Changes in clinical, biochemical, immunological and integrative parameters in patients with chronic hepatitis C virus infection according to the virus genotype and the grade of activity
DOI:
https://doi.org/10.14739/2310-1210.2020.4.208363Keywords:
chronic hepatitis C virus, genotype, activity, clinical and biochemical blood test, integrative parametersAbstract
The aim of this study is to determine the features of the course of chronic hepatitis C virus (CHCV) infection and the dependence of changes in integrative indicators of endogenous intoxication, nonspecific immunoreactivity and inflammation on the virus genotype and the grade of activity.
Materials and methods. In total, 287 CHCV patients were examined and their inpatient and outpatient medical cards were analyzed. The study included 55 healthy individuals. In addition to the general group, which included all the patients, the examined people were divided into groups, depending on the grade of activity (minimal activity – 210 people, moderate – 68, expressed – 9) and the virus genotype (1b – 150 people, 2 – 19, 3a – 102). Clinical and laboratory examination was performed according to the protocol. The integrative indices of severity, nonspecific reactivity, indices of inflammation and intoxication activity were also calculated.
The statistical processing of the obtained results was carried out by Microsoft Office Excel 2010 and IBM SPSS Statistic 23 computer software.
Results. The groups were sex- and age-representative. The 1b genotype (52.30 %), moderate liver fibrosis (F2 – 31.25 %) and minimal activity (73.17 %) were the most frequently encountered in patients with CHCV.
The most frequent clinical manifestations were asthenovegetative syndrome (81.88 %) and heaviness in the right hypochondrium (64.76 %). Patients with CHCV caused by different virus genotypes had evenly distributed clinical data (P > 0.05), with the exception of the 1b genotype patients who were diagnosed with telangiectasia 1.3 times more frequently than in the total sample; and liver enlargement were 1.5 times (P < 0.05) less frequently seen in the 2 genotype patients, there were no anemia cases (P < 0.05).
A decrease in platelet counts (1.3 times) and segmented neutrophils (1.2 times) as well as an increase in lymphocytes (1.1 times) and ESR (1.4 times) was observed in CHCV patients compared to apparently healthy individuals (P < 0.05). The changes obtained were significant in the groups with all genotypes, except for the patients with genotype 2 as the level of erythrocytes and hemoglobin was lower than in the comparison group and in the total group (1.1 times in all cases, P < 0.05), and patients with genotype 3 had a lower ESR compared to all patients (1.2 times) (P < 0.05). The groups of patients with different grades of activity were homogeneous with the exception that the leukocyte count in minimal activity (P < 0.05) was lower than in the total group, ESR was higher only in the total group in minimal activity (P < 0.05), the level of segmented neutrophils and lymphocytes in expressed activity did not differ from the comparison group, unlike other groups.
In the total group, leukopenia (15.68 %), erythrocytopenia (18.47 %), anemia (6.62 %), and thrombocytopenia (33.10 %) were more common than in the comparison group (5.45 %, 3.63%, 0 %, 5.45 %, respectively) (P < 0.05). People with different HCV genotypes had similar changes, except for the patients with genotype 2 who did not have anemia.
All CHCV patients had higher values of total protein, ALT, AST, GGT relative to the comparison group (P < 0.05), and AlP and creatinine were lower (P < 0.05). No dependence of changes in these parameters on the genotype was found, except for protein content, as it was higher in the groups with genotype 1c and 2; AlP was lower in individuals with the 1c and 3a, and creatinine – in 1c and 2 genotype patients (P < 0.05). There was also no dependence of changes in patients with CHCV on the grade of activity, except for those with expressed activity who had higher AlP, GGT and total bilirubin with reduced glucose level (P < 0.05).
In the total group of patients with CHCV, the entropy indices of leukocyte formula were higher, the indexes of nonspecific reactivity had higher values of RC (1.3 times), Ilimph (1.3 times), IA (1.1 times), but NMRI (1.1 times) and ELRI (1.3) (P < 0.05) were lower than in the comparison group. There was a decrease (TII – 1.1 times; KI– 1.3 times) or an increase (ILG – 1.3 times; IL ESR – 1.5 times) in inflammatory parameters (P < 0.05). Indices of endogenous intoxication were decreased in patients compared with the healthy individuals (ILS – 1.2 times, NRR – 1.8 times). No dependence of changes in patients with CHCV on the genotype was found, except for IA, which was higher only in the total group and with genotype 3a (P < 0.05), and IL ESR in the patients with genotype 3a, which was lower than in the total group (P < 0.05) but did not differ from the comparison group (p> 0.05); IIS with genotype 3a was 1.7 times lower compared with all patients (P < 0.05). The ELR indicator did not change in all grades of activity and did not differ from those of healthy individuals. In patients with moderate activity, IA was higher than in the comparison group and NI was lower than in the total group (P < 0.05).
