Persistently normal alanine transaminase levels in chronic C hepatitis: what does it tell us?
OBJECTIVE
We evaluated the demographic, clinical, histological and serological characteristics of chronic hepatitis C infection with persistently normal serum alanine transaminase levels and compared the results with those obtained in a group of chronic hepatitis C infection with serum alanine transaminase levels above normal.


METHODS
Twenty-one patients who had chronic hepatitis C infection with normal alanine transaminase during the follow-up period and 34 patients who had chronic C infection with serum alanine transaminase levels above normal were included in this study. Demographic, clinical, histological and serological parameters of these two groups were evaluated.


RESULTS
There were no significant differences in age, gender, known route of infection, viral load and genotype distribution between the two groups (P > 0.05). The gamma-glutamyltransferase and gamma-globulin levels were significantly higher in the serum alanine transaminase levels above normal group (P < 0.01 and P < 0.05). Among the patients with normal alanine transaminase, liver biopsy findings were normal in eight patients (38%). None of the patients with serum alanine transaminase levels above normal had normal liver biopsy findings. Histologic activity index was significantly higher in serum alanine transaminase levels above normal group (9.7 +/- 2.2 vs. 6.4 +/- 1.9; P < 0.001). Histologic activity index and alanine transaminase levels correlate with the stage of the disease (P < 0.05).


CONCLUSIONS
For a definite diagnosis in patients with HCV-RNA+ and normal alanine transaminase liver biopsy is necessary and significant liver disease may be present in such patients irrespective of viral load, genotype and alanine transaminase levels.
Dinçer
D
D
Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul, Turkey. ddinc@med.akdeniz.edu.tr
Okten
A
A
Kaymakoglu
S
S
Besisik
F
F
Demir
K
K
Tuncer
I
I
Bozaci
M
M
Turkoglu
S
S
Cevikbas
U
U
Cakaloglu
Y
Y
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001706:Biopsy; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000201:enzymology / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012016:Reference Values
D000410:Alanine Transaminase