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NASH und Hepatitis C

NASH and hepatitis C

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Zusammenfassung

Die nichtalkoholische Fettlebererkrankung (NAFLD) mit Ausbildung einer Steatohepatitis (NASH) und die chronische Hepatitis-C-Virus-(HCV-)Infektion sind die häufigsten Ursachen für Leberzirrhose und hepatozelluläres Karzinom (HCC). Die Entstehung der NAFLD/NASH ist mit Insulinresistenz, Diabetes mellitus Typ 2, Dyslipidämie und Adipositas assoziiert. In der Normalbevölkerung liegt die Prävalenz der NAFLD bei 20–30%, bei Patienten mit chronischer Hepatitis C bei 40–80%. Die Steatosis hepatis bei Patienten mit chronischer Hepatitis C steht in Zusammenhang mit viralen Faktoren wie Genotyp-3-Infektion und metabolischen Faktoren wie Diabetes mellitus und einem erhöhten Body-Mass-Index. HCV kann durch direkte und indirekte Interaktion mit zellulären Signalwegen eine Steatosis hepatis auslösen. Die klinische Bedeutung liegt in einem erhöhten Leberzirrhose- und HCC-Risiko und einem schlechteren Ansprechen auf eine antivirale Therapie bei nicht mit Genotyp 3 infizierten Patienten. Die Therapie der Steatosis hepatis bei Patienten mit chronischer Hepatitis C besteht in einer viralen Eradikation und in der Behandlung der Adipositas und der Insulinresistenz.

Abstract

Non-alcoholic fatty liver disease (NAFLD) with development of steatohepatitis (NASH) and chronic hepatitis C virus (HCV) infection are the most frequent causes of chronic liver disease and its sequelae. NAFLD has a prevalence of 20–30% in the general population, whereas liver steatosis is observed in 40–80% of patients with chronic hepatitis C. Steatohepatitis in patients with chronic hepatitis C is associated with viral factors, such as genotype 3 infection and with diabetes mellitus and obesity as host factors. HCV has been shown to cause liver steatosis by direct and indirect interference with cellular signal transduction pathways. Liver steatosis in patients with chronic hepatitis C is clinically relevant because of its association with an increased risk for liver cirrhosis, hepatocellular carcinoma and failure to respond to interferon-based antiviral therapy in genotype non-3 infected patients. Treatment of liver steatosis in patients with chronic hepatitis C should aim at viral eradication and treatment of obesity, insulin resistance and diabetes mellitus.

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Literatur

  1. Marchesini G, Bugianesi E, Forlani G et al (2003) Nonalcoholic fatty liver, steatohepatitis and the metabolic syndrome. Hepatology 37: 917–923

    Article  PubMed  Google Scholar 

  2. Machado MV, Cortez-Pinto H (2009) Insulin resistance and steatosis in chronic hepatitis C. Ann Hepatol 8 (Suppl 1): S67–S75

    CAS  PubMed  Google Scholar 

  3. White DL, Ratziu V, El Serag HB (2008) Hepatitis C infection and risk of diabetes: a systematic review and meta-analysis. J Hepatol 49: 831–844

    Article  PubMed  Google Scholar 

  4. Leandro G, Mangia A, Hui J et al (2006) Relationship between steatosis, inflammation and fibrosis in chronic hepatitis C: a meta-analysis of individual patient data. Gastroenterology 130: 1636–1642

    Article  PubMed  Google Scholar 

  5. Clement S, Pascarella S, Negro F (2009) Hepatitis C virus infection: Molecular pathways to steatosis, insulin resistance and oxidative stress. Viruses 1: 126–143

    Article  CAS  Google Scholar 

  6. Bochud PY, Cai T, Overbeck K et al (2009) Genotype 3 is associated with accelerated fibrosis progression in chronic hepatitis C. J Hepatol 51: 655–666

    Article  CAS  PubMed  Google Scholar 

  7. Ohata K, Hamasaki K, Toriyama K et al (2003) Hepatic steatosis is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C virus infection. Cancer 97: 3036–3043

    Article  PubMed  Google Scholar 

  8. Pekow JR, Bhan AK, Zheng H Chung RT (2007) Hepatic steatosis is associated with increased frequency of hepatocellular carcinoma in patients with hepatitis C-related cirrhosis. Cancer 109: 2490–2496

    Article  PubMed  Google Scholar 

  9. Veldt BJ, Chen W, Heathcote EJ et al (2008) Increased risk of hepatocellular carcinoma among patients with hepatitis C cirrhosis and diabetes mellitus. Hepatology 47: 1856–1862

    Article  PubMed  Google Scholar 

  10. Targher G, Bertolini L, Padovani R et al (2006) Increased prevalence of cardiovascular disease in Type 2 diabetic patients with non-alcoholic fatty liver disease. Diabet Med 23: 403–409

    Article  CAS  PubMed  Google Scholar 

  11. Sookoian S, Pirola CJ (2008) Non-alcoholic fatty liver disease is strongly associated with carotid atherosclerosis: a systematic review. J Hepatol 49: 600–607

    Article  PubMed  Google Scholar 

  12. Aslam F, Alam M, Lakkis NM (2009) Hepatitis C and carotid atherosclerosis: a retrospective analysis. Atherosclerosis [Epub ahead of print]

