Association of Liver Histology with Serum ALT Levels in Patients with Chronic Hepatitis C
Keywords:
Chronic hepatitis C, Liver histology, Normal alanine transaminaseAbstract
ABSTRACT:
Objective: To evaluate the incidence of liver damage based on grading of necro-inflammatory and fibrotic changes on hepatic
cytology in patients suffering chronically with hepatitis C, presenting with alanine transaminase levels in normal ranges.
Methodology: A cross-sectional survey was accomplished at department of medicine, PAF Hospital Mushaf, Sargodha for six
months of duration from April 2012 to October 2012. 100 cases were evaluated. Liver biopsy was done using large bore sure
cut biopsy needle under all aseptic measures after ultrasound marking and sent in 10% formalin for histological studies of
inflammation and necrosis. Liver damage was declared for patients having grade 1 or more activity on METAVIR scoring
system.
Results: Majority of the patients were between 31-40 years of age and lowest age was 20 years. Average age of the patients
was 33.2±7.4 years. Out of 100 patients, 47 patients (47.0%) were male while remaining 53 patients (53.0%) were females.
Liver damage was found in 41.0% patients.
Conclusion: Liver biopsy should be performed for a clear diagnosis in patients suffering from HCV with alanine transaminase
level within the normal ranges. Patients may suffer advanced hepatic disease despite normal levels of hepatic enzymes.
References
Arif A, Ahmed W, Alam SE, Qureshi H. Active disease in chronic hepatitis C patients with normal alanine aminotransferase. J Coll Physicians Surg Pak. 2012 Aug 1; 22(8):488-91
Cãruntu FA, Benea L. Acute hepatitis C virus infection: Diagnosis, pathogenesis, treatment. Journal of Gastro- intestinal and Liver Diseases. 2006 Sep;15(3):249
Kamal SM. Acute hepatitis C: a systematic review. The American journal of gastroenterology. 2008 May 1;103 (5):1283-97
Cox AL, Netski DM, Mosbruger T, Sherman SG, Strathdee S, Ompad D, et al. Prospective evaluation of community
-acquired acute-phase hepatitis C virus infection. Clinical Infectious Diseases. 2005 Apr 1;40(7):951-8
Mohammadi M, Talei G, Sheikhian A, Ebrahimzade F, Pournia Y, Ghasemi E, et al. Survey of both hepatitis B virus (HBsAg) and hepatitis C virus (HCV-Ab) coinfection among HIV positive patients. Virology journal. 2009 Nov 18;6(1):202
Bartos V, Krkoska D, Slavik P, Lauko L, Adamkov M. Histological status of the liver in relation to serum amin- otransferase levels in patients with chronic hepatitis C. Bratislavske lekarske listy. 2006 Dec;108(12):522-5
McPhee SJ, Papadakis MA, Tierney LM, editors. Current medical diagnosis & treatment 2010. New York: McGraw-Hill Medical; 2010
Ngo Y, Munteanu M, Messous D, Charlotte F, Imbert- Bismut F, Thabut D, et al. A prospective analysis of the prognostic value of biomarkers (FibroTest) in patients with chronic hepatitis C. Clinical chemistry. 2006 Oct 1;52(10):1887-96
Syed SI, Sadiq S. Histopathological grading and staging in liver biopsies of Hepatitis-C patients and their assoc- iation with ALT levels. Pak J Med Sci.2010 Jul 1;26(3)
:644-8
Sanai FM, Benmousa A, Hussaini H, Ashraf S, Alhafi O, Abdo AA, et al. Is serum alanine transaminase level a reliable marker of histological disease in chronic hepatitis C infection? Liver International. 2008 Aug 1; 28(7):1011-8
Cooke GS, Lemoine M, Thursz M, Gore C, Swan T, Kamarulzaman A, et al. Viral hepatitis and the Global Burden of Disease: a need to regroup. J Viral Hepat. 2013;20: 600–601
Hanafiah MK, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013; 57: 1333–42
Raja NS, Janjua KA. Epidemiology of hepatitis C virus infection in Pakistan. J Microbiol Immunol Infect. 2008; 41(1):4
Sy T, Jamal MM. Epidemiology of hepatitis C virus (HCV) infection. Int J Med Sci. 2006; 3(2): 41–6
Pradat P, Alberti A, Poynard T, Esteban JI, Weiland O, Marcellin C, et al. Predictive value of ALT levels for histologic findings in chronic hepatitis C: a European collaborative study. Hepatology. 2002 Oct 1; 36(4):973-7
Taraneh DM, Naseer ED, Muhammad B, Ali AH, Babak H, Ali RS et al. Relationship between serum ALT levels and liver histology in chronic hepatitis C infected patients. Indian J Gastro 2005; 24: 49-51
Bhatty SA, Shaikh NA, Akhter SS. Liver histology in hepatitis C virus positive patients with normal and elevated alanine amino transferase levels. J Pak Med Assoc. 2009 Dec; 59: 832-4
Afdhal NH, Nunes D. Evaluation of liver fibrosis: a con- cise review. The American journal of Gastroenterology. 2004 Jun 1; 99(6): 1160-74
McCormick SE, Goodman ZD, Maydonovitch CL, Sjo- gren MH. Evaluation of liver histology, ALT elevation, and HCV RNA titer in patients with chronic hepatitis
C. Am J Gastroenterol. 1996 Aug; 91(8): 1516-22
Alberti A, Benvegnu L, Boccato S, Ferrari A, Sebastiani
G. Natural history of initially mild chronic hepatitis C. Digestive and liver disease. 2004 Oct 31; 36(10):646- 54
Anderson FH, Zeng L, Rock NR, Yoshida EM. An asses- sment of the clinical utility of serum ALT and AST in chronic hepatitis C. Hepatol Res. 2000 Jul;18(1):63-71
Shiffman ML, Diago M, Tran A, Pockros P, Reindollar R, Prati D, et al. Chronic hepatitis C in patients with persistently normal alanine transaminase levels. Clin Gastroenterol Hepatol. 2006; 4: 645–52
Gholson CF, Morgan K, Catinis G, Favrot D, Taylor B, Gonzalez E, Balart L. Chronic hepatitis C with normal aminotransferase levels: a clinical histologic study. Am J Gastroenterol. 1997; 92: 1788–92
Persico M, Perrotta S, Persico E, Terracciano L, Folgori A, Ruggeri L, et al. Hepatitis C virus carriers with persi- stently normal ALT levels: biological peculiarities and update of the natural history of liver disease at 10 years. J Viral Hepat. 2006; 13: 290–6
Bacon BR. Treatment of patients with hepatitis C and normal serum aminotransferase levels. Hepatology. 2002; 36(5 Suppl 1):S179-84
Ito H, Yoshioka K, Ukai K, Watanabe K, Yano M, Ishigami M, et al. Hepatol Res. 2004 Sep; 30(1):11-7
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Copyright (c) 2017 Wajeeha Ahad, Ayaz Ahmed, M Fahad Waseem, Muhammad Tahir, Muhammad Tarique
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