Clinical Profile and Prevalence of Hepatic Fibrosis in Patients with Chronic Virus Hepatitis C or with Opisthorchis felineus Invasion

Study Objective: To study the clinical symptoms and prevalence of hepatic fibrosis in patients with chronic virus hepatitis C (CVHC), genotype 1, or Opisthorchis felineus invasion.

Study Design: Cross-sectional comparative study of random groups of inpatient or outpatient patients.

Material and Methods. We examined 297 patients with CVHC, genotype 1, and 214 patients with chronic opisthorchiasis. CVHC was diagnosed in accordance with the guidelines of the European Association for the Study of the Liver. Opisthorchiasis was diagnosed when eggs or mature parasites were found in duodenal content and/or faeces of the patient. Hepatic fibrosis was assessed with shear wave elastography using the METAVIR scale. Study Results. We have found differences in clinical symptoms: prevailing cytolytic syndrome (82.8% vs 9.8%; p < 0.001), hepatomegaly (20.9% vs 10.3%; p = 0.002), and stage F3-F4 hepatic fibrosis (METAVIR) (20.5% vs 8.4%; p < 0.001) in patients with CVHC and higher prevalence of cholestatic syndrome (14.5% vs 0.3%; p < 0.001), chronic cholecystitis (18.2% vs 8.8%; р = 0.002), gallstones (4.7% vs 0.7%; р = 0.008) in patients with opisthorchiasis.

Conclusion. Highly significant is frequently diagnosed F2, F3 and F4 hepatic fibrosis (METAVIR) in patients with opisthorchiasis (20.5%). These evidences point out that O. felineus invasion is a hepatic pre-cancer condition. Taking into account the high prevalence of O. felineus invasion in some regions of Siberia, the available data show that opisthorchiasis is a relevant medical and social issue which must be addressed.

1. Ивашкин В.Т., Шептулин А.А., Алексеева О.П. и др. Динамика показателей смертности от болезней органов пищеварения в различных субъектах Российской Федерации в период пандемии новой коронавирусной инфекции. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2021; 31(5): 25–33. [Ivashkin V.T., Sheptulin A.A., Alekseeva O.P. et al. Digestive disease mortality dynamics during new coronavirus infection pandemic in different subjects of Russian Federation. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2021; 31(5): 25–33. (in Russian)]. DOI: 10.22416/1382-4376-2021-31-5-25-33

2. Цуканов В.В., Васютин А.В., Тонких Ю.Л. и др. Бремя заболеваний печени в современном мире. Некоторые показатели качества ведения больных с циррозом печени в Сибирском федеральном округе. Доктор.Ру. 2019; 3(158): 6–10. [Tsukanov V.V., VasyutinA.V., Tonkikh Yu.L. et al. The burden of hepatic pathologies in the modern world. some quality parameters of management of patients with liver cirrhosis in the Siberian Federal District. Doctor.Ru. 2019; 3(158): 6–10. (in Russian)]. DOI: 10.31550/1727-2378-2019-158-3-6-10

3. Kozlov A., Vershubskaya G. The prevalence of helminthiases in North Western Siberia rural indigenous and long-term resident people in 1988–89 and 2018–19. Int. J. Circumpolar Health. 2021; 80(1): 1917270. DOI: 10.1080/22423982.2021.1917270

4. Bouvard V., Baan R., Straif K. et al.; WHO International Agency for Research on Cancer Monograph Working Group. A review of human carcinogens — Part B: biological agents. Lancet Oncol. 2009; 10(4): 321–2. DOI: 10.1016/s1470-2045(09)70096-8

5. Saijuntha W., Sithithaworn P., Kiatsopit N. et al. Liver flukes: Clonorchis and Opisthorchis. Adv. Exp. Med. Biol. 2019; 1154: 139– 80. DOI: 10.1007/978-3-030-18616-6_6

6. Максимова Г.А., Жукова Н.А., Кашина Е.В. и др. Роль Opisthorchis felineus в индукции рака желчных протоков. Паразитология. 2015; 49(1): 3–11. [Maksimova G.A., Zhukova N.A., Kashina E.V. et al. Role of Opisthorchis felineus on induction of bile duct cancer. Parazitologiia. 2015; 49(1): 3–11. (in Russian)]

7. Fedorova O.S., Kovshirina Y.V., Kovshirina A.E. et al. Opisthorchis felineus infection and cholangiocarcinoma in the Russian Federation: a review of medical statistics. Parasitol. Int. 2017; 66(4): 365–71. DOI: 10.1016/j.parint.2016.07.010

8. Peters L., Burkert S., Grüner B. Parasites of the liver — epidemiology, diagnosis and clinical management in the European context. J. Hepatol. 2021; 75(1): 202–18. DOI: 10.1016/j.jhep.2021.02.015

9. Stanghellini V., Chan F.K., Hasler W.L. et al. Gastroduodenal disorders. Gastroenterology. 2016; 150(6): 1380–92. DOI: 10.1053/j.gastro.2016.02.011

10. Gines P., Castera L., Lammert F. et al. Population screening for liver fibrosis: toward early diagnosis and intervention for chronic liver diseases. Hepatology. 2022; 75(1): 219–28. DOI: 10.1002/hep.32163

11. Wong R.J., Gish R.G. Metabolic manifestations and complications associated with chronic hepatitis C virus infection. Gastroenterol. Hepatol. (NY). 2016; 12(5): 293–9.

12. Heim M.H., Thimme R. Innate and adaptive immune responses in HCV infections. J. Hepatol. 2014; 61(1 suppl.): S14–25. DOI: 10.1016/j.jhep.2014.06.035

13. Zeremski M., Petrovic L.M., Talal A.H. The role of chemokines as inflammatory mediators in chronic hepatitis C virus infection. J. Viral. Hepat. 2007; 14(10): 675–87. DOI: 10.1111/j.1365-2893.2006.00838.x

14. Prueksapanich P., Piyachaturawat P., Aumpansub P. et al. Liver fluke-associated biliary tract cancer. Gut Liver. 2018; 12(3): 236– 45. DOI: 10.5009/gnl17102

15. Ninlawan K., O'Hara S.P., Splinter P.L. et al. Opisthorchis viverrini excretory/secretory products induce toll-like receptor 4 upregulation and production of interleukin 6 and 8 in cholangiocyte. Parasitol. Int. 2010; 59(4): 616–21. DOI: 10.1016/j.parint.2010.09.008