Abdominal ultrasound, regardless of the group, most frequently revealed liver enlargement (76.26% of persons) and an increase in its echogenicity (82.35 %).
Conclusions. Chronic hepatitis C virus patients were dominated by asthenovegetative syndrome, feeling of heaviness in the right hypochondrium, liver enlargement, increase in lymphocyte count, ESR, transaminase activity. Telangiectasia in genotype 1b and liver enlargement in genotype 2 were less frequent. Laboratory changes were accompanied by leukocytopenia, erythrocytopenia, anemia and thrombocytopenia, an increase in total protein content, ALT, AST and GGT activity. In chronic hepatitis C virus, the entropy indexes of leukocyte formula, RC, Ilimph, AI, ILG and IL ESR were increased. Positive ANAs were significantly more frequently identified than AMAs.
References
Blach, S., Zeuzem, S., Manns, M., Altraif, I., Duberg, A.-S., Muljono, D. H., Waked, I., Alavian, S. M., Lee, M.-H., Negro, F., Abaalkhail, F., Abdou, A., Abdulla, M., Rached, A. A., Aho, I., Akarca, U., Al Ghazzawi, I., Al Kaabi, S., Al Lawati, F., … Razavi, H. (2017). Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. The Lancet Gastroenterology & Hepatology, 2(3), 161-176. https://doi.org/10.1016/s2468-1253(16)30181-9
Malyi, V. P. (2014). Virusnyi hepatyt S [Viral hepatitis C]. Klinichna imunolohiia. Alerholohiia. Infektolohiia, (4), 11-16. https://kiai.com.ua/uploads/files/2014/4%20(73)/53018406.pdf [in Ukrainian].
Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, & TB Prevention. (n.d.). Hepatitis C Questions and Answers. CDC.Gov. Retriеved March 30, 2020. https://www.cdc.gov/knowmorehepatitis/HepatitisC-FAQ.htm
Mayberry, J., & Lee, W. M. (2019). The Revolution in Treatment of Hepatitis C. The Medical Clinics of North America, 103(1), 43-55. https://doi.org/10.1016/j.mcna.2018.08.007
Kurmanova, G. M., Akeshova, N. A., Baratova, G. M., Mamutova, A. E., Shakieva, L. A., & Aytmetova, G. A. (2016). Osobennosti klinicheskikh proyavlenii khronicheskikh virusnykh gepatitov C i V [Peculiarities of clinical displays of chronic viral hepatitis C and B]. Vestnik KazNMU, (4), 37-44. [in Russian].
European Association for the Study of the Liver (2018). EASL Recommendations on Treatment of Hepatitis C 2018. Journal of Hepatology, 69(2), 461-511. https://doi.org/10.1016/j.jhep.2018.03.026
Mitsura, V. M., & Tereshkov, D. V. (2016). Nepryamye markery fibroza pecheni u patsientov s khronicheskimi virusnymi gepatitami V i S [Indirect markers of liver fibrosis in patients with chronic hepatitis B and C]. Problemy zdorov'ya i ekologii, (3), 24-29. [in Russian].
Mashko, O. P., Ryabokon, O. V., Ushenina N. S., Savelyev V. G., & Zadiraka, D. A. (2016). Osoblyvosti kliniko-biokhimichnykh parametriv ta pokaznykiv neirohumoralnoi rehuliatsii u khvorykh na khronichnyi hepatyt C zi zmishanoiu kriohlobulinemiieiu zalezhno vid infikuvannia riznymy henotypamy HCV [Features of clinical and biochemical parameters and indicators of neurohumoral regulation in patients with chronic hepatitis C and mixed cryoglobulinemia depending on the infection with different HCV genotypes]. Aktualna infektolohiia, (3), 52-56. https://doi.org/10.22141/2312-413x.3.12.2016.81713[in Ukrainian].
Shulyat'ev, I. S., Borunova, Zh. V., Shaposhnikova, N. N., Noskova, K. K., & Drozdov, V. N. (2010). Vliyanie genotipa virusa gepatita С na uroven' virusnoi nagruzki i kliniko-laboratornye osobennosti porazheniya pecheni [The influence of the genotype of hepatitis C virus on the level of viral load and clinical and laboratory features of liver damage]. Eksperimental'naya i klinicheskaya gastroenterologiya, (10), 17-21 [in Russian].
Galimzyanov, Kh. M., Aliyeva, A. A., Burkin, A. V., & Goreva, O. N. (2014). Dinamika fermentativnoi aktivnosti fagotsitov krovi u bol'nykh khronicheskim virusnym gepatitom S v zavisimosti ot genotipa [The dynamics of enzymatic activity of phagocytes in patients with chronic viral hepatitis C depending on the genotype] Astrakhanskii meditsinskii zhurnal, 9(3), 19-24. [in Russian].
