The role of metabolic and immunological abnormalities in the progression of chronic hepatitis C

E.P. Patlusov^1,2, Zh.B. Ponezheva³, I.V. Mannanova³

¹Military Clinical Hospital of the National Guard Troops of Russian Federation No. 5, Ekaterinburg

²Ural State Medical University, Ekaterinburg

³Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow

Aim: to assess the effect of metabolic and immune abnormalities on the course of chronic hepatitis C.

Patients and Methods: 250 patients with chronic hepatitis C older than 18 years without prior antiviral treatment were enrolled in the study. All patients provided informed consent for medical examinations and treatment. Exclusion criteria were alcoholism, inherited liver diseases, pregnancy, mixed hepatitis and coinfections, and examination/treatment refusal. Subpopulations of peripheral blood lymphocytes were assessed by flow cytometry. In addition to the standard panel of immune status, the levels of circulating lymphocytes were measured. Instrumental tests (i.e., abdominal ultrasound, liver fibroelastometry, and liver biopsy to assess the degree of hepatic steatosis) were performed. The degree of liver fatty degenerat ion was evaluated using CRN scoring system (2005) by hepatocyte fat content (in %).

Results: non-alcoholic fatty liver disease was diagnosed in 55.4% of patients with hepatic steatosis of various degrees. In 16.7% of patients, chronic hepatitis C was associated with metabolic disorders and type 2 diabetes characterized by high biochemical activity and significant dyslipidemia. Moderate direct correlation between the degree of hepatic steatosis and the stage of hepatic fibrosis was established. Progressive hepatic fibrosis in chronic hepatitis C was associated with higher rate of fatty degeneration, in particular, in patients with stage 3 (F3) and 4 (F4) fibrosis (89.3% of patients). Significant increase in the levels of circulating lymphocytes expressing IFN-α/β (CD118⁺) and IFN-γ (CD119⁺) is typical of advanced liver fibrosis (F4).

Conclusions: the levels of CD118⁺ and CD119⁺ can be used as additional immunological markers of the prediction of advanced liver fibrosis in chronic hepatitis C. Metabolic abnormalities significantly aggravate the course of chronic hepatitis C. These abnormalities are more significantly associated with the progression of fibrosis stage thus requiring personalized approach to determine management strategy.

Keywords: chronic hepatitis C, hepatic steatosis, liver fibrosis, non-alcoholic fatty liver disease.

For citation: Patlusov E.P., Zh.B. Ponezheva, Mannanova I.V. The role of metabolic and immunological abnormalities in the progression of chronic hepatitis C. RMJ. 2019;10:7–11.