RESUMO
The patient's history is inaccurate and unreliable in diagnosis of ALD. None of laboratory test gives an unequivocal indication of Alcohol Abuse. GGT indicates Alcohol Abuse only in background of normal LFT. After the onset of liver disease due to any etiology, GGT rise parallel to ALP. Although, AST/ALT>2 is useful marker for ALD, its valid only in Steatohepatitis. The ratio may be normal in Cirrhosis. Although serum carbohydrate deficit transferrin is most specific biomarker for ALD, its an acute phase reactant, its valid only in Steatohepatitis, not in Cirrhosis. The main metabolite of ethanol is acetaldehyde which accumulates in alcoholics. Acetaldehyde binds exposed proteins which trigger immunoglobulin production.The antibodies directed against acetaldehyde adducts are predominantly IgA type. MATERIAL: All subjects admitted to hospital with ALD with cirrhotic dose consumption were studied. The stage of ALD was decided based on serum albumin, Ultrasound abdomen and Fibroscan. Those seronegative for Viral Hepatitis were included in the study. Serum IgA, Serum IgA/IgG ratio, serum AST/ALT ratio, serum GGT and MCV were computed and correlated using Pearson's Chi-square test and ANOVA test. OBSERVATION: A total of 55 patients were studied. Mean age was 44 years with male preponderance of 91%. 24% were in steatosis,32% were in steatohepatitis, while 44% were in cirrhosis. Normal serum IgA upto 300 mg/dl. In this study, mean IgA in steatosis - 701 mg/dl, in steatohepatitis 1180mg/dl and cirrhosis- 1181 mg/dl. Normal serum IgA/ IgG ratio upto 0.2. In this study, this ratio in steatosis -0.3, steatohepatitis -0.5, cirrhosis- 0.6. There was significant correlation between IgA levels with advancing stages of ALD and amount of alcohol consumed. Since majority of subjects were cirrhotics where AST and ALT were normal, there was no association between AST/ALT ratio and IgA/IgG ratio. There was significant correlation between serum GGT and IgA/IgG ratio since majority were active alcoholics. Serum IgA>1200 mg/dl and IgA/IgG >0.5 correlated with onset of Hepatorenal Syndrome. CONCLUSION: The present study shows that IgA concentration increases in all stages of ALD, while AST/ ALT ratio increase only in Steatosis/Hepatitis. Although Hypergammaglobulinemia is known to occur in CLD, the fraction of immunoglobulin elevated indicates etiology of Liver Disease. IgA is elevated fraction in ALD. Its level can be used to decide the stage of ALD and prognosis.
