Abstract:

Objective: The study aims to determine the histopathological findings in patients with chronic Hepatitis B infection and their relationship to liver function tests. Materials and methods: A total of 200 HBV-positive patients aged 16 years or older who attended the gastroenterology unit of the Federal University Teaching Hospital, Lafia, were recruited using convenience sampling. The socio-demographic characteristics were recorded; venous blood was sampled for HBV serological marker testing using Enzyme-linked immunosorbent assay kits; a Tru-Cut biopsy needle was used for liver biopsy; and liver pathology was assessed using a magnetic resonance imaging machine. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 23.0. The results were presented in the table, with a significance level of p < 0.05. Results: The mean age of patients was 34.87 ± 10.78 years. There were (70.5%) males, and (29.5%) females. Histology results revealed ballooning degeneration (9.5%), Fibrosis (5.5%), inflammation (6.0%), Steatosis and ground-glass (1.5%), fatty liver and necrosis (1.0%). The liver function test revealed that (15.0%), (52.5%), (32.5%), and (6.5%) had elevated platelet prothrombin ratio, international normalization ratio, protein, and albumin, with (35.5%), (44.0%), and (29.0%) had elevated alkaline phosphatase, alanine transaminase (ALT), and aspertase transaminase (AST). The patient with normal AST had the greatest ballooning compared with those with elevated AST (13.6% vs 4.5%), a difference that was statistically significant.  Patients with normal ALT had higher inflammation than those with high ALT (9.2% vs 1.4%), with a statistically significant difference (p=0.033). Conclusion: Liver biopsy will be recommended for patients with chronic hepatitis B showing normal AST and ALT levels.

References:

[1].   Mitra, V., and Metcalf, J., 2009, Functional Anatomy and blood supply of the liver. Anesthesia and Intensive Care Medicine, 10(7), 332-333.

[2].   Hiroi, K., Matsuzaki, T., Kaku, R., Umeda, Y., Yagi, T., Morimatsu, H., 2019, Postoperative course of serum albumin levels and organ dysfunction after liver transplantation. Transplant Proc, 51:2750–2754. Doi:10.1016/j.transproceed.01.199.0041-1345/19.

[3].   Yakalashi, Y., and Fukusato, T., 2014, Histopathology of Nonalcoholic fatty liver disease/Nonalcoholic steatohepatitis. World Journal of Gastroenterology. 2014, 20(42), 15539-15543: https://dx.doi.org/10.3748/wjg.v20.i42.15539

[4].   Takahashi Y, Fukusato T., Histopathology of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol,  2014; 20(42): 15539-15548 [PMID: 25400438 DOI: 10.3748/wjg.v20.i42.15539].

[5].   Lok, A. S., & McMahon, B. J., 2007, Chronic hepatitis B., Hepatology, 45(2), 507-539, Doi: 10.1002/hep. 21513.

[6].   WHO, 2014, Hepatitis B. Available at: http://www.who.inf/inf-s/en/fact204.html

Accessed July 28, 2013. https://www.who.inf/inf-s/en/fact204.html

[7].   Global Burden of Disease Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2013;385(9963):117–71. December 18, 2014, http://dx.doi.org/10.1016/S0140-6736(14)61682-2

[8].   World Health Organization. Global health sector strategy on viral hepatitis, 2016.

[9].   World Health Organization, 2021, Hepatitis B fact sheet. 2019. https://www.who.int/newsroom/factsheets/detail/hepatitis-b

[10].           Kramvis, A., Kew M. C., 2007, Epidemiology of hepatitis B virus in Africa, its genotypes, and clinical associations of genotypes. Hepatol Res, 2007;37(s1): S9–19. Doi: 10.1111/j.1872-034X.2007.00098.x.

[11].  World Hepatitis Alliance, 2018, Find the missing millions: Global report on barriers to diagnosis. 2018.

[12].  de Martel, C., Georges, D., Bray, F., Ferlay, J., Cliford, G. M., 2020, Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis. Lancet Glob Health, 8(2): e180–90. Doi: 10.1016/S2214-109X (19)30488-7.

[13].  Howell, J., Lemoine, M., Thursz, M., 2014, Prevention of materno-fetal transmission of hepatitis B in sub-Saharan Africa: the evidence, current practice and future challenges. J Viral Hepatitis, 21(6):381–96. Doi: 10.1111/jvh. 12263.

