Histological features of chronic hepatitis c with persistently normal serum ALT level

ABSTRACT

Approximately one third of patients with chronic hepatitis C [CHC] injection have normal alanine transaminases [ALT] levels, definition and Meal significance of persistently normal ALT in CHC have been revised. Liver biopsy is usually the most accurate test for assessing the severity of liver disease. To evaluate the liver histological feature of patients suffering from CHC with persistently normal ALT levels. In this study 50 patients with CHC with persistently normal ALT since last six months who enrolled for the antiviral treatment and subjected to liver biopsy for assessing the severity of liver disease. Histological results were scored using the METAVIR system. Mean age of these patients was 40.1 +/- 9.3 years; out of these 39 [78%] were male. Significant fibrosis [F 2-4] in 19 patients [38%] and insignificant fibrosis [stage 0-1] 62%. Cirrhosis [F 4] were present in 6 patients [12%]. The necro-inflammatory changes were grade 1 in 36 [72%] patients and grade 2 in 14 [28%] patients, no patients showed more severe changes. Steatosis were minimal [0-1] in 43 [86%] patients and severe [score 2-3] in 7 patients [14%]. Viral load were weak in 16, [32%] moderte in 27 [54%] and high in 7 [14%] patients, severity of fibrosis were highly correlated to grade of inflammation [P=0.002] and slightly to steals [p=0.048] but no correlated to age, sex, ALT value or viral load. The grade of inflammation were related to age [p=0.011]. Extent of steatosis were not correlated to clinical or laboratory variables. There was no correlation found between the transaminase level and biopsy scores. Approximately 38% of the patients with normal transaminases have fibrosis equal to or greater than stage 2 and 12% have cirrhosis. The grade of inflammation and extent of steatosis is related to the score of fibrosis