Yuschuk, N. D., Shmeleva, E. V., Kapitonova, O. S., Fedoseeva, N. V., Balmasova, I. P., & Eremina, O. F. (2012). Proliferativnyi otvet limfotsitov krovi u bol'nykh khronicheskim gepatitom C s razlichnymi genotipami vozbuditelya [Proliferative response of blood lymphocytes in patients with chronic hepatitis C with different genotypes of the causative agent]. Immunologiya, (5), 264-267 [in Russian].
Godlevs'kii, A. І., & Savolyuk, S. І. (2015) Diahnostyka ta monitorynh endotoksykozu u khirurhichnykh khvorykh [Diagnosis and monitoring of endotoxicosis in surgical patients: a monograph]. Nova Knyha. [in Ukrainian].
Kuznetsov, P. L., & Borzunov, V. M. (2013). Sindrom endogennoi intoksikatsii v patogeneze virusnogo gepatita [Endogenous intoxication syndrome in the pathogenesis of viral hepatitis]. Eksperimental'naya i klinicheskaya gastroenterologiya, (4), 44-50. [in Russian].
Botheju, W., Zghyer, F., Mahmud, S., Terlikbayeva, A., El-Bassel, N., & Abu-Raddad, L. J. (2019). The epidemiology of hepatitis C virus in Central Asia: Systematic review, meta-analyses, and meta-regression analyses. Scientific Reports, 9(1), Article 2090. https://doi.org/10.1038/s41598-019-38853-8
Stasi, C., Silvestri, C., Berni, R., Rossana Brunetto, M., Zignego, A. L., Orsini, C., Milani, S., Ricciardi, L., De Luca, A., Blanc, P., Nencioni, C., Aquilini, D., Bartoloni, A., Bresci, G., Marchi, S., Filipponi, F., Colombatto, P., Forte, P., Galli, A., Luchi, S., … Cipriani, F. (2019). Epidemiological, demographic and clinical data on chronic viral hepatitis C in Tuscany. Current Medical Research and Opinion, 35(4), 661-666. https://doi.org/10.1080/03007995.2018.1482264
Minme, R., Holzmann, I., Tovo, C. V., & Almeida, P. (2018). Profile of patients with chronic hepatitis C in a public health program in Southern Brazil. Arquivos de Gastroenterologia, 55(4), 403-406. https://doi.org/10.1590/S0004-2803.201800000-86
Younossi, Z., Park, H., Henry, L., Adeyemi, A., & Stepanova, M. (2016). Extrahepatic Manifestations of Hepatitis C: A Meta-analysis of Prevalence, Quality of Life, and Economic Burden. Gastroenterology, 150(7), 1599-1608. https://doi.org/10.1053/j.gastro.2016.02.039
Gill, K., Ghazinian, H., Manch, R., & Gish, R. (2016). Hepatitis C virus as a systemic disease: reaching beyond the liver. Hepatology International, 10(3), 415-423. https://doi.org/10.1007/s12072-015-9684-3
Petta, S., Maida, M., Macaluso, F. S., Barbara, M., Licata, A., Craxì, A., & Cammà, C. (2016). Hepatitis C Virus Infection Is Associated With Increased Cardiovascular Mortality: A Meta-Analysis of Observational Studies. Gastroenterology, 150(1), 145-155e4. https://doi.org/10.1053/j.gastro.2015.09.007
Mukhtar, N. A., Ness, E. M., Jhaveri, M., Fix, O. K., Hart, M., Dale, C., Pratt, C., & Kowdley, K. V. (2019). Epidemiologic features of a large hepatitis C cohort evaluated in a major health system in the western United States. Annals of Hepatology, 18(2), 360-365. https://doi.org/10.1016/j.aohep.2018.12.003
WHO (n.d.). Diabetes country profiles 2016. WHO. Retrieved June 30, 2020. https://www.who.int/diabetes/country-profiles/en/
Ahmadinejad, Z., Abdiliaei, Z., Mohamadi, R., & Rezahosseini, O. (2017). Treatment Related Hematologic Changes in a Population of Iranian Patients with Chronic Hepatitis C Infection from 2009 to 2014. Iranian Journal of Public Health, 46(10), 1386-1394.
Vukovic, V. R., Baskic, D., Mijailovic, Z., & Djurdjevic, P. (2016). Hepatitis C Therapy – Related Haematological Side Effects are Associated with Treatment Outcome / Hematološka Neželjena Dejstva Terapije Hepatitisa C Su Povezana Sa Ishodom Lecenja. Serbian Journal of Experimental and Clinical Research, 17(1), 9-14. https://doi.org/10.1515/sjecr-2015-0036
Khokhlova, N. I., Tolokonskaya, N. P., Pupyshev, A. B., & Vasilets, N. M. (2010). Mnogofaktornaya otsenka endogennoi intoksikatsii u bol'nykh khronicheskim virusnym gepatitom C [Multifactorial evaluation of endogenous intoxication in patients with chronic viral hepatitis C]. Klinicheskaya laboratornaya diagnostika, (8), 30-33.
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