IBN AL- HAITHAM J. FO R PURE & APPL. SCI. VO L.24 (1) 2011 Comparison in Some Biochemical and Hematological Tests Between Chronic Hepatitis B and C Received in : 7 April 2010 Accepte d in : 9 November 2010 R.H. Hussein College of Health and Medical Technology Abstract Chronic viral hepatitis is an imp ortant health p roblem in the world, where hepatitis B virus (HBV) or hepatitis C virus (HCV) infections are the main causes of liver insufficiency. The study included 100 blood samp les from p atients with chronic viral hepatitis, fifty of them with HBV infection and 50 with HCV infection. Twenty app arently healthy age and gender matched subjects were included as a control group . Out of the 50 patients with HBV, 36(72%) were males and 14(28%) were females. Thirty two (64%) p atients with HCV were males and 18(36%) were females. The mean age for HBV p atients was 36.9 ± 15.8 y ear and for HCV p atients it was 39.9 ±14.2 y ear. The results of the liver function tests showed no significant difference between HBV and HCV p atients. Both of HBV and HCV p atients showed a significant difference regarding liver function tests when comp ared with the control group . Total white blood cell count and hemoglobin concentration were lower (4296± 1050.9 cell/ mm3 and 10.9 ± 2.2g/dl resp ectively) in HCV p atients than those in HBV p atients (6224 ± 1749.1 cell /mm3 and 13.4 ±1.3 g/dl ) with a significant difference. However there was no significant difference between HBV p atients and control regarding total white blood cell count and hemoglobin concentration. Aim of st udy : to comp are between chronic hepatitis B, chronic hepatitis C and control regarding some hematological and biochemical p arameters. Key Words :Chroni c Hepatitis B and C Introduction Viral hepatitis is a major global p ublic health concern, it is a source of substantial morbidity and mortality around the world. Viral hepatitis is caused by at least five distinct viruses A, B, C, D, or E. Each belongs t o an entirely different family of viruses, and they have very little in common excep t the target organ, they affect the liver and a certain degree of shared ep idemiology . [1] Chronic hepatitis B and chronic hepatitis C are p rogressive diseases linked to the development of cirrhosis and hepatocellular carcinoma. Chronic liver disease is accomp anied by derangement of hep atocy te function including the sy nthesis of haemostastic factors. [2] Four sep arate liver enzy mes are included on most routine laboratory tests. They are- asp artate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT), which are known together as transaminases; and alkaline p hosp hatase (ALP) and gamma- glutamyl transferase (GGT), which are known together as cholestatic liver enzy mes. Elevations of these enzy mes can indicate the p resence of liver disease. In cases of acute viral hepatitis, aminotransferase levels usually p eak before jaundice app ears and have a more gradual decrease thereafter, and there is a greater increase in serum bilirubin levels. The entire alp habet of viral hepatitis (A, B, C, D and E) may be resp onsible for a marked increase in aminotransferase levels, although the increase associated with hep atitis C infection tends to be IBN AL- HAITHAM J. FO R PURE & APPL. SCI. VO L.24 (1) 2011 more modest than that associated with hepatitis A or B. Liver and bone diseases are the most common causes of p athological elevation of ALP levels, although ALP may originate from other tissue, such as the placenta, kidneys or intestines, or from leukocytes.