  13. Bressler BL, Guindi M, Tomlinson G, Heathcote J (2003) High body mass index is an independent risk factor for nonresponse to antiviral treatment in chronic hepatitis C. Hepatology 38: 639–644

    Article  CAS  PubMed  Google Scholar 

  14. Patton HM, Patel K, Behling C et al (2004) The impact of steatosis on disease progression and early and sustained treatment response in chronic hepatitis C patients. J Hepatol 40: 484–490

    Article  PubMed  Google Scholar 

  15. Poynard T, Ratziu V, McHutchison J et al (2003) Effect of treatment with peginterferon or interferon alfa-2b and ribavirin on steatosis in patients infected with hepatitis C. Hepatology 38: 75–85

    Article  CAS  PubMed  Google Scholar 

  16. Petta S, Camma C, Di MV et al (2009) Time course of insulin resistance during antiviral therapy in non-diabetic, non-cirrhotic patients with genotype 1 HCV infection. Antivir Ther 14: 631–639

    CAS  PubMed  Google Scholar 

  17. Arase Y, Suzuki F, Suzuki Y et al (2009) Sustained virological response reduces incidence of onset of type 2 diabetes in chronic hepatitis C. Hepatology 49: 739–744

    Article  CAS  PubMed  Google Scholar 

  18. Andersen T, Gluud C, Franzmann MB, Christoffersen P (1991) Hepatic effects of dietary weight loss in morbidly obese subjects. J Hepatol 12: 224–229

    Article  CAS  PubMed  Google Scholar 

  19. Marchesini G, Brizi M, Bianchi G et al (2001) Metformin in non-alcoholic steatohepatitis. Lancet 358: 893–894

    Article  CAS  PubMed  Google Scholar 

  20. Romero-Gomez M, Diago M, Andrade RJ et al (2009) Treatment of insulin resistance with metformin in naive genotype 1 chronic hepatitis C patients receiving peginterferon alfa-2a plus ribavirin. Hepatology 50: 1702–1708

    Article  CAS  PubMed  Google Scholar 

  21. Belfort R, Harrison SA, Brown K et al (2006) A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med 355: 2297–2307

    Article  CAS  PubMed  Google Scholar 

  22. Overbeck K, Genne D, Golay A, Negro F (2008) Pioglitazone in chronic hepatitis C not responding to pegylated interferon-alpha and ribavirin. J Hepatol 49: 295–298

    Article  CAS  PubMed  Google Scholar 

  23. Omata M, Yoshida H, Toyota J et al (2007) A large-scale, multicentre, double-blind trial of ursodeoxycholic acid in patients with chronic hepatitis C. Gut 56: 1747–1753

    Article  CAS  PubMed  Google Scholar 

  24. Sato S, Miyake T, Tobita H et al (2009) A dose-up of ursodeoxycholic acid decreases transaminases in hepatitis C patients. World J Gastroenterol 15: 2782–2786

    Article  CAS  PubMed  Google Scholar 

  25. Vidali M, Tripodi MF, Ivaldi A et al (2008) Interplay between oxidative stress and hepatic steatosis in the progression of chronic hepatitis C. J Hepatol 48: 399–406

    Article  CAS  PubMed  Google Scholar 

  26. Harrison SA, Torgerson S, Hayashi P et al (2003) Vitamin E and vitamin C treatment improves fibrosis in patients with nonalcoholic steatohepatitis. Am J Gastroenterol 98: 2485–2490

    Article  CAS  PubMed  Google Scholar 

  27. Gabbay E, Zigmond E, Pappo O et al (2007) Antioxidant therapy for chronic hepatitis C after failure of interferon: results of phase II randomized, double-blind placebo controlled clinical trial. World J Gastroenterol 13: 5317–5323

    CAS  PubMed  Google Scholar 

  28. Miller ER III, Pastor-Barriuso R, Dalal D et al (2005) Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 142: 37–46

    CAS  PubMed  Google Scholar 

  29. Colmenero J, Bataller R, Sancho-Bru P et al (2009) Effects of losartan on hepatic expression of non-phagocytic NADPH oxidase and fibrogenic genes in patients with chronic hepatitis C. Am J Physiol Gastrointest Liver Physiol 297: G726–G734

    Article  CAS  Google Scholar 

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Interessenkonflikt

Die Autoren weisen auf folgende Beziehungen hin:

PD Dr. Bernd Kronenberger: Vortragshonorare von Bristol-Myers Squibb, Essex, Falk, Gilead, Novartis, Roche.

Prof. Dr. Stefan Zeuzem: Vortragshonorare von Bristol-Myers Squibb, Bayer, Essex, Falk, Gilead, Novartis, Roche.

PD Dr. Jörg Bojunga: Vortragshonorare von Bristol-Myers Squibb, Essex, Novartis, MSD.

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Authors and Affiliations

  1. Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    B. Kronenberger, S. Zeuzem &  J. Bojunga

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  1. B. Kronenberger
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  2. S. Zeuzem
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  3. J. Bojunga
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Correspondence to J. Bojunga.

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Kronenberger, B., Zeuzem, S. & Bojunga, J. NASH und Hepatitis C. Gastroenterologe 5, 116–122 (2010). https://doi.org/10.1007/s11377-009-0371-6

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  • DOI: https://doi.org/10.1007/s11377-009-0371-6

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