METABOLIC FACE OF CHRONIC HEPATITIS B AND C IN BULGARIA

Abstract

It is well known that NAFLD, as well as diabetes mellitus (DM), correlated with the progression of liver fibrosis in chronic hepatitis C (CHC). The impact of NAFLD overlap in chronic hepatitis B (CHB) is not well established. Aim. In this study we compared the prevalence of NAFLD and related metabolic parameters in CHC and CHB, and their relationship with disease activity and fibrosis. Methods. The parameters of metabolic syndrome (MetS), glucose, insulin, HOMA-IR and histological features of steatosis / steatohepatitis were investigated in total of 700 patients with chronic viral hepatitis - CHB (n=334) and genotype 1 CHC (n=366). Glucose and insulin were also assessed during OGTT (60 and 120 min.) in 100 cases with CHB and 100 – with CHC. Results. Nonalcoholic metabolic related steatosis was more frequent (62% v/s 48%) and severe in CHC compared to CHB (p66%) HBV DNA was negative or <10 000 copies/ml. The advanced liver fibrosis (F3-F4) was associated with moderate or severe steatosis (CHC), as well as with the glucose levels, markers of insulin resistance, and presence of DM (p<0.001), but not with the other components of metabolic syndrome.In conclusion, nonalcoholic metabolic related steatosis, diabetes mellitus and insulin resistance are associated with the both viral hepatitis, but the prevalence is higher in chronic hepatitis C. The degree of steatosis correlates with the activity grade and stage of fibrosis only in patients with chronic hepatitis C. Insulin resistance and diabetes mellitus are associated with more advanced liver fibrosis in the both viral hepatitis

Keywords

• hepatic steatosis
• metabolic syndrome
• insulin resistance
• diabetes mellitus
• chronic hepatitis C
• chronic hepatitis B