[14].  Dwiartama, A., Nirbayati, W. F., Giri-Rachman, E. A., Niloperbowo, W., Tan, M. I., & Anin, A., 2022, Knowledge, attitude, and practice towards hepatitis B infection prevention and screening among Indonesians. International Journal of Environmental Research and Public Health. 19(8), 464. Doi: 10.3390/ijerph19084644.

[15].  Ndubuisi, J. C., Aisha, M., Ugboaja, I., & Ubani, C. D., 2022, Prevalence of hepatitis B virus among students of Faculty of Natural and Applied Sciences, Nasarawa State University, Keffi, Nasarawa State, Nigeria. South Asian Journal of Parasitology. 5(3), 86–90. https://journalsajp.com/index.php/SAJP/article/view/125

[16].  Rockey, D. C., Caldwell, S. H., Goodman, Z. D., et al., 2009, Liver biopsy. Hepatology, 49:1017–1044. [PubMed: 19243014]. Doi: 10.1002/hep.22742.

[17].  Anka, Y., Rampal, L., Ibrahim, N., Sidik, S., & Iliyasu, Z., 2016. The effectiveness of an education intervention program for improving knowledge, attitude, and practice related to hepatitis B infection among non-medical and non-veterinary undergraduate university students in Northern Nigeria: A randomized controlled trial. Pan African Clinical Trials Registry. 15(11), 114–12. Doi: 10.21010/Ajidv19i1.6.

[18].  Asaye, Z., Aferu, T., Asefa, A., Feyissa, D., Regasa, T., Kebede, O., Feyisa, D., & Feyisa, M., 2021, Prevalence of hepatitis B virus among pregnant women on antenatal care follow-up at Mizan-Tepi University Teaching Hospital and Mizan Health Center, Southwest Ethiopia. International Journal of General Medicine, 14, 195–200. Doi: 10.2147/IJGM.S292070.

[19].  Balegha, A., Yidana, A., & Abiiro, G., 2021, Knowledge, attitude, and practice of hepatitis B infection prevention among nursing students in the Upper West Region of Ghana: A cross-sectional study. PLoS ONE, 16(10), 1-18. https://doi.org/10.1371/journal.pone.0258757

[20].  Bigna, J. J., Kenne, A. M., Hamroun, A., Ndangang, M. S., Foka, A. J., Tounouga, D. N., Lenain, R., Amougou, M. A., & Nansseu, J. R., 2019, Gender development and hepatitis B and C infections among pregnant women. Doi: 10.1186/s40249-019-0526-8.

[21].  Ngbalaga, G. A., Fuh, N. J., Upla, P. U., Akeh, M. A., Ombugadu, A., Ablaku, A. A., & Goche, N. I.,2023, Microbiological evaluation of street-vended Saccharum officinarum (sugarcane) sold within Lafia Metropolis, Nasarawa State, Nigeria. Transactions on Science and Technology,10(1), 21–27. https://doi.org/10.21010/Ajid v19i 1.6

[22].  Shabi, O. M., Omolayo, T., 2018, Sample size determination. NFMJ. 1(1): 32-3828. https://www.journalcra.com

[23].  Zhan, Z., Hao, H., Bi, X., Lin, Y., Yang, L., Wang, S., Shen, G., Chang, M., Jiang, T., et al., 2022, Study on Liver histopathology of chronic Hepatitis B virus-infected patients with different normal ALT values. Frontiers in Immunology. 13:1069792. https://doi.org/10.3389/fimmu.2022.1069752

[24].  Mei-hwei, C., 2008, Natural history and clinical management of chronic hepatitis B virus infection in children. Hepatol Int. 2:28–36. Doi: 10.1007/s12072-008-9050-9

[25].  Andersson, M. I., Rajbhandari, R., Kew, M. C., Sandro, V., Wolfgang, P., Andy, I. M. H., 2015. Mother-to-child transmission of hepatitis B virus in sub-Saharan Africa: time to act. Lancet, 3(7):358–9. e358-9. Doi: 10.1016/S2214-109X (15)00056-X

[26].  Agbede, O. O., Iseniyi, J. O., Kolawole, M. O., Ojuawo, A., 2007, Risk factors and seroprevalence of hepatitis B surface antigenemia in mothers and their preschool-age children in Ilorin. Nigeria Therapy, 4(1):67–72. 14750708.4.1.67.

