Determination of trace elements in patients with chronic hepatitis B.

Abstract

Chronic hepatitis B virus (HBV) infection is a major liver disease worldwide and its clinical manifestations are linked to immune response. The purpose of this study was to evaluate the relationship between selenium, copper, and zinc in comparison with transaminase level in chronic HBV patients. Serum samples of the HBV infected patients were obtained from Tooba medical center, Sari, Iran. Sixty patients were enrolled in this study (36 men and 24 women), mean age: 39.6 ± 12.2 years. The concentration of zinc, selenium, copper and transaminases were determined using an autoanalyzer system. Concentrations of selenium (0.273 ± 0.056 μg/dl) and zinc (2.1 ± 0.037) was elevated in patients with low transaminase levels as were significantly different in comparison with patients with high transaminase level (P<0.05). Serum copper concentration was similar in two groups of patients. Elevated levels of transaminase concentrations were independently associated with low zinc and selenium concentrations in chronic HBV patients. It is concluded that serum zinc and selenium levels are associated with less hepatic damage in chronic HBV patients and might have a protective role during liver injury.

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ORIGINAL REPORT

Correspondence Author: Saeid Abediankenari
Department of Microbiology and Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Tel: +98 151 3247505, 912 1985667, Fax: +98 151 3247106, E-mail: abedianks@razi.tums.ac.ir, abedianlab@yahoo.co.uk

Determination of Trace Elements in Patients with Chronic Hepatitis B
Saeid Abediankenari1, Maryam Ghasemi2, Mohammad Mahdi Nasehi3, Siavash Abedi4, and Vahid Hosseini5
1 Department of Microbiology and Immunology, School of Medicine, Mazandaran University of medical Sciences, Sari, Iran
2 Department of Pathology, School of Medicine, Mazandaran University of medical Sciences, Sari, Iran
3 Department of Pediatrics, School of Medicine, Mazandaran University of medical Sciences, Sari, Iran
4 Department of Internal Medicine, School of Medicine, Mazandaran University of medical Sciences, Sari, Iran
5 Department of Gastroenterology, School of Medicine, Mazandaran University of medical Sciences, Sari, Iran

Received: 23 Aug. 2010; Received in revised form: 18 Apr. 2011; Accepted: 14 Jun. 2011

Abstract- Chronic Hepatitis B virus (HBV) infection is a major liver disease worldwide and its clinical
manifestations are linked to immune response. The purpose of this study was to evaluate the relationship
between selenium, copper, and zinc in comparison with transaminase level in chronic HBV patients. Serum
samples of the HBV infected patients were obtained from Tooba medical center, Sari, Iran. Sixty patients
were enrolled in this study (36 men and 24 women), mean age: 39.6 ± 12.2 years. The concentration of zinc,
selenium, copper and transaminases were determined using an autoanalyzer system. Concentrations of
selenium (0.273 ±0.056 μg/dl) and zinc (2.1±0.037) was elevated in patients with low transaminase levels as
were significantly different in comparison with patients with high transaminase level (P<0.05). Serum copper
concentration was similar in two groups of patients. Elevated levels of transaminase concentrations were
independently associated with low zinc and selenium concentrations in chronic HBV patients. It is concluded
that serum zinc and selenium levels are associated with less hepatic damage in chronic HBV patients and
might have a protective role during liver injury.
© 2011 Tehran University of Medical Sciences. All rights reserved.
Acta Medica Iranica, 2011; 49(10): 667-669.

Keywords: Zinc; Selenium; Hepatitis B; Copper

Introduction

Chronic Hepatitis B virus (HBV) infection is a major
liver disease that clinical outcome of infection is linked
to immune response (1,2).
The disease may develop to liver carcinoma in
during infection. Up to now, many studies have shown
that trace elements have an important role in metabolic
activity and health condition (3). It is demonstrated that
trace elements have a major role in protein synthesize,
pregnancy abnormalities and immune function (4,5).
Selenium is an antioxidant trace element that has a key
role in immune defense. It is recognized that selenium
deficiency might be associated with diabetes and
cardiovascular diseases
deficiency has an undesirable role in growth
development, gonads maturation and ulcer repair (4,6).
Copper is another trace element that has an effective role
in hemoglobin synthesize, increased iron absorption and
phospholipids synthesize (6,7). In addition, the levels of
selenium, zinc and copper are altered in a variety of
(5). Furthermore, Zinc
malignancies (7). Liver damage is associated with
elevated transaminases levels in chronic HBV patients
(8). AST and ALT levels are routinely determined in
patients with hepatitis (9). The role of trace elements
and their association with degree of liver damage is not
completely understood in patients with chronic hepatitis
B. Thus, the purpose of this study was to evaluate serum
selenium, zinc and copper concentrations in chronic
HBV infected patients in regards to their serum
transaminase levels.

