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. 2007 May;21(5):289-94.
doi: 10.1155/2007/876076.

Association between leptin, metabolic factors and liver histology in patients with chronic hepatitis C

Robert P Myers  1 , Djamila Messous, Thierry Poynard, Francoise Imbert-Bismut
Affiliations

Association between leptin, metabolic factors and liver histology in patients with chronic hepatitis C

Robert P Myers et al. Can J Gastroenterol. 2007 May.

Abstract
in English, French

Background: Steatosis is common in hepatitis C virus (HCV)-infected patients and likely accelerates fibrosis progression. Leptin, the peptide product of the obesity gene (ob), has been implicated in hepatic fibrogenesis; circulating levels of leptin correlate with body fat mass. The objective of the present study was to determine the clinical and histological correlates of serum leptin in HCV-infected patients, and to determine its utility in predicting liver histological lesions.

Patients and methods: In 62 patients with chronic HCV, serum leptin was measured using a commercially available immunoassay. Associations between leptin, metabolic parameters, and severe hepatic fibrosis (stages 2 to 4) and steatosis (30% or greater) were determined. The utility of leptin in predicting liver histology was determined using receiver operating characteristic (ROC) curves.

Results: The median body mass index (BMI) was 23.2 kg/m2 (range 17.7 kg/m2 to 35.6 kg/m2); 16% of patients (n=10) had HCV genotype 3. Severe fibrosis and steatosis were present in 23% and 13% of patients, respectively. Leptin was strongly correlated with the BMI, and its levels were higher in women. BMI-corrected leptin levels were not independently associated with severe fibrosis but were significantly associated with steatosis (OR of 1.07; 95% CI 1.01 to 1.04). On it own, leptin was poorly predictive of severe steatosis (area under the ROC curve was 0.64; 95% CI 0.42 to 0.87). However, its accuracy improved with the addition of HCV genotype (area under the ROC curve was 0.86; 95% CI 0.72 to 1.00; P=0.07).

Conclusions: As observed in the non-HCV setting, serum leptin correlates with BMI; higher leptin levels are found in women than men with chronic HCV. Serum leptin is a poor predictor of HCV-related fibrosis but may play a role in predicting steatosis when combined with HCV genotype.

HISTORIQUE :: La stéatose est courante chez les patients infectés par le virus de l’hépatite C (VHC) et elle accélère probablement l’évolution de la fibrose. On a constaté la présence de leptine, le produit peptidique du gène de l’obésité (ob) dans des cas de fibrogenèse hépatique. Les taux de leptine qui circulent sont corrélés avec la masse grasse. La présente étude visait à déterminer les corrélats cliniques et histologiques de leptine sérique chez les patients infectés par le VHC et à déterminer leur utilité pour prédire les lésions hépatiques histologiques.

PATIENTS ET MÉTHODOLOGIE :: Chez 62 patients atteints de VHC chronique, on a mesuré la leptine au moyen d’un dosage immunologique commercial. On a déterminé les associations entre la leptine, les paramètres métaboliques, une grave fibrose hépatique (stades 2 à 4) et la stéatose (30 % ou plus). On a établi l’utilité de la leptine pour prédire l’histologie hépatique au moyen des courbes de fonction d’efficacité du récepteur (FER).

RÉSULTATS :: L’indice de masse corporelle (IMC) médian était de 23,2 kg/m2 (fourchette de 17,7 kg/m2 à 35,6 kg/m2), 16 % des patients étant infectés par le génotype 3 du VHC. On constatait une fibrose grave et une stéatose chez 23 % et 13 % des patients, respectivement. La leptine était fortement corrélée avec l’IMC, et ses taux étaient plus élevés chez les femmes. Les taux de leptine corrigés par l’IMC n’étaient pas indépendants de la fibrose grave, mais ils étaient significativement associés à une stéatose grave (RR de 1,07; 95 % IC 1,01 à 1,04). Seule, la leptine était peu prédictive d’une stéatose grave (la zone sous la courbe de FER était de 0,64; 95 % IC 0,42 à 0,87). Cependant, sa précision s’améliorait avec l’ajout du génotype du VHC (la zone sous la courbe de FER était de 0,86; 95 % IC 0,72 à 1,00; P=0,07).

CONCLUSIONS :: Comme on l’a observé hors du cadre du VHC, la leptine sérique est corrélée avec l’IMC. On remarque des taux de leptine plus élevés chez les femmes atteintes de VHC chronique que chez les hommes. La leptine sérique est un mauvais prédicteur de fibrose reliée au VHC, mais il peut contribuer à prédire une stéatose lorsqu’elle est combinée à un génotype de VHC.

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Figures

Figure 1)
Figure 1)
Correlation between serum leptin, body mass index (BMI) and sex in chronic hepatitis C virus-infected patients. Serum leptin is strongly correlated with BMI, particularly in women
Figure 2)
Figure 2)
Box plots illustrating the association between body mass index (BMI)-corrected leptin levels and hepatic fibrosis in patients with chronic hepatitis C stratified by genotype. F0 No fibrosis; F1 Portal fibrosis without septa; F2 Portal fibrosis with few septa; F3 Numerous septa without cirrhosis; F4 Cirrhosis
Figure 3)
Figure 3)
Box plots illustrating the association between body mass index (BMI)-corrected leptin levels and hepatic steatosis in patients with chronic hepatitis C stratified by genotype
Figure 4)
Figure 4)
Receiver operating characteristic (ROC) curve of indexes including serum leptin (dashed line) and leptin plus genotype (solid line), for the prediction of severe steatosis (30% or greater). The area under the ROC curve of leptin plus genotype was higher than that of leptin alone (0.86 versus 0.64; P=0.07). The solid diagonal line indicates that predicted by chance alone (area under the ROC curve of 0.50)
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