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초록
Background
Hepatitis C virus (HCV) causes a chronic infection, resulting in progressive liver damage. Recent studies have described the protective effect of the apolipoprotein E (ApoE) genotype on liver damage in cases of HCV infection. Their findings were explained by the influence of the ApoE genotype on HCV pathology, which seems to be integrally linked to the process of HCV uptake into hepatocytes. We investigated whether specific ApoE genotypes were associated with the different clinical aspects of HCV infection in patients with chronic HCV.
Methods
From the whole blood of 196 chronic HCV hepatitis patients, the ApoE genotypes were determined by an allele-specific polymerase chain reaction. Several markers, including liver enzymes, platelet counts and HCV viral loads, as well as the radio-logic findings, were investigated. In order to estimate the treatment outcome, the sustained virologic response (SVR), early virologic response (EVR) and end-of-treatment response (ETR) were determined according to the HCV viral loads.
Results
Based on genotyping, 15.8% (n=31) of the patients had the ApoE E4 allele (E2/E4, E3/E4, E4/E4), while 84.2% (n=165) were missing the ApoE E4 allele (E2/E2, E2/E3, E3/E3). Several clinical results of the E4-positive group, including liver enzymes, albumin, platelet counts, HCV viral loads and hepatic coarseness were not significantly different from those of E4-negative group. There were no differences in the SVR, EVR and ETR between patients with the ApoE E4 allele and those without the ApoE E4 allele.
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Table 1.
ApoE genotypes of study subjects
Table 2.
Clinical findings of study subjects at the time of initial diagnosis
| All patients (N) | HCV genotype 1 (N) | HCV genotype non-1 (N) | P | |
|---|---|---|---|---|
| Age (year)∗ | 58.8±11.6 (196) | 57.3±11.6 (99) | 58.7±11.5 (65) | NS† |
| Sex | ||||
| Male | 57.1% (112/196)‡ | 62.6% (62/99)‡ | 46.2% (30/65)‡ | ＜0.05§ |
| Female | 42.9% (84/196)‡ | 37.4% (37/99)‡ | 53.8% (35/65)‡ | |
| Radiologic findings | ||||
| Coarse echotexture | 48.0% (94/153)‡ | 68.8% (53/77)‡ | 55.6% (30/54)‡ | NS§ |
| Fatty liver | 33.2% (65/153)‡ | 44.2% (34/77)‡ | 44.4% (24/54)‡ | NS§ |
| Laboratory findings | ||||
| AST (U/L)∗ | 71.7±60.1 (193) | 72.9±53.9 (96) | 73.9±61.6 (65) | NS† |
| ALT (U/L)∗ | 77.2±82.6 (195) | 84.2±78.3 (98) | 77.9±98.5 (65) | NS† |
| Albumin (mg/dL)∗ | 4.19±0.51 (188) | 4.23±0.53 (95) | 4.22±0.44 (64) | NS† |
| Cholesterol (mg/dL)∗ | 161.5±31.0 (163) | 163.6±30.3 (82) | 162.3±27.9 (58) | NS† |
| Platelet count (103/μ L)∗ | 175.8±71.9 (185) | 175.4±72.9 (92) | 184.8±71.8 (63) | NS† |
| Prothrombin time (%)∗ | 90.7±14.6 (120) | 90.2±14.1 (65) | 91.3±14.9 (35) | NS† |
| HCV RNA (106 IU/mL)∗ | 3.72±6.30 (167) | 5.22±7.60 (94) | 1.78±3.37 (62) | ＜0.05† |
| Virologic response | ||||
| SVR | 48.9% (65/133)‡ | 40.9% (27/66)‡ | 68.1% (32/47)‡ | ＜0.05§ |
| EVR | 60.4% (84/139)‡ | 62.0% (49/79)‡ | 72.7% (32/44)‡ | NS§ |
| ETR | 57.7% (75/130)‡ | 58.0% (40/69)‡ | 71.1% (32/45)‡ | NS§ |
Table 3.
