Etiologies of Liver Cytolysis in the Service of Hepato-Gastroenterology of the Gabriel Toure University Hospital

Aggression to the liver by xenobiotic and endogenous agents essentially results in an increase in serum aminotransferases related to hepatic cytolysis, the diagnosis of which is not always easy due to the diversity of its causes. This was a cross-sectional study from April 2019 to March 2020 that took place in the Department of Hepato-gastroenterology of the Gabriel Touré University Hospital Center. This was a cross-sectional study from April 2019 to March 2020 which took place in the Hepato Gastroenterology department of the Gabriel Touré university hospital whose objective of which was to study the etiology of hepatic cytolysis. We included all patients with hepatic cytolysis resulting in increased aminotransferase alanine at a rate higher than the normal upper limit with or without an increase of aspartate aminotransferase. We collected 199/2800 patients who met our inclusion criteria, i.e., a frequency of 7.1%. The mean age was 44.06 years ± 16.4 years, the sex ratio was 1.73. The most common clinical signs were jaundice, ascites, hepatomegaly, asthenia and anorexia. Biologically, chronic cytolysis was noted with a moderate elevation of aminotransferase alanine in 77.9% and a significant elevation in 15.5% of cases. HBs antigen (HBsAg) was positive in 80 patients (40.2%) and anti-hepatitis C virus (HCV) antibody in 18 patients (9%). Abdominal ultrasound was the first-line morphological examination and hepatomegaly alone or associated with splenomegaly was the most common abnormality. The main causes of acute cytolysis were viral hepatitis B, bile duct obstructions, drug-induced hepatitis and malaria while chronic cytolysis was mainly due to cirrhosis and hepatocellular carcinoma (HCC). How to cite this paper: Coulibaly, H.S.w., Samaké, K.D.w., Dicko, M.Y., Sidibé, D.S.w., Tounkara, M.S., Diarra, O., Konaté, A., Diarra, M.T. and Maiga, M.Y. (2021) Etiologies of Liver Cytolysis in the Service of Hepato-Gastroenterology of the Gabriel Toure University Hospital. Open Journal of Gastroenterology, 11, 211-219. https://doi.org/10.4236/ojgas.2021.1111022 Received: May 28, 2021 Accepted: October 31, 2021 Published: November 3, 2021 Copyright © 2021 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access H. S. w. Coulibaly et al. DOI: 10.4236/ojgas.2021.1111022 212 Open Journal of Gastroenterology


Introduction
The liver, the crossroads of most metabolisms, is subject to attack by many xenobiotic and endogenous agents. This aggression is essentially reflected by an increase in serum aminotransferases in connection with hepatic cytolysis. Thus, the etiological diagnosis of hepatic cytolysis is not always easy due to the diversity of its causes. It is, therefore, useful to determine the cause for appropriate management. Although alanine aminotransferase (ALAT) has narrower specificity for the liver, a predominance of aspartate aminotransferase (ASAT) may be observed in some situations. Although these enzymes expressed hepatocellular suffering, they do not always have a prognostic value.
On the other hand, if a value greater than 15 times the upper limit of normal (15N) indicates acute cytolysis and a value less than 10 times the upper limit of normal (10 N) suggests chronic cytolysis, and among the two there is a gray area difficult to classify [1]. Another source of hepatic cytolysis must also be eliminated. In the United States, the prevalence of hepatic cytolysis has been reported at 7.9%, of which 31% are closely linked to excessive alcohol consumption, or to viral hepatitis or iron overload and 69% are associated with a metabolic syndrome [2]. In two (2) French studies in blood donors, hepatic cytolysis was reported to be 0.5% and 5% respectively [3] [4]. In Mali, we did not find any studies on hepatic cytolysis, hence this study on their etiologies.

Patients and Methods
This was a cross-sectional study that took place from April 2, 2019 to March 31, 2020 in the hepato-gastroenterology department of the Gabriel Touré university hospital. Our inclusion criteria were: -Patients with an increase in alanine aminotransferase alone beyond the upper normal limit; -Patients with an increase in alanine aminotransferase beyond the upper normal limit associated with an increase in aspartate aminotransferase.
We excluded cases of cytolysis involving only aspartate aminotransferases.

Results
At the end of this study, 199 patients were able to meet our inclusion criteria out of 2800 consultations, either a hospital frequency of 7.1%.

Discussion
Limitations: In our study, some investigations necessary for etiological diagnosis could not be carried out because of the lack of financial resources and our traditional beliefs. However, the results obtained allowed a reasonable analysis of the characteristics of hepatic cytolysis in our study center. This study reported a frequency of cytolysis of 7.1% in 2800 patients who consulted during the study period. This result is superior to those of Friedman et al., of Capron and al and of Driss et al. [3] [4] [5] who reported 0.5%, 5% and 4.8% respectively. This difference could be explained by the high frequency of viral hepatitis and its complications (cirrhosis, HCC) in our context. The mean age of the patients was 44.06 ± 16.4 years, lower than that reported by Hachicha et al. [6] which was 55 years in a study on the contribution of PBF in the etiological diagnosis of cytolysis and/or unexplained cholestasis. The sex ratio was 1.73 in our study, which was contrary to that found by Hachicha et al. [6] which was 0.44. This difference could be explained by the frequency of chronic HBV carriage in humans in our Open Journal of Gastroenterology context [7]. The predominance of cytolysis in farmers and housewives were reported by our study. This could be explained by the promiscuity in these social strata which would favor the transmission of HBV. Asthenia and anorexia were the signs that prompted the consultation, thus confirming Bragança's result [8].
The physical signs were dominated by jaundice, hepatomegaly, ascites in our study. Hachicha et al. [6] reported a predominance of hepatosplenomegaly, jaundice, pruritus and gastrointestinal bleeding. HBsAg and anti-HCV Ab were found in 40.2% and 9% of our patients, respectively. This frequency of HBV infection in our context is reported by a previous study which found at least one serum marker of HBV in 60.2% of patients with HCC [9]. A study recent report has reported the prevalence of HBs Antigen to be 14.7% of the general population [7]. A recent study reported the prevalence of the HBs Antigen to 14.7% of the general population [7]. In the work Debonne et al. [10], after steatosis (52%),  [17]. Cirrhosis and hepatocellular carcinoma were significantly associated with chronic cytolysis p = 3 × 10 −5 and 8 × 10 −4 . This result confirms that of Diallo [6] and Ouavene et al. [19] who found chronic cytolysis in 52% and 68% of cirrhotic patients, respectively. Otherwise, Aoudad found 10% of chronic cytolysis associated with hepatocellular carcinoma [20]. The greater representativeness of hepatocellular carcinoma in our study could be explained by delayed diagnosis of this condition [21], for which infection by HBV remains the main cause in our context [9].

Conclusion
Hepatic cytolysis has been little studied in Africa and particularly in Mali. This study was carried out with a view to providing information on this biological anomaly. The prevalence of cytolysis was 7.1% in our patients. The main reasons for consultation were physical asthenia and anorexia. Jaundice, hepatomegaly and ascites were the physical signs commonly found in patients. The main causes of acute cytolysis were viral hepatitis B, bile duct obstructions, drug-induced hepatitis and malaria, while chronic cytolysis was mainly tied to cirrhosis and