The Study of Serum Aminotransferase and AST/ALT Ratio in Pediatric Patients with Acute Hepatitis

ABSTRACT

PURPOSE: Serum level of the aminotransferase is the most common test in use to assess hepatocellular injury and are sensitive test of hepatocyte necrosis, but both AST and ALT level in serum rise in a variety of hepatic disorders. Some clinical study reports that AST/ALT ratio was possible to predict prognostic outcome of infants with liver disease. We have tried to assess whether AST/ALT ratio is valuable or not for predict prognosis of hepatitis and differentiate cause of it. METHODS: Serum AST, ALT, and AST/ALT ratio were evaluated in the infants with acute hepatitis. They were grouped into 12 patients with Hepatitis B surface antigen positive only(group I), 23 patients with Hepatitis B surface antibody positive only(group II), and 12 patients with not-known cause of hepatitis(group III). The 24 patients were able to follow-up of AST and ALT for 2 months. They are grouped into 12 patients with normalized AST and ALT within 2 months(group A) and 12 patients not normalized within 2 months(group B). RESULTS: 1)There were no statistical difference of mean serum level of AST and ALT that were tested on admission day, one week and 2 week of admission respectively among the group I, II, and III. 2)The value of AST/ALT ratio were increased from 0.6 on admission day to 0.9 after 2 week of admission in group I(p<0.05), decreased from 1.1 to 0.8 in group II. It were not changed in group III. 3)The mean values of AST/ALT ratio were not statistically different in group A and B. 4)The mean values of serum alkaline phosphatase, total bilirubin, and prothrombin time were not statistically different among these groups, if we exclude two cases of cholestatic jaudice, one case of acute fulminant hepatitis, and one case of hepatitis C from these groups. CONCLUSIONS: On the basis of this study, we concluded that progression of hepatitis and damage of hepatic cell was different according to the cause of hepatitis. AST/ALT ratio of the acute phase hepatitis were not able to reflect the time duration of normalization of AST and ALT and it was not related to etiology of hepatitis. For predict prognosis of infant with acute hepatitis, long term follow up is needed in many more cases of infants with acute hepatitis.