The role of Adiponectin and Tumor necrosis factor in Hepatic Steatosis in patients with Chronic Hepatitis C
Hosny A Younis, Wael SH Mohammad, Kamal SH Ibraheem, Ali S Mohammad
Objective: Hepatic steatosis is a common histological feature in chronic hepatitis C (CHC), but its pathogenic mechanisms are not completely understood. We aimed to evaluate the metabolic factors associated with hepatic steatosis and fibrosis in CHC patients, and the relation between metabolic syndrome (Met S) and CHC. Patients and Methods: This study included 71 patients with CHC infection who underwent clinical, BMI, biochemical (assessment of insulin resistance, serum adiponectin, TNF-α, cholesterol and triglycerides), virological and histological assessments in addition to 24 age and sex matched healthy individual serve as a control group. All patients were referred to the Department of internal Medicine Al-Azhar Assiut University Hospital and to Sohag Specialized Liver Institute (in the period from April 2015 to May 2016). Results: Significant steatosis (>33%) was detected in 54% of the patients, while 21.12% of the patients had stage 3/4 fibrosis. Higher degree of steatosis was significantly associated with higher Body Mass Index (BMI), serum insulin, Homeostasis Model of Assessment (HOMA) index and Tumor Necrosis Factor-α (TNF-α ) (P <0.0001, P <0.0006, P< 0.0001, and P <0.01 respectively). Higher stages of fibrosis were significantly associated with higher BMI and serum triglycerides (P <0.04, P <0.02 respectively). Multivariate analysis of the metabolic factors showed that HOMA index (P<0.001) and TNF-α (P <0.03) were the factors mostly predicting higher degree of steatosis. While, BMI index (P <0.01) and serum triglycerides (P <0.03) were the factors mostly predicting higher stage of fibrosis. We also found that CHC is closely related to Met S, and we recognized that older age (P<0.011), higher BMI (p<0.0001), lower serum adiponectin (P <0.0001), higher TNF-α (p<0.0001) and higher steatosis degree (p<0.04) were significantly associated with Met S in these patients. Conclusions: Inpatients with CHC in Upper Egypt, steatosis is of metabolic origin as it is closely associated with the presence of metabolic syndrome. Higher BMI, HOMA-IR, lower serum adiponectin and higher serum TNF-α and triglycerides were associated with HCV hepatic steatosis and metabolic syndrome, while higher BMI and serum triglycerides are the predictors of more advanced fibrosis stage in CHC patients.