Increased serum gamma-glutamyl-transpeptidase concentration is associated with nonalcoholic steatosis and not with cholestasis in patients with chronic hepatitis C.
OBJECTIVE
Increased pretreatment gamma-glutamyl-transpeptidase (gammaGT) is common in patients with chronic hepatitis C and with little or no alcohol consumption. The mechanism involved in this phenomenon is unclear, and the aim of this study was to investigate factors associated with increased gammaGT levels, specifically looking at the role of cholestasis that frequently accompanies hepatitis C.


METHODS
Fifty patients with chronic hepatitis C enrolled in two trials of antiviral treatment, 25 with normal and 25 with elevated pretreatment gammaGT levels, were retrospectively selected. In addition to the common liver function and virological tests, other values measured were serum bile acid concentration and composition by gas-chromatography as a sensitive index of cholestasis, and liver biopsy scores for cholestasis and steatosis in addition to siderosis, fibrosis and inflammation.


RESULTS
Total mean serum bile acid concentration was 11.6 +/- 1.4 micromol/L and 8.5 +/- 1.2 micromol/L (not significant) in patients with elevated and with normal gammaGT, respectively, and individual bile acid composition was similar in the two groups. By univariate analysis, serum gammaGT level was linearly related to total serum bile acid (P < 0.05) and to cholestasis score (P < 0.001) among other variables, but steatosis score (P < 0.001) and Knodell score (P < 0.04) were the only variables independently associated with elevated serum gammaGT level by multivariate analysis.


CONCLUSIONS
Increased serum gammaGT level in patients with chronic hepatitis C is associated with liver steatosis and fibrosis, and indicates more advanced liver disease rather than reflecting the cholestasis that often accompanies this condition.
Benini
Federica
F
Gastroenterology Unit, Department of Medicine, Spedali Civili and University, Brescia, Italy.
Pigozzi
Marie Graciella
MG
Baisini
Ornella
O
Romanini
Laura
L
Ahmed
Hafez
H
Pozzi
Alessandro
A
Ricci
Chiara
C
Lanzini
Alberto
A
D000328:Adult; D001647:Bile Acids and Salts / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002779:Cholestasis / Q000201:enzymology; D002849:Chromatography, Gas; D005234:Fatty Liver / Q000201:enzymology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000201:enzymology*; D006801:Humans; D008103:Liver Cirrhosis / Q000201:enzymology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D005723:gamma-Glutamyltransferase / Q000097:blood*
D001647:Bile Acids and Salts; D015415:Biomarkers; D005723:gamma-Glutamyltransferase