ABSTRACT
Chronic hepatitis C [CHC] infection is a progressive disease whose activity must be regularly assessed. alpha -Glutathione S-transferase [alpha -GST] has been suggested as a better marker of hepatocellular damage than aminotransferases in toxic and autoimmune hepatitis. The present study assessed alpha -GST as a biochemical marker of hepatocellular damage in 50 Egyptian patients with CHC [seropositive for anti-hepatitis C virus [HCV] and HCV-RNA]. They were evaluated for conventional liver biochemistry, plasma alpha -GST, serum HCV-RNA levels and liver biopsy. Plasma alpha -GST was significantly higher in CHC patients than the reference values [p < 0.01] Sixteen patients [32%] had normal values for alanine aminotransferase [ALT], plasma alpha -GST was elevated in 11 of them [3 with minimal hepatitis; 6 mild and 2 moderate hepatitis]. Elevated plasma alpha -GST levels may indicate a hepatocellular damage even when ALT level is normal in CHC infection. Plasma alpha -GST was significantly higher in cirrhotic than non-cirrhotic patients [p < 0.01] suggesting that alpha -GST measurement is probably a sensitive test detecting liver damage occurring in association with cirrhosis. Plasma alpha -GST was significantly correlated with ALT [r = 0.67, p < 0,01] and aspartate aminotransferase [AST] [r = 0.62, p < 0.01] suggesting that alpha -GST may be a potential indicator of chronic hepatocellular damage due to HCV. Furthermore, plasma alpha -GST was significantly correlated with histologic grading score of hepatitis activity [r = 0.94, p < 0.01] and staging score of architectural alterations [r = 0.65, p < 0.01] indicating that plasma alpha -GST may be a sensitive and non invasive marker for detecting hepatitis activity and hepatocellular damage in CHC patients. There was a non-significant correlation between alpha -GST and serum HCV-RNA level indicating that plasma alpha -GST could not reflect the degree of viremia in these patients. The present data showed that alpha-GST has the highest sensitivity, specificity and accuracy [84%, 90% and 90%, respectively] for the diagnosis of parenchymal disintegrity and hepatocellular damage associated with chronic HCV infection followed by ALT [68%, 85% and 80%, respectively] then AST [62%, 75% and 68%, respectively]. This may indicate that alpha -GST gives better results than ALT and AST and may be preferred to them for monitoring hepatocellular damage associated with HCV infection. In conclusion, plasma alpha-GST determination appeared to be a sensitive, specific and non-invasive biochemical marker for detecting hepatocellular damage and may have a role in the follow up of CHC patients