Hepatitis C; validity of alanine aminotransferase levels in predicting histological changes in young asymptomatic patients

ABSTRACT

Liver biopsy the gold standard for the histological assessment in chronic hepatitis C is an invasive procedure with certain limitations. It was to evaluate the relation of serum ALT levels with the histological changes in healthy blood donors screened positive for HCV. This cross sectional comparative study. It was conducted at department of medicine Combined Military Hospital Lahore, from January to August 2004 It was to evaluate the relation of serum ALT levels with the histological changes in healthy blood donors screened positive for HCV. 76 apparently healthy blood donor soldiers age 20 - 49 years positive for HCV antibodies by third generation ELISA test, evaluated by medical history, physical examination, serum ALT levels, PCR test for HCV RNA and ultrasound abdomen were enrolled. Liver biopsy was done through percutaneous route and histology was graded according to Knodell scoring system. Serum ALT levels showed a skewed distribution with mean of 130.9+96.9 IU/L and median of 8.5IU/L. Eleven patients had normal ALT [<40 IU/L].On histological analysis of liver biopsy specimen 17 had Knodell score inflammation],38 had score between 4 and 7 [moderate inflammation]and 21 had > 8. Patients with score > 8 were older than the former groups. The difference was significant [p=0.047]. Relation of ALT levels with stage of fibrosis and grade of inflammation was estimated using ANOVA it showed no statistical significance. Patients with stage 1 fibrosis had highest mean serum ALT levels [p=0.108]. No association found between the ALT level and liver biopsy histological score. However patients with normal ALT levels usually had mild necroinflammatory changes