Value of serum Adiponectin level in patients with decompensated liver cirrhosis and hepatocellular carcinoma

Abstract

Persistent Hepatitis C virus (HCV) infection is widespread; it affects millions of people worldwide and induces a range of chronic liver diseases. Chronic HCV infection causes progressive hepatic fibrosis and cirrhosis in up to 20% of patients and approximately 10%-20% of cirrhotic patients may go on to develop hepatocellular carcinoma (HCC) within five years. Chronic HCV infection is associated with the development of hepatic steatosis and unique, virus-specific alterations in host metabolism leading to the development of IR, which is one of the gravest metabolic disturbances of human body, growing rapidly all over the world. It is an important marker of metabolic syndrome in general, and is an independent risk factor for its cardiovascular complications. It has been reported that IR can increase the risk of developing HCC in patients with chronic HCV infection. A multiplicity of viral and host factors may play a crucial role in facilitating the onset of IR in patients with chronic hepatitis C (CHC) that may ultimately end with HCC development. HCV-associated insulin resistance is involved in the development of various complications including Hepatic steatosis, Resistance to anti-viral treatment, Hepatic fibrosis and esophageal varices, Hepatocarcinogenesis and proliferation of HCC, as well as extrahepatic manifestations. The focus of the study was to elucidate the potential role of IR in the development of HCC in CHC patients and to determine the value of serum Adiponectin level in patients with decompensated liver cirrhosis and hepatocellular carcinoma and to correlate this level with the metabolic profile in these patients. This study was conducted at the gastroenterology and Hepatology unit, department of internal medicine, Ain Shams University hospitals. 90 Egyptian patients with HCV related end stage liver disease were recruited from the Hepatology outpatient clinic. Patients were divided into 2 groups as follow: • Group I: 61 patients with HCV related liver cirrhosis and well established diagnosis of HCC; diagnosis of HCC was based on the appearance of typical vascular pattern of enhancement in triphasic spiral CT scan of the abdomen. • Group II: 29 patients with HCV related liver cirrhosis (HCC was excluded in these patients at time of recruitment in the study; exclusion of HCC was based on the absence of any hepatic focal lesion in repeated abdominal ultrasonography scanning). The results in the current study revealed that adiponectin is significantly lower in the serum of HCC patients than in serum of CHC patients and it is negatively correlated to tumor size and number of lesions&HOMA In conclusion: we demonstrated the independent association between IR&Adiponectin and HCC development in chronic HCV infection. These findings may have important prognostic and therapeutic implications in the management of chronic HCV-infected patients. Since IR is a potentially modifiable factor, therapeutic intervention aimed at decreasing IR may be warranted in these patients,also upregulation of adiponectin receptors and targeting them with adiponectin like substances may decreasethe risk of developing HCC together with improving its prognosis.