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 amin otransferases and the response to interferon, but it is not known whet her inflammation and fibrosis correlate with hepatic iron content, Our aim was to establish whether hepatic iron content correlates with his tological and serum indices of hepatic inflammation and fibrosis in he patitis B and C. Methods: Total hepatic iron was measured using comput erized 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 h epatitis B and C groups (0.82+/-1.72 % and 0.56+/-1.12%; mean+/-SD). N o iron was detectable in 11 patients with hepatitis B and 13 with hepa titis 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) a nd 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 betw een the amount of hepatic iron and inflammatory or fibrosis scores, In hepatitis C, fibrosis was minimal in 77% of patients if iron was abse nt 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). Conclusio n: Hepatic iron is associated with increased hepatic inflammation in c hronic hepatitis B and hepatitis C and with high fibrosis scores in he patitis C, There is a threshold effect, and once present, increasing i ron does not correlate with increasing inflammation or fibrosis.