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CRYOGLOBULINEMIA IS ASSOCIATED WITH STEATOSIS AND FIBROSIS IN CHRONIC HCV
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Our study shows in a large population of patients with chronic hepatitis C, an independent association between cryoglobulin and steatosis as well as advanced fibrosis.
Reported by Jules Levin
http://www.natap.org
from AASLD
Nov 11, 2005, San Francisco
David Saadoun, Department of Internal Medicine, Pitie-Salpetriere Hospital, Paris, France; Tarik Asselah, Department of Hepatology, Ho pital Beaujon,
Clichy, France; Mathieu Resche-Rigon, Department of Statistic, Ho pital Saint-Louis, Paris, France; Frederic Charlotte, Department of Anatomo-Pathologie, Ho pital Pitie-Salpetriere, Paris; Pierre Bedossa, Department of Anatomo-Pathologie, Ho pital Beaujon, Clichy; Dominique Valla, Department of Hepatology, Ho pital Beaujon, Clichy; Jean Charles Piette, Department of Internal Medicine, Ho pital Pitie-Salpetrie`re, Paris; Patrick Marcellin, Department of Hepatology, Ho pital Beaujon, Clichy, France; Patrice Cacoub, Department of Internal Medicine, Ho pital Pitie-Salpetrie`re, Paris, France
Background and Aim: Chronic hepatitis C virus (HCV) infection is associated with numerous extrahepatic manifestations, mostly mixed cryoglobulinemia (MC). The relationship between cryoglobulins and severity of liver lesions (necroinflammation and fibrosis) is debated. No study has focused on the relationship between presence of cryoglobulin and liver steatosis which is
associated with progression of liver disease. The aim of this study was to determine the relationship of cryoglobulins with liver lesions (necroinflammation, fibrosis, and steatosis) in HCV infected patients.
Methods: 659 adults patients with untreated chronic hepatitis C admitted for liver biopsy were included in this study. Risk factors for fibrosis and steatosis were assessed.
Results:
Mean age was 49.0 ± 13.0 years and 49% were male. Cryoglobulin was present in 263 patients, 103 of whom had vasculitis. In multivariate analysis, cryoglobulin increased by nearly 3 folds the risk to have a high stage fibrosis (F3-F4) and a steatosis higher than 10%.
There was no significant difference with regard to grade of fibrosis or steatosis between symptomatic and asymptomatic patients with cryoglobulins. Steatosis higher than 10% was associated with a higher body mass index (p<0.001), HCV
genotype 3 (p=0.003), cryoglobulin (p=0.02), and a high grade of liver fibrosis (p=0.009).
A high stage of fibrosis (F3-F4) was associated with cryoglobulin (p=0.008), high grade of necroinflammation (A2-A3) (p 0.009), and steatosis higher than 10% (p=0.01).
Conclusion: Our study shows in a large population of patients with chronic hepatitis C, an independent association between cryoglobulin and steatosis as well as advanced fibrosis. Cryoglobulins with or without vasculitis may be a prognostic indicator associated with the severity of liver disease in patients with chronic hepatitis C.
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