8/11/2019 Is Serum Alanine Transaminase Level a Reliable Marker of Histological Disease in Chronic Hepatitis C Infection

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Is Serum Alanine Transaminase Level

a Reliable Marker of Histological

Disease in Chronic Hepatitis CInfection?

Faisal M. Sanai; Ali Benmousa; Hussa Al-Hussaini; Suhail Ashraf; Osama Alhafi;

Ayman A. Abdo; Hatem F. Alameri; Hisham O. Akbar; Khalid I. Bzeizi

Authors and is!losures 

"osted# $%&$'&($$'; )i*er International. ($$';('+,#$-$'. / ($$'

Bla!k0ell "ublishin1

• "rint 2his 

 3ro!essin1....

 

• Abstract an Introuction 

• "atients and Methods 

• 4esults 

•

is!ussion 

• 4eferen!es 

Information from Inustr!

Metastati! 5IS2# 6e0 7ase Study "ro1ram

r. 8oa9uina Baranda and three !ollea1ues 3resent the !ase of a :-year-old

female 0ith unrese!table 5IS2 to hel3 you 1ain insi1ht into dia1nosin1 and

treatin1 1astrointestinal stromal tumors.

7li!k here 

Abstract an Introuction

Abstract

"ackgroun# A33ro<imately ($-$= of 3atients !hroni!ally infe!ted 0ith

he3atitis 7 *irus +H7> ha*e 3ersistently normal alanine transaminase +"6A)2

le*els. 2hese 3atients are des!ribed to ha*e a mild de1ree of histolo1i!al li*er

dama1e. ?e aimed to assess the histolo1i!al li*er !han1es in H7> 3atients 0ith

"6A)2.

$atients an Methos# Si<ty-fi*e 3atients 0ith H7> and "6A)2 +1rou3 A

under0ent a li*er bio3sy. "6A)2 0as defined as three or more determinations

8/11/2019 Is Serum Alanine Transaminase Level a Reliable Marker of Histological Disease in Chronic Hepatitis C Infection

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identified to be 0ithin the normal ran1e o*er @ months or lon1er. 2he

demo1ra3hi!al features and histolo1i!al !han1es 0ere !om3ared 0ith @@

!onse!uti*e 3atients 0ith !hroni! H7> infe!tion and ele*ated A)2 +1rou3 B. All

 3atients had a dete!table H7> 46A. Histolo1i!al disease 0as s!ored a!!ordin1 to

the M2A>I4 system.Results# Females 0ere more likely to ha*e normal A)2 le*els +@:=. 2he mean

A)2 le*el in 5rou3 A and B 0as $ and $: I&) res3e!ti*ely. 6o 3atient in

either 1rou3 had normal histolo1y. 2he mean ne!ro-inflammatory s!ores in 1rou3s

A and B +(.$C$.@' *s (.$%C$.@, and the mean fibrosis s!ores +(.C$.', *s

(.(DC.$D 0ere not si1nifi!antly different. Brid1in1 fibrosis in 1rou3s A and B

0as seen in (D.@ and ,.%= 3atientsE res3e!ti*elyE 0hile !irrhosis 0as seen in @.(

and ,.@= 3atients res3e!ti*ely. He3ati! steatosis in 1rou3s A and B +$.%DC$.'@ *s

.$C.$( res3e!ti*ely 0as also not si1nifi!antly different and did not sho0 any

asso!iation 0ith the fibrosis s!ores a!ross the t0o 1rou3s. In 1rou3 AE the ne!ro-

inflammatory and fibrosis s!ores of 3atients 0ith and 0ithout steatosis 0ere not

statisti!ally si1nifi!ant. A1e 0as the only 3redi!tor of normal A)2 le*els.Ho0e*erE in!reasin1 a1e did not sho0 a si1nifi!ant in!rease in histolo1i!al

a!ti*ity in either 1rou3 beyond a !ertain a1e.

Conclusion# 2his study demonstrates that A)2 is a 3oor surro1ate marker for

inflammation and fibrosis in H7> 3atients. 5i*en the 3resen!e of si1nifi!ant

ne!ro-inflammation in "6A)2 3atientsE the risk&benefit ratio ustifies treatment

0ithout the need for a li*er bio3sy.

Introuction

He3atitis 7 *irus +H7> infe!tion is a maor !ause of end-sta1e li*er disease

0orld0ide and more than ,$ million 3eo3le are !hroni!ally infe!ted. 2he !lini!al

features asso!iated 0ith !hroni! H7> are hi1hly hetero1eneous and the natural

history of the underlyin1 li*er disease is *ariable and not fully understood.

An ele*ated alanine transaminase +A)2 le*el is indi!ati*e of he3ato!ellular

ne!rosis and has been used as a surro1ate marker of li*er inury. Most 3atients

0ith !hroni! H7> ha*e ele*ated or flu!tuatin1 le*els of serum A)2 and these

 3atients !ommonly e<hibit histolo1i!al e*iden!e of a!ti*e inflammation and

fibrosis. Ho0e*erE a33ro<imately (:-D@= of 3atients 0ith H7> ha*e 3ersistently

normal A)2 +"6A)2.G- 2he 3resen!e of ele*ated A)2 le*els in H7> 3atients is

fre9uently used as a 1uideline for !ommen!in1 treatmentE e<!e3t for 1enoty3es (and .GDE: 2he e*iden!e for su!h a strate1y arises from *arious re!ent re3orts

su11estin1 that 3atients 0ith normal A)2 ha*e mild disease and slo0 3ro1ression

of both inflammatory a!ti*ity and fibrosis.G@-' "atients 0ith normal A)2 0ere

found to demonstrate an ele*ation of A)2 in u3 to (,= of !ases 0hen monitored

for : years.G% 2reatment 1uidelines by different he3atolo1y asso!iations therefore

ha*e not ad*o!ated treatment in these 3atientsE e<!e3t in !ertain !onditions su!h

as 1enoty3es ( and . 2he !onsensusE other0iseE is of an indi*idualised strate1yE a

lar1e 3art of 0hi!h is defined by li*er histolo1i!al findin1sE the 3otential of

serious side effe!ts and the likelihood of a res3onse.

8/11/2019 Is Serum Alanine Transaminase Level a Reliable Marker of Histological Disease in Chronic Hepatitis C Infection

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In our !lini!al 3ra!ti!eE 0e ha*e fre9uently en!ountered se*ere li*er inury in

H7> 3atients 0ith "6A)2. 5enoty3e D is the 3redominant H7> 1enoty3e in our

re1ionEG$-( and the de1ree of histolo1i!al !han1e in this !ate1ory of 3atients in

relation to the A)2 le*els has not been studied ade9uately. 2hereforeE 0e

!ondu!ted this retros3e!ti*e study so as to assess the *alue of A)2 le*els in 3redi!tin1 histolo1i!al findin1s in 3atients 0ith !hroni! H7>.