THRESHOLD EFFECT OF LIVER IRON CONTENT ON HEPATIC INFLAMMATION
AND FIBROSIS IN HEPATITIS-B AND HEPATITIS-C
Background/Aims:
In hepatitis C, iron depletion may improve serum aminotransferases
and the response to interferon, but it is not known whether
inflammation and fibrosis correlate with hepatic iron content, Our
aim was to establish whether hepatic iron content correlates with
histological and serum indices of hepatic inflammation and fibrosis
in hepatitis B and C.
Methods:
Total hepatic iron was measured using computerized
histomorphometry, inflammation and fibrosis using Knodell score, on
histological slides from 31 patients with chronic hepatitis B and
38 with hepatitis C.
Results:
Total hepatic iron was similar in the hepatitis B and C groups
(0.82+/-1.72 % and 0.56+/-1.12%; mean+/-SD). No iron was detectable
in 11 patients with hepatitis B and 13 with hepatitis C. Alanine
aminotransferase (85.96+/-67.1 vs 44.2+/-39.7 p<0.05), aspartate
aminotransferase (93.8+/-75.6 vs 47+/-33.5 IU/ml p<0.05) and
histological inflammatory score (9.33+/-3.51 vs 7.79+/-3.3 p=0.07)
mere increased in those with stainable hepatic iron compared to
those without. However where iron was present, no association was
found between the amount of hepatic iron and inflammatory or
fibrosis scores, In hepatitis C, fibrosis was minimal in 77% of
patients if iron was absent vs 24% with iron present, while marked
fibrosis was present in 56% with iron vs 15% without iron
(p<0.01, Fisher's exact test).
Conclusion:
Hepatic iron is associated with increased hepatic inflammation in
chronic hepatitis B and hepatitis C and with high fibrosis scores
in hepatitis C, There is a threshold effect, and once present,
increasing iron does not correlate with increasing inflammation or
fibrosis.
Author: MD VOIGT, GROOTE SCHUUR HOSP, MRC, UCT, LIVER RES
CTR, OMB, K4651, K FLOOR, ZA-7925, CAPE TOWN, CAPE TOWN
Source: JOURNAL OF HEPATOLOGY 1996 NOV;25(5):633-638
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