HEPATITIS C;

VALIDITY OF ALANINE AMINOTRANSFERASE LEVELS IN PREDICTING HISTOLOGICAL CHANGES IN YOUNG ASYMPTOMATIC PATIENTS

Abstract

Background: Liver biopsy the gold standard for the histological assessment in chronic hepatitis C is an invasive procedure with
certain limitations. Objective: It was to evaluate the relation of serum ALT levels with the histological changes in healthy blood donors screened
positive for HCV. Study Design: This cross sectional comparative study Setting: It was conducted at department of medicine Combined
Military Hospital Lahore, from January to August 2004 Method: 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. Results: 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 ≤3 (mild 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). Conclusions: No association found between the
ALT level & liver biopsy histological score. However patients with normal ALT levels usually had mild necroinflammatory changes.