[3] The epidemiology of HBV and HCV infection varies according to geographical area. HBV infection is a serious global health p roblem, with two billion p eople infected worldwide, and 350 million suffering from chronic HBV infection. Chronic hepatitis B (CHB) affects more than 400 million p eople globally , of whom 75% are Asians [4]. In the M iddle East , HBV p revalence has altered from high to intermediate or low p revalence, but HBV infection is a p roblem of p ublic health, and a major cause of mortality and morbidity p articularly in developing countries. [5] In the M iddle East , Bahrain, Iran, and Kuwait are areas of low endemicity , Cy p rus, Iraq and the United Arab Emirates have intermediate endemicity , and Egy p t, Jordan, Oman, Palest ine, Yemen and Saudi Arabia have high endemicity [6]. Studies in the M iddle East show the p revalence of HBsAg to range from 3% to 11% in Egy p t, 4% to 5% in Iraq, 2.6% to 10% in Jordan, 2% to 6% in the Liby an Arab Jamahiriy a, 2.3% to 10% in Oman, 5% to 6% in Palestine, 7.4% to 17% in Saudi Arabia, 16% to 20% in Sudan, 6.5% in Tunisia, 2% to 5% in UAE and 12.7% to 18.5% in the Republic of Yemen. The st udies conducted in the M iddle East have collectively found that HBV infection is a serious p ublic health p roblem in the region. [7] Hep atitis C infection is now the most common cause of end-stage liver disease in many countries. It is a blood-borne infection that was a well-known cause of p ost -transfusion hepatitis after introduction of hepatitis B screening in blood banking and before imp lementation of hepatitis C-sensitive screening laboratory methods. World Health Organization (WHO) estimations suggest that up to 3% of the world's p op ulation (170 million) have been infected with HCV [8]. Regionally , the highest p revalence of HCV infection occurs in Egy p t, where the p revalence of infection increases st eadily with age, and high rates of infection are observed among p ersons in all age group s [9]. Materials and Methods Patie nts popul ation We st udied one hundred patients with chronic viral hepatitis, 50 of them (36 males and 14 females) with chronic HBV infection and 50 p atients ( 32 males and 18 females) with chronic HCV infection , who were in regular follow-up at the gastroenterology and hepatology center / Baghdad. Twenty unrelated app arently healthy , age and gender matched subjects were included as a control group . Chronic HBV infection was defined by the p resence of hepatitis B surface antigen ( HbsAg ) in serum for more than 6 months, while chronic HCV infection was defined by the p resence of HCV RNA in serum for more than 6 months which was done by using commercially available enzy me linked immunosorbent assay (ELISA) and p erformed according to the manufactures inst ructions. Methods Venous blood samples were collected from all p atients, hematological tests were done, including total white blood cell count and estimation of hemoglobulin concentration. Liver function tests were p erformed manually by using assay s which were done according to the manufacturers instructions using st andard routine sp ectrop hotometric methodology [10] in all p atients which included the following kits; 1-Total serum bilirubine (TSB)-randox comp any; Sp ectrop hotometric determination (Winst el and Cehely k method) 2- Alanine aminotransferase (ALT)-randox comp any; Sp hectrop hotometric determination (Reitman and Frankel method) 3- Asp artate aminotransferase (AST)-randox comp any; IBN AL- HAITHAM J . FO R PURE & APPL. SCI. VO L.24 (1) 2011 Sp hectrop hotometric determination (Reitman and Frankel method) 4-Alkaline p hosp hatase (ALP)-biomerieux-comp any; Sp ectrop hotometric determination of alkaline p hosp hatase activity S tatistical anal ysis The test results are exp ressed as the mean ± st andard deviation (SD). Data collected were subjected to analysis of variance (ANOVA), while the means were sep arated with LSD test using st atist ical p rogramme for windows, P value of ≤ 0.05 was considered significant [11]. Results In our st udy the p atients p op ulation consisted of 68 males (68 %) and 32 females (32 %). M ean age of our p atients was 38.4±14.9 y ears. M ean ages for chronic hepatitis B and hepatitis C p atients were 36.9 ± 15.8 y ears (11 – 65y ears) and 39.9 ±14.2 y ears (7-61 y ears) resp ectively, table (1). Table (2) comp ares the levels of liver function tests between HBV and HCV p atients, which shows that the mean of total serum bilirubine level was 4.1 ± 3.1 and 4.2 ± 3 mg/dl in HBV and HCV patients resp ectively. On t he other hand, AST level in HBV and HCV p atients were 37.8± 10.4 IU/L and 41.6± 14.2 IU/L resp ectively. The same table also demonst rates that t he level of ALT was 55±40.8 and 60.4±29.3 IU/L in HBV and HCV cases resp ectively, meanwhile ALP level was 82.1±46.5 IU/L in HBV p atients and 86.3± 44.7 IU/L in HCV p atients. Statist ical analysis showed that there was no significant difference between HBV and HCV p atients concerning liver function tests. However both HBV and HCV showed a significant difference in liver function tests when compared with the control group . The data demonst rated by table (3) and figure (1) show a significant difference between HBV and HCV p atients concerning total WBC count which was 6224 ± 1749.1 and 4296± 1050.9 cell/ mm3 resp ectively. Hemoglobulin concentration was 13.4 ± 1.3 g/dl in HBV p atients and 10.9 ± 2.2 g/dl in HCV p atients which was significant as illustrated by table (3) and figure (2). However HBV patients showed no significant difference when comp ared with control group regarding total white blood cell count (7599±980 cell/ mm3) and hemoglobine concentration (13.8±1.9 g/dl). Discussion Viral hep atitis is an imp ortant cause of chronic hepatitis. Based on the data obtained in this st udy , chronic viral hepatitis was more p revalent among males than females. These findings were similar to those obtained in another st udy which reported that t he male: female ratio was 2:1 in Iraq [12]. On the other hand the current findings disagree with the findings of another st udy conducted in Iraq, which rep orted that an equal ratio in both males and females [13]. Our results agreed with a st udy conducted in Turkey which also found that male: female ratio was 2:1. [14] Although the results of liver function tests in the current st udy was higher in HCV p atients than those in HBV p atients, st atist ical analysis revealed that t here was no significant difference between HBV and HCV p atients concerning liver function test. These findings disagreed with those obtained in another st udy which reported that HCV-infected p atients p resented more liver inflammation (higher AST, ALT and ALP) than HBV-infected p atients. This difference in liver inflammation can be att ributed to the higher p ercentage of p revious antiviral treatment and the higher resp onse rate to therap y in the HBV group comp ared with the HCV group [15]. It is well known that chronic hepatitis C is associated with a wide variation in ALT, from normal ALT to p ersistent elevation of ALT, although st udies have IBN AL- HAITHAM J . FO R PURE & APPL. SCI. VO L.24 (1) 2011 shown that p atients with p ersistently normal ALT usually have slower p rogression and lower p revalence of cirrhosis. [16] In this st udy we noted that hemoglobin concentration and total WBC count were different in HBV and HCV p atients. Hep atitis C p atients included in this st udy had lower total hemoglobin concentration and total WBC count than those found in hepatitis B p atients with a significant difference. These results were similar to those obtained in another st udy which reported that HCV p ositive p atients have lower hemoglobin and white blood cell count. [17] Nevertheless the current results were consistent with the data reported by a st udy which concluded that regarding liver disease severity , chronic hepatitis B comp ared with chronic hepatitis C p atients