Clinical and laboratory characteristics associated with
                    dyslipidemia and liver steatosis in chronic HBV carriers

Nau, Angélica Luciana; Soares, Júlia Cristina; Shiozawa, Maria Beatriz Cacese; Dantas-Corrêa, Esther Buzaglo; Schiavon, Leonardo de Lucca; Narciso-Schiavon, Janaína Luz

doi:10.1590/0037-8682-0009-2014

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Major Articles • Rev. Soc. Bras. Med. Trop. 47 (2) • Mar-Apr 2014 • https://doi.org/10.1590/0037-8682-0009-2014 copy

Clinical and laboratory characteristics associated with dyslipidemia and liver steatosis in chronic HBV carriers

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction

Chronic hepatitis B virus (HBV) infection and liver steatosis (LS) are the most common causes of chronic liver disease, and their coexistence is frequently observed in clinical practice. Although metabolic syndrome is the main cause of LS, it has not been associated with HBV infection. The aims of this study were to describe the lipid profile and prevalence of LS among HBV carriers and to identify the characteristics associated with LS in this group.

Methods

This retrospective cross-sectional study included hepatitis B surface antigen (HBsAg)-positive patients evaluated during 2011 and 2012.

Results

Of the 83 patients included, the mean age was 46.4±12.5 years, 53% were men, and 9.1% were hepatitis B e antigen (HBeAg) -positive. These patients exhibited the following lipid profile: total cholesterol = 175.4±38.8mg/dL, low-density lipoprotein (LDL) = 113.0±32.7mg/dL, and triglycerides = 91.1±45.2mg/dL. Their fasting glucose was 95.3±14.5g/dL, and fasting insulin was 6.1±5.9µIU/mL. Liver steatosis was observed on abdominal ultrasound in 11.3% of individuals. Factors associated with the presence of LS included higher levels of total cholesterol, prothrombin activity, fasting insulin, and body mass index (BMI) as well as lower levels of aspartate aminotransferase (AST).

Conclusions

These findings suggest that LS in patients with chronic HBV appears to be a consequence of metabolic alterations and insulin action rather than of viral factors.

HBV; Hepatitis B; Fatty liver; Lipids; Cholesterol; Triglycerides

Characteristics	Total n = 71	HS (+) n = 8	HS (-) n = 63	P value
Age (years)^* * mean ± standard deviation;	47.5 ± 3.1	45.4 ± 11.0	47.8 ± 13.4	0.63^t t Student's t test;
Male gender (%)	53.5	25.0	57.1	0.13^f f Fisher's exact test;
Hypertension (%)	22.7	12.5	24.1	0.67^f f Fisher's exact test;
Diabetes mellitus (%)	10.9	0.0	12.5	0.58^f f Fisher's exact test;
Dyslipidemia (%)	9.4	12.5	8.9	0.57^f f Fisher's exact test;
NUCs (%)	34.9	10.0	38.4	0.15^f f Fisher's exact test;
lamivudine (%)	14.1	0.0	15.9	0.59^f f Fisher's exact test;
adefovir (%)	2.8	0.0	3.2	1.00^f f Fisher's exact test;
entecavir (%)	19.7	12.5	20.6	1.00^f f Fisher's exact test;
tenofovir (%)	12.7	0.0	14.3	0.58^f f Fisher's exact test;
BMI^{§ a} § median; (kg/m²)	27.5	33.5	26.1	0.01^m m Mann-Whitney U test;
Creatinine (mg/dL)^§ § median;	0.9	0.9	0.9	0.83^m m Mann-Whitney U test;
Hemoglobin (g/dL)^* * mean ± standard deviation;	14.3 ± 1.6	14.7 ± 1.0	14.3 ± 1.7	0.42^t t Student's t test;
Platelets (/mm³)^* * mean ± standard deviation;	183,577 ± 64,744.3	213,250.0 ± 36,050.6	179,809.5 ± 66,800.6	0.17^t t Student's t test;
Serum iron (µg/dL)^* * mean ± standard deviation;	36.4 ± 92.2	48.1 ± 87.09	89.0 ± 36.5	0.82^t t Student's t test;
Prothrombin activity (%)^* * mean ± standard deviation;	83.0 ± 15.2	94.2 ± 8.3	81.4 ± 15.3	0.01^t t Student's t test;
Total protein (g/dL)^* * mean ± standard deviation;	7.2 ± 0.6	7.3 ± 0.4	7.2 ± 0.6	0.76^t t Student's t test;
Albumin (g/dL)^* * mean ± standard deviation;	3.9 ± 0.4	4.2 ± 0.4	3.9 ± 0.4	0.05^t t Student's t test;
HBeAg (%)	11.9	0.0	13.3	0.59^f f Fisher's exact test;
AFP (ng/mL)^§ § median;	1.9	1.6	1.9	0.37^m m Mann-Whitney U test;
AST (×ULN)^§ § median;	0.7	0.5	0.8	0.01^m m Mann-Whitney U test;
ALP (×ULN)^§ § median;	0.6	0.5	0.6	0.05^m m Mann-Whitney U test;
GGT (×ULN)^§ § median;	0.4	0.3	0.4	0.23^m m Mann-Whitney U test;
Direct bilirubin (mg/dL)^§ § median;	0.1	0.2	0.1	0.88^m m Mann-Whitney U test;
HBV-DNA (U/ml)^{§ b} § median;	5,675.0	2,970.0	6,758.5	0.87^m m Mann-Whitney U test;
Advanced fibrosis^† † advanced fibrosis = structural changes of stage 3 or 4; (%)	15.2	0.0	17.2	1.00^f f Fisher's exact test;
Marked inflammatory activity^‡ ‡ marked inflammatory activity = periportal activity of stage 3 or 4; (%)	28.1	0.0	32.1	0.30^f f Fisher's exact test;

Characteristics	Total n = 71	HS (+) n = 8	HS (-) n = 63	P value
Total cholesterol (mg/dL)^* * mean ± standard deviation;	173.8 ± 39.7	217.5 ± 41.2	168.2 ± 36.2	<0.01^t t Student's t test;
HDL (mg/dL)^* * mean ± standard deviation;	47.6 ± 3.5	45.6 ± 5.4	47.9 ± 14.2	0.40^t t Student's t test;
LDL (mg/dL)^§ § median;	109.5	135.0	104.0	0.01^m m Mann-Whitney U test;
Triglycerides (mg/dL)^§ § median;	77.5	116.5	86.9	0.05^m m Mann-Whitney U test;
Fasting glucose (mg/dL)^{§ a} § median;	93.0	98.0	93.0	0.86^m m Mann-Whitney U test;
Fasting insulin (µIU/mL)^{§ b} § median;	3.5	9.2	3.3	0.03^m m Mann-Whitney U test;
Glycated hemoglobin (%)^{§ c} § median;	5.8	5.8	5.7	0.75^m m Mann-Whitney U test;

Characteristics	HS (+) Bx (n = 16)		HS (-) Bx ( n = 23)		Total (n = 39)
Characteristics	n	%	n	%	n	%
HS (+) on ultrasonography	5	31.3	1	4.3	6	15.4
HS (-) on ultrasonography	11	68.8	22	95.7	33	84.6

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[1] CONFLICT OF INTEREST The authors declare that there is no confl ict of interest.