Material and Methods

The study group included 60 patients with chronic HBV
who were referred to Tooba medical center (Mazandaran
province, Iran) for diagnosis and treatment. Patients
were enrolled in the study after obtaining written
consent. Patients with positive HBSAg for more than six
months were considered for the study.
Whole peripheral blood was obtained from chronic HBV
patients.

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Trace elements in the chronic hepatitis B patients
668 Acta Medica Iranica, Vol. 49, No. 10 (2011)
Table 1. The concentrations of AST and ALT in the two
groups of patients infected with HBV. Data are expressed as
mean ± SD.
Transaminase
AST (IU/L)
ALT (IU/L)


After serum separation, the concentration of
selenium, zinc and copper was determined using
standard kit-based assays. The assays were performed
in duplicate and the concentrations were calculated from
a standard curve according to the manufacturers protocol
(Greiner, Germany). AST and ALT were measured
using an autoanalyzer system (Prestige 24i Instrument,
Kobe, Japan).
We categorized the patients in two groups based on
their AST and ALT levels in comparison with trace
elements levels as shown in table 1.

Statistical analysis
Student’s t-test was used for statistical analysis. The
P<0.05 was considered statistically significant. Data are
presented as mean ± SD.

Results

The patients groups were 60 patients with HBV (36 men
and 24 women), mean age 39.6±12.2 years. All patients
were HBSAg positive, HBeAg negative and HBeAb
positive. Low levels of AST and ALT were observed in
patients with elevated selenium and zinc levels (Table
2). Increased levels of AST and ALT concentrations
were correlated with low concentrations of zinc and
selenium. The mean values of zinc and selenium was
significantly different in patients with high transaminase
levels in comparison with low AST and ALT levels
(Table1, 2). No significant difference was found in mean
copper values between the two groups.

Table 2. Trace elements concentration in the chronic HBV
patients with normal and abnormal AST and ALT. Data are
expressed as mean ± SD.
Group 1
29.6±7.5
33±17.2
Group 2
103±11.56
195±11.40
P value
<0.05
<0.05
Trace
elements
Patients with
normal ALT
and
AST(group1)
2.1± 0.37
169.5±64
0.273± 0.056
Patients with
elevated ALT
and
AST(group2)
0.87 ± 0.2
115±40
0.002± 0.0006
P value
Zn(mg/L)
Copper(μg/dl)
Se(μg/dl)

<0.05
>0.05
<0.05
Discussion

In this study, the concentration of zinc, copper, and
selenium were determined in hepatitis patients in regards
to their transaminase levels. It is known that
immunomodulatory agents such as zinc and copper play
an important role in cancer and pregnancy (10). Zinc
influences host immune defense via innate and acquired
immunity (10). We showed that higher zinc
concentration in chronic HBV patients' correlated with
low levels of AST and ALT. Initial studies showed that
zinc has an important role in tissue repair (11). In
addition, trace elements can modify some enzymes
activity (12,13). Gomes et al., showed that trace
elements are involved in pathogenesis of hepatitis C
infection (14,15).
Our study showed that zinc and selenium levels were
decreased in HBV patients with higher degree of hepatic
damage. Increased AST and ALT concentrations in
HBV patients was consistent with low concentrations of
zinc and selenium.
These finding can suggest that zinc and selenium
level in serum could be related with structural condition
of the liver. Although, the effects of zinc and selenium
deficiency on the liver damage is not clear but the effect
of zinc and selenium deficiency on liver repair
mechanism might be modified by dietary zinc and
selenium consumption. This study showed that zinc and
selenium might be considered as a marker of healthier
liver. It is also concluded that suitable concentration of
zinc and selenium are necessary for preventing the liver
damage in chronic HBV patients.

Acknowledgment

This study was supported by grant (No.88-116) from
Mazandaran University of Medical Sciences. The
authors are grateful to Mr Mohammad Akbari and Ms
Sarvenaz Azarnoosh for technical assistance.

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