had significantly lower white blood cell and p latelet counts, but similar biochemical (aminotransferases levels) and histological (grading and st aging) findings as well as a similar p revalence of all other thrombophilic or coagulation factors [18]. This variation may be due to the following factors, first p atients in our study were younger than those in the other st udy . Second geographic variation in HBV genoty p es in st udy p op ulation would influence the p revalence of chronic hepatitis B. Anot her factor is that the cause may also be nutritional or infectious, finally difference in sample size. Furt her st udies on a much larger scale are needed to evaluate other factors that might affect t he relationship between HBV and HCV infection with resp ect to hemoglobin, hematocrit levels, differential leucocy te count , p hy logenic analysis for viral genoty p es, viral titers, serum ferritin level and the degree of hepatic injury. Re ferences 1- Purcell, R. H.(1994), Hep atitis viruses; changing p att erns of human disease. Proc Natl Acad Sci USA:91; 2041-6. 2- Fujiwara, A.; Sakaguchi, K.;Fujioka, S.; Iwasaki ,Y.; Senoh, T.; Nishimura, M .; Terao, M . and Shiratori, Y. (2008) Fibrosis p rogression rates between chronic hepatitis B and C p atients with elevated alanine aminotransferase levels. J Gastroenterol; 43:484–491. 3- Park, K.S.; Lee, Y.S. and Lee, S.K. (2003) A study on markers of viral hep atitis in adults living in Daegu and Gy ungbuk area. Korean J Gast roenterol;41:473-479. 4- Lee, W.M . (1997),Hep atitis B virus infection. N Engl J M ed; 337: 1733-45. 5- Andre, F. (2000),Hepatitis B epidemiology in Asia, the M iddle East and Africa. Vaccine; 18: S20-2. 6- International Congress on Viral Hep atitis A and B: Exp erience in Education and Prevention, Warsaw, POLOGNE (18/10/1998) 2000,VOL.18(121P.)(8ref.):S20-22 7- Qirbi ,N. and A.J. (2001),Hall Ep idemiology of hepatitis B virus infection in the M iddle East East ern M editerranean Health Journal, November,: 1034-1045 8- Alavian, S.M .; Adibi, P.and Zali, M .R. (2005)Hep atitis C virus in Iran: Ep idemiology of an emerging infection. Arch Iranian M ed; 8: 84-90. 9- Abdel-Aziz ,F.; Habib, M .; M ohamed, M .K.; Abdel-Hamid, M .; Gamil, F.; M adkour, S. M ikhail, N.; Thomas, D.;Fix, A.D.; Strickland, G.T .; Anwar ,W.and Sallam, I. (2000),Hep atitis C virus (HCV) infection in a community in the Nile Delta: pop ulation descrip tion and HCV prevalence. Hep atology ; 32: 111-115 10- Koff, R.S. (2004)."acute viral hepatitis." In: clinical p ractice of gastroenterology ."by : Lawrence J,Brandt,Churchil Livingst one CO. vol 11.p p :831-839. 11-Statist ics for windows (1999)"Edition 99", , Kernel release. 12- Sabri, H.J. (2003) "the diagnost ic role of liver biopsy in grading, st aging and etiology of chronic hep atitis" A t hesis fellowship Iraq commission for medical sp ecialization in p athology . 13- Rahi, S.J. (2003). " Cy tokines p rofile in Iraqi p atients infected with HCV" M .Sc. Thesis College of M edicine /University of Baghdad. IBN AL- HAITHAM J. FO R PURE & APPL. SCI. VO L.24 (1) 2011 14- Saadet ,A.; Erensoy ,A.; Elkran, O.; Kurt, A.; Nese setak Kurt, A.and Denizmen Ay gün,A. 2008, Hematological Abnormalities and Acute Viral Hep atitis A and B, J Pediatr Inf ; 3: 90-5. 15- Siagris, D. ;Vafiadis,G.; M ichalaki,M .; Lekkou, A.; Starakis, I.; M akri,M .; M argaritis,V. Christofidou,M . ;Tsamandas,A. and Labropoulou-Karatza, C. (2007),Serum Adip onectin in Chronic Hepatitis C and B J Viral Hepat. ;14(8):577-583. 16-Jamal ,M .M .; Son, A.; Quinn, P.G.; Wheeler, D.E.; Arora, S.and Johonston, D. (1999),Clinical features of hepatitis C-infected p atients with p ersistently normal alanine transaminase levels in the Southwest United States. Hepatology ; 30:1307-1311. 17- Sabry, A.; El-Dahshan, K.; M ahmoud, K.; El-Husseini, A.; Sh eashaa, H.and Abo-Z enah H.