The association with histopathological findings and predictive significance of transforming growth factor beta 1 (TGF β1) in patients with chronic viral hepatitis

Background: Chronic Viral Hepatitis (CVH) is the most common cause of hepatocellular cancer and cirrhosis related to liver fibrosis. The gold standard in the diagnosis of fibrosis is liver biopsy. TGF β1 is a pleiotropic cytokine that plays a pivotal role in carcinogenesis and fibrosis. The results of studies investigating the relationship between TGF β1 and histopathological findings are controversial. We aimed to investigate the relationship between TGF β1 and histopathological findings. Methods: Patients with Chronic Hepatitis B (CHB) and C (CHC), Non-Alcoholic Steatohepatitis (NASH), inactive HBsAg carriers, patients with cirrhosis and healthy control cases presenting to the Gastroenterology Clinic of Sisli Etfal Training and Research Hospital between 2009-2010 were included in the study. Laboratory tests, HCV RNA, HBV DNA, viral load, and viral markers (such as HBsAg, anti-HCV) were determined. Biopsies were performed on patients with hepatitis B and C, and non-alcoholic steatohepatitis (NASH). Histologic features were defined as Histologic Activity Index (HAI) and fibrosis stage (Knodell’s scoring). TGF β1 was evaluated by the ELISA method. Results: 267 cases including 44 non-alcoholic steatohepatitis cases [27 female (57%)], 38 inactive HBsAg carriers [23 female (60%)], 48 patients with chronic hepatitis B [17 female (35%)], 27 chronic hepatitis C [14 female (60%)], 15 decompensated cirrhosis [3 female (20%)] and 94 healthy control cases were included in the study. Compared with healthy controls, all other subgroups had significantly elevated TGF β1 levels. TGF β1 was found to have a specificity of 93.6% and a sensitivity of 88.9% (AUC: 0.948, 95% CI: 0.916-0.981) in determining liver diseases. TGF β1 had a positive correlation with fibrosis and histological activity index in patients with CHB and CHC. There was a negative correlation between TGF β1 and HBV DNA and HCV RNA. TGF β1 had a significant correlation with LDL and total cholesterol in cases with CHB and CHC. Conclusion: TGF β1 is correlated with both HAI and fibrosis in patients with CHB and CHC. TGF β1 might have a role in the prognostic significance of elevated LDL levels and low viral load in patients with CHC.