[27].  Moses, A. P., Gyar, S. D., Pechulano, S., Obadiah, D. B., Samuel, E. E., Timothy, Z., et al., 2010, Hepatitis B virus infections in apparently healthy urban Nigerians: data from pre-vaccination tests. J Infect Dev Ctries, 4(6):397–400. Doi: https://doi.org/10.3855/jidc.591

[28].  Modupeola, O. M., Kolawale, O. J., Ijarotimi, O., Adekunle, O., Jegede, O. S., Ndububa, D. A., 2024, Liver histology patterns of young patients with inactive chronic hepatitis B virus infection from a Hospital in Southwest Nigeria. BMC Gastroenterology. 24:438. Doi: https://doi.org/10.1186/s12876-024-03501-7

[29].  Takahashi, Y., Fukusato, T., 2014, Histopathology of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroen­terol, 20:15539-15548.

[30].  Schwabe, R. F., Tabas, I., Pajvani, U. B., 2020, Mechanisms of fibrosis development in non-alcoholic steatohepatitis. Gastroenterology. 158:1913-1928. Doi: 10.1053/j.gastro.2019.11.311

[31].  Leow, W. Q., Chain, A. W., Mendoza, P. Q., LO, R., Yap, K., Kim, H. Y.,2023, Non alcoholic fatty liver disease: The Pathologist’s Perspective. Clinical and Molecular Hepatology. 29(Suppl)S302-S318. Doi: 10.3350/cmh. 2022.0329.

[32].  He, T., Li, J., Ouyang, Y., Lv, G., Ceng, X., Zhang, Z., & Ding, J., 2020, FibroScan detection of fatty liver/liver fibrosis in 2266 cases of chronic hepatitis B. Journal of Clinical and Translational Hepatology, 8. 109-112. Doi: 10.14218/JCTH.2019.00053

[33].  Whitehead, M. W., Hawkes, N. D., Hainsworth, I., et al., 1999, A prospective study of the causes of notably raised aspartate aminotransferase of liver origin. Gut, 45: 129. Doi:10.1136/gut.45.1.129.

[34].  Cataldo, I., Sarcognato, S., et al., 2021, Pathology of nonalcoholic fatty liver disease. Pathologica, 113: 194-202. Doi: 10.32074/1591-951X-242.

[35].  Daniel, S., Ben-Menachem, T., Vasudevan, G., et al., 1999, Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol. 94:3010– 4. Doi:10.1111/j.1572-0241.1999.01451.

[36].  Newsome, P. N., Cramb, R., Davison, S. M., et al., 2018, Guidelines on the management of abnormal liver blood tests. Gut. 67:6-19. Doi: 10.1136/gutjnl-2017-314924

[37].  Asirri, A. M., Joumah, B. A., Alharthi, Y. S., et al., 2022, The assessment of liver Disease utilising a panel of liver function tests. International Journal of Pharmaceutical and Bio-Medical Science. 2(8):327-332. Available on: https://ijpbms.com/

[38].  Li, H., Wang, Y J., Tan, K, Zeng, L., Liu, L., Liu, F J., et al., 2009, Prevalence and risk factors of fatty liver disease in Chengdu, Southwest China. Hepatobiliary Pancreat Dis Int, 8(4):377–82. https://pubmed.ncbi.nlm.nih.gov/19666406/

[39].  Musarrat, N., 2009, Prothrombin time is an indicator of the severity of liver disease. JPMI, 23(1):102-108.

[40].  Fallatah, H. I., Akbar, H. O., Fallatah, A. M., 2016, FibroScan compared to FIB-4/APRI and AST/ALT Ratio for assessment of liver fibrosis in Saudi patients with Nonalcoholic Fatty Liver Disease. Hepatology, 16(7). Doi: 10.5812/hepatmon. 38346

[41].  LI, Y. Y., Zheng, T. L., Xiao, S. Y., Wang, P. Y., Yang, W. J., et al., 2023, Hepatocytic Ballooning in Non-Alcoholic Steatohepatitis: Delimmas and Future Direction, Willy: Liver International, 43.1170-1182e38346. 10.5812/hepatmon. 38346

[42].  Gallaher, H., Mehkri, S., 2023, Advanced Stage Hepatic Fibrosis with Normal Liver Chemistries: A Case Report. Cureus, 15(6): e40732. Doi: 10.7759/cureus. 40732

[43].  Takahashi, H., Kawanaka, M., Fujii, H., Iwaki, M., Hayashi, H., Toyoda, H., et al., 2023, Association of serum albumin level and long-term prognosis in patients with biopsy-confirmed Non alcoholic Fatty Liver Disease. MDPI. Nutrients.15,2014. https://doi.org/10.3390/nu15092014