(2007),. Effect of hep atitis C virus on hematocrit and hemoglobin levels in Egy p tian hemodaily sis p atients Europ ean Journal of General M edicine, Vol. 4, No. 1: 9-15. 18- Pap atheodoridis, G.; Papakonstantinou, E.; Andrioti, E.; Cholongitas, E.; Petraki, K.; Kont op oulou, I.and Hadziyannis, S. 2003,Thrombotic risk factors and extent of liver fibrosis in chronic viral hepatitis. Gut ;52:404–409. Table (1): Demographi c characteristics of cases HBV HCV total Number of patient (%) 50 50 100 Sex M ale (%) 36(72) 32(64) 68(68) Female (%) 14(28) 18(36) 32(32) Age( mean±SD) Years (min - max) 36.9 ± 15.8 11 - 65 39.9 ±14.2 7 - 61 38.4±14.9 7 - 65 IBN AL- HAITHAM J. FO R PURE & APPL. SCI. VO L.24 (1) 2011 Table (2): levels of liver function tests in chronic HBV , HCV patients and control. NS= non significant , S=significant Table (3): Total WBC count and hemoglobulin concentration in HBV , HCV patients and control. NS= non significant , S=significant TEST HBV HCV control P-value* Total Bilirubin e (mean , mg/dl) 4.1 ± 3.1 4.2 ± 3 0.5±0.3 HBV*control=S HCV*control=S HBV*HCV=NS AST(IU/L) ( mean ± SD) 37.8± 10.4 41.6± 14.2 16±10.7 HBV*control=S HCV*control=S HBV*HCV=NS ALT (IU/L) ( mean ± SD) 55±40.8 60.4±29.3 20±7.8 HBV*control=S HCV*control=S HBV*HCV=NS ALP (IU/L) ( mean ± SD) 82.1±46.5 86.3± 44.7 40.6±9 HBV*control=S HCV*control=S HBV*HCV=NS HBV HCV control P-value Total WBC count (cell//mm3) ( mean±SD 6224 ± 1749.1 4296± 1050.9 7599±980 HBV*contr ol=NS HCV*contr ol=S HBV*HCV =S Hemoglobin concentration (g/dl) ( mean±SD 13.4 ± 1.3 10.9 ± 2.2 13.8±1.9 HBV*contr ol=NS HCV*contr ol=S HBV*HCV =S IBN AL- HAITHAM J. FO R PURE & APPL. SCI. VO L.24 (1) 2011 HBV HCV control 0 1000 2000 3000 4000 5000 6000 7000 8000 c e ll /m 3 Fig. (1):Total WBC count in HBV , HCV patients and control. HBV HCV control 0 2 4 6 8 10 12 14 g /d l Fig. (2): Hemoglobulin concentration in HBV , HCV patients and control. 2011) 1( 24المجلد مجلة ابن الھیثم للعلوم الصرفة والتطبیقیة لتهاب الكبد امقارنة في بعض الفحوصات البایوكیمیائیة وفحوصات الدم بین Cو Bمن نوع الفایروسي المز رغد حسن حسین كلیة التقنیات الصحیة والطبیة الخالصة وأ Bالتهــاب الكبـد الفایروســي نــوع إن ،اذ. المــزمن هـو مشــكلة صــحیة مهمـة فــي العـالم فایروسـيالتهـاب الكبــد ال عینـة دم لمرضـى 100تضـمنت الدراسـة . ة الكبدیالمسببة لعدم كفا الرئیسةمن العوامل هما Cالتهاب الكبد الفایروسي نوع امریضــ 50و Bنــوع المــزمن مصـابون بالتهــاب الكبــد الفایروســي امریضــ 50مــنهم ، یعـانون مــن التهــاب الكبــد الفایروســي ن من االشخاص األصـحاءالمطابقین بـالعمر والجـنس یتضمن البحث عشر .Cنوع المزمن الكبد الفایروسي بالتهابمصابون من الـذكور %) 72( 36كان هناك Bن بالتهاب الكبد الفایروسي نوع یمن الخمسین مریض المصابمن ض .مجموعة سیطرة هـم مـن الـذكور C من المرضى المصابون بالتهاب الكبد الفایروسي نـوع %) 64(وثالثون اثنان. اإلناثمن %) 28(14و ± 39,9سـنة و 15,8 ± 36,9كـان Bمعـدل العمـر لمرضـى التهـاب الكبـد الفیروسـي نـوع . اإلنـاثمن %) 63(18و نتـائج فحوصــات وظــائف الكبـد أظهــرت عــدم وجـود فــرق معنــوي بــین . Cسـنة لمرضــى التهــاب الكبـد الفیروســي نــوع 14,2 C والتهـاب الكبـد نـوع Bمرضـى التهـاب الكبـد نـوع أظهـر كـل مـن .Cوالتهاب الكبـد نـوع Bمرضى التهاب الكبد نوع مجمـوع في حین أظهـرت النتـائج أن . فحوصات وظائف الكبد عند مقارنتهم بمجموعة السیطرةلى اوجود فرق معنوي بالنسبة ــاء وتركیــز الهیموغلــوبین كــان أقــل فـــي ) مـــل 100/غــم 2,2±10,9و 3ملــم/ خلیـــة1050,9±4296(كریــات الــدم البیضـ 100/غـم 1,4± 13,4و 3ملـم/ خلیـةB )6224 ±1749,1 9من مرضى التهاب الكبـد نـوع Cمرضى التهاب الكبد نوع مجموعـة السـیطرة فیمـا و Bمرضـى التهـاب الكبـد نـوع في حین لم یكن هناك فرق معنوي بین . نوي مع وجود فرق مع) مل .یخص مجموع كریات الدم البیضاء وتركیز الهیموغلوبین فـي بعـض فحوصـات الــدم C و التهــاب الكبـد المـزمن Bیهـدف البحـث إلـى المقارنـة بــین التهـاب الكبـد المـزمن نـوع .وبعض فحوصات الكیمیاء الحیاتیة Cو Bالتهاب الكبد الفایروسي المزمن نوع : الكلمات المفتاحیة