Could Complement C4 be an Alternative to Biopsy for Chronic Hepatitis B Histopathologic Findings?

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J Clin Gastroenterol. 2011 Mar 16. [Epub ahead of print]

Could Complement C4 be an Alternative to Biopsy for Chronic Hepatitis B

Histopathologic Findings?

Bugdaci MS, Alkim C, Karaca C, Kesici B, Bayraktar B, Sokmen M.

*Gastroenterohepatology Clinic, Sisli Etfal Training and Research Hospital

†Department of Gastroenterohepatology, Istanbul Medical Faculty of Istanbul

University ‡Microbiology and Clinical Microbiology Clinic, Sisli Etfal

Training and Research Hospital, Ä°stanbul.

Abstract

BACKGROUND: Hepatitis B leads to chronic liver disease, cirrhosis, and

hepatocellular cancer. Viral markers and other laboratory tests used in

diagnosis and follow-up of chronic hepatitis B (CHB) do not correlate well with

disease activity and liver histopathology. For this reason, alternative tests

that indicate disease activity are needed. We aimed to investigate the utility

of serum complement levels for follow-up in patients with CHB with normal and

high transaminase levels.

METHODS: One hundred forty-three patients that were evaluated between 2009 and

2010 were included in the study. Hepatitis B early antigen negative CHB cases

with high transaminase levels were evaluated as the first group, and cases with

normal transaminase level (inactive hepatitis B surface antigen carrier) as the

second group, patients with cirrhosis were included as a third group. Age, sex,

hepatitis B surface antigen, anti-HBcAg IgM, hepatitis B early antigen, anti-δ,

anti-HCV, anti-HIV, serum hepatitis B virus (HBV) DNA, alanine aminotransferase

(ALT), aspartate aminotransferase (AST), γ-glutamyltranspeptidase (GGT),

complement C3, and C4 levels of both groups were compared. The relationship

between Knodell histologic activity index (HAI) score and fibrosis in liver

biopsy specimens and serum complement levels of cases with high transaminase

levels were investigated.

FINDINGS: There were 49 patients with CHB with high transaminase levels;

(Female/Male: 22/27). Mean age was 42.3±15.7 y, ALT=104.41±101.74,

AST=69.7±65.2, GGT=35.37±20.4, C3 level=104.2±28.8, C4=16.11±4.17, and HBV

DNA >2000 IU/mL (>105 copies/mL) in all cases. Remaining 27 patients had

cirrhosis. There were 67 patients with CHB with normal transaminase levels

(Female/Male: 32/35). Mean age was 39.56±12.9 y, ALT=22.7±5.5, AST=22±5.18,

GGT=48.8±60.4, C3=117.85±22.15, and C4=21.44±5.46. Serum complement C4 level

in 4 of the CHB cases with normal transaminase levels was low. Serum C3

(P=0.024) and C4 (P=0.001) levels in patients with CHB with high transaminase

level were significantly lower. Low serum complement levels were negatively

correlated with Knodell-HAI scores in patients with high transaminase levels

(r=-0.84; P<0.001). There was no correlation between HAI and HBV DNA, AST, ALT,

and GGT. There was no significant correlation between complement C3 and C4

levels and ALT, AST, HBV DNA, and GGT in any of the groups. Child score in

patients with cirrhosis negatively correlated with both C3 (P=0.001) and C4

levels (P=0.001). Complement levels in patients with cirrhosis and CHB with high

transaminase levels did not significantly differ.

RESULTS: Serum complement C4 levels (in contrast to virologic markers and

transaminases) significantly correlate with liver biopsy findings and may be a

useful indicator of disease activity and/or damage in patients with CHB with

high transaminase levels.

PMID: 21415769 [PubMed - as supplied by publisher]

[Guest guest]

J Clin Gastroenterol. 2011 Mar 16. [Epub ahead of print]

Could Complement C4 be an Alternative to Biopsy for Chronic Hepatitis B

Histopathologic Findings?

Bugdaci MS, Alkim C, Karaca C, Kesici B, Bayraktar B, Sokmen M.

*Gastroenterohepatology Clinic, Sisli Etfal Training and Research Hospital

†Department of Gastroenterohepatology, Istanbul Medical Faculty of Istanbul

University ‡Microbiology and Clinical Microbiology Clinic, Sisli Etfal

Training and Research Hospital, Ä°stanbul.

Abstract

BACKGROUND: Hepatitis B leads to chronic liver disease, cirrhosis, and

hepatocellular cancer. Viral markers and other laboratory tests used in

diagnosis and follow-up of chronic hepatitis B (CHB) do not correlate well with

disease activity and liver histopathology. For this reason, alternative tests

that indicate disease activity are needed. We aimed to investigate the utility

of serum complement levels for follow-up in patients with CHB with normal and

high transaminase levels.

METHODS: One hundred forty-three patients that were evaluated between 2009 and

2010 were included in the study. Hepatitis B early antigen negative CHB cases

with high transaminase levels were evaluated as the first group, and cases with

normal transaminase level (inactive hepatitis B surface antigen carrier) as the

second group, patients with cirrhosis were included as a third group. Age, sex,

hepatitis B surface antigen, anti-HBcAg IgM, hepatitis B early antigen, anti-δ,

anti-HCV, anti-HIV, serum hepatitis B virus (HBV) DNA, alanine aminotransferase

(ALT), aspartate aminotransferase (AST), γ-glutamyltranspeptidase (GGT),

complement C3, and C4 levels of both groups were compared. The relationship

between Knodell histologic activity index (HAI) score and fibrosis in liver

biopsy specimens and serum complement levels of cases with high transaminase

levels were investigated.

FINDINGS: There were 49 patients with CHB with high transaminase levels;

(Female/Male: 22/27). Mean age was 42.3±15.7 y, ALT=104.41±101.74,

AST=69.7±65.2, GGT=35.37±20.4, C3 level=104.2±28.8, C4=16.11±4.17, and HBV

DNA >2000 IU/mL (>105 copies/mL) in all cases. Remaining 27 patients had

cirrhosis. There were 67 patients with CHB with normal transaminase levels

(Female/Male: 32/35). Mean age was 39.56±12.9 y, ALT=22.7±5.5, AST=22±5.18,

GGT=48.8±60.4, C3=117.85±22.15, and C4=21.44±5.46. Serum complement C4 level

in 4 of the CHB cases with normal transaminase levels was low. Serum C3

(P=0.024) and C4 (P=0.001) levels in patients with CHB with high transaminase

level were significantly lower. Low serum complement levels were negatively

correlated with Knodell-HAI scores in patients with high transaminase levels

(r=-0.84; P<0.001). There was no correlation between HAI and HBV DNA, AST, ALT,

and GGT. There was no significant correlation between complement C3 and C4

levels and ALT, AST, HBV DNA, and GGT in any of the groups. Child score in

patients with cirrhosis negatively correlated with both C3 (P=0.001) and C4

levels (P=0.001). Complement levels in patients with cirrhosis and CHB with high

transaminase levels did not significantly differ.

RESULTS: Serum complement C4 levels (in contrast to virologic markers and

transaminases) significantly correlate with liver biopsy findings and may be a

useful indicator of disease activity and/or damage in patients with CHB with

high transaminase levels.

PMID: 21415769 [PubMed - as supplied by publisher]