PLASMA ALPHA GLUTATHIONE S-TRANSFERASE IN CHRONIC HEPATITIS C INFECTION IN EGYPT
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Chronic hepatitis C (CHC) infection is a progressive disease whose activity must be regularly assessed. a -Glutathione S-transferase (a -GST) has been suggested as a better marker of hepatocellular damage than aminotransferases in toxic and autoimmune hepatitis. The present study assessed a -GSTas a biochemical marker of hepatocellular damage in 50 Egyptian patients with CHC [seropositive for anti-hepatitis C virus (HCV) and HCV-RNA]. They were evaluated for conventional liver biochemistry, plasma a -GST, serum HCV-RNA levels and liver biopsy. Plasma a -GST was significantly higher in CHC patients than the reference values (p <0.01). Sixteen patients (32%) had normal values for alanine aminotransferase (ALT), plasma a -GST was elevated in 11 of them (3 with minimal hepatitis ; 6 mild and 2 moderate hepatitis). Elevated plasma a -GST levels may indicate a hepatocellular damage even when ALT level is normal in CHC infection. Plasma a -GST was significantly higher in cirrhotic than non-cirrhotic patients (p < 0.01) suggesting that a -GST measurement is probably a sensitive test detecting liver damage occurring in association with cirrhosis. Plasma a -GST was significantly correlated with ALT (r = 0.67, p < 0.01) and aspartate aminotransferase (AST) (r = 0.62, p <0.01) suggesting that a -GST may be a potential indicator of chronic hepatocellular damage due to HCV. Furthermore, plasma a -GST was significantly correlated with histologic grading score of hepatitis activity (r = 0.94, p < 0.01) and staging score of architectural alterations (r 0.65, p <0.01) indicating that plasma a -GST may be a sensitive and non invasive marker for detