg-negative and anti-HBeAg positive. In cases of HCV infection, all patients were HCV RNA and anti-HCV positive, in which HCV genotype type 1 had been predominated. None case of HBV/HCV coinfection was recorded. The biopsy samples were fixed in buffered formalin, embedded in paraffin blocks, stained with hematoxylin-eosin and special histochemical methods and after complete processing examined by two independent pathologists - specialists in hepatology. Histological grading and staging of hepatitis were evaluated according to Ishak’s modified Index Histological Activity (mHAI) criteria, degree of steatosis was classified in 5 groups proposed by Wyatt. Results: In CHC and CHB, steatosis occured in 47 (61,8 %), and 20 (44,4 %) of cases, retrospectively. The most frequent degree of steatosis was 3-10 % in both groups. Microvesicular type predominated in lower degrees (S I, II), macrovesicular type in higher degrees (S III, IV). In CHC, we revealed a significant correlation between a degree of steatosis and histological grade (p=0,006), but not between steatosis and stage (p=0,6). A strong association was also present between steatosis and age of patients (p=0,002). In CHB, we did not reveal a significant relationship of steatosis neither to grade (p=0,4) nor to stage (p=0,5). A correlation between steatosis and age was near to statistical significance (p=0,06). Conclusion: Liver steatosis was a frequent histological findings in both disorders. In HCV-infected patients, we revealed an association between steatosis and necro-inflammatory activity, but not between steatosis and portal fibrosis. In HBV-infected individuals, we did not demonstrate a significant association of the hepatic steatosis neither with a necroinflammatory score, nor with a portal fibrosis. Further studies are warranted to assess the effect of fatty changes on microscopical tissue damage progression in patients with these infectious diseases.

Ročník 2008  Témy časopisu Internal medicine 1 / 2008

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prof. MUDr. Ivica Lazúrová, CSc. FRCP

REPRESENTATIVE OF CHAIRMAN
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MEMBERS OF THE EDITORIAL BOARD
doc. MUDr. Viera Fábryová, CSc.
MUDr. Viera Fedelešová, CSc.
prof. MUDr Martin Haluzík, CSc.
prof. MUDr. Štefan Hrušovský, CSc. Dr.SVS.
prof. MUDr. Rudolf Hyrdel, CSc.
doc. MUDr. Oľga Jurkovičová, CSc.
doc. MUDr. Zdenko Killinger, PhD.
doc. MUDr. Soňa Kiňová, PhD.
prof. MUDr. Peter Mitro, PhD.
doc. MUDr. Viliam Mojto, CSc., MHA
prof. MUDr. Karel Pacák, DrSc.
prof. MUDr. Juraj Payer, CSc., FRCP
doc. MUDr. Ján Podoba, CSc.
prof. MUDr. Igor Riečanský, DrSc.
doc. MUDr. Ján Staško, PhD.
doc. MUDr. Mária Szántová, PhD.
prof. MUDr. Ivan Tkáč, PhD.

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