Relationship between ApoE genotypes and clinical findings
| All patients | HCV genotype 1 | HCV genotype non-1 | |||||||
|---|---|---|---|---|---|---|---|---|---|
| E4 negative (N) | E4 positive (N) | P | E4 negative (N) | E4 positive (N) | P | E4 negative (N) | E4 positive (N) | P | |
| Age (year)∗ | 58.5±11.4 (165) | 60.3±12.6 (31) | NS† | 56.7±11.3 (84) | 60.4±13.4 (15) | NS† | 58.3±11.5 (53) | 60.3±11.6 (12) | NS† |
| Sex | |||||||||
| Male | 57.6% (95/165)‡ | 54.8% (17/31)‡ | NS§ | 63.1% (53/84)‡ | 60.0% (9/15)‡ | NS§ | 56.6% (30/53)‡ | 41.7% (5/12)‡ | NS§ |
| Female | 42.4% (70/165)‡ | 45.2% (14/31)‡ | NS§ | 36.9% (31/84)‡ | 40.0% (6/15)‡ | NS§ | 43.4% (23/53)‡ | 58.3% (7/12)‡ | NS§ |
| Radiologic findings | |||||||||
| Coarse echotexture | 49.7% (82/130)‡ | 38.7% (12/23)‡ | NS§ | 70.8% (46/65)‡ | 58.3% (7/12)‡ | NS§ | 58.7% (27/46)‡ | 37.5% (3/8)‡ | NS§ |
| Fatty liver | 32.7% (54/130)‡ | 35.5% (11/23)‡ | NS§ | 41.5% (27/65)‡ | 58.3% (7/12)‡ | NS§ | 43.5% (20/46)‡ | 50% (7/12)‡ | NS§ |
| Laboratory findings | |||||||||
| AST (U/L)∗ | 72.9±63.9 (162) | 65.5±34.0 (31) | NS† | 73.7±57.1 (81) | 68.7±32.6 (15) | NS† | 74.8±65.9 (53) | 70.0±38.6 (12) | NS† |
| ALT (U/L)∗ | 77.4±87.8 (164) | 76.3±47.4 (31) | NS† | 84.7±83.0 (83) | 81.5±46.0 (15) | NS† | 77.3±106.5 (53) | 80.5±53.8 (12) | NS† |
| Albumin (mg/dL)∗ | 4.17±0.53 (157) | 4.30±0.44 (31) | NS† | 4.21±0.54 (80) | 4.37±0.44 (15) | NS† | 4.21±0.45 (52) | 4.26±0.40 (12) | NS† |
| Cholesterol (mg/dL)∗ | 160.8±31.8 (137) | 165.0±26.9 (26) | NS† | 164.3±30.8 (69) | 159.5±28.0 (13) | NS† | 160.6±28.9 (49) | 171.4±21.0 (9) | NS† |
| Platelet count (103/μ L)∗ | 175.0±73.0 (156) | 177.7±68.0 (29) | NS† | 174.1±72.8 (78) | 182.4±75.9 (14) | NS† | 185.6±73.1 (52) | 180.9±68.4 (11) | NS† |
| Prothrombin time (%)∗ | 90.1±15.2 (99) | 93.6±10.9 (21) | NS† | 90.1±14.1 (55) | 90.9±14.6 (10) | NS† | 90.3±16.4 (28) | 95.4±6.1 (7) | NS† |
| HCV RNA (106 IU/mL)∗ | 3.93±6.63 (140) | 2.62±4.12 (27) | NS† | 5.46±7.93 (80) | 3.87±5.38 (14) | NS† | 1.93±3.67 (51) | 1.10±1.03 (11) | NS† |
Table 4.
Viral response rates to antiviral therapy in chronic HCV infection according to ApoE genotype
| All patients | HCV genotype 1 | HCV genotype non-1 | |||||||
|---|---|---|---|---|---|---|---|---|---|
| E4 negative | E4 positive | P∗ | E4 negative | E4 positive | P∗ | E4 negative | E4 positive | P∗ | |
| SVR | 47.7% (53/111) | 54.5% (12/22) | NS | 41.8% (23/55) | 36.4% (4/11) | NS | 65.0% (26/40) | 85.7% (6/7) | NS |
| EVR | 60.0% (72/120) | 63.2% (12/19) | NS | 61.2% (41/67) | 66.7% (8/12) | NS | 71.8% (28/39) | 80.0% (4/5) | NS |
| ETR | 58.4% (66/113) | 52.9% (9/17) | NS | 59.3% (35/59) | 50.0% (5/10) | NS | 70.0% (28/40) | 80.0% (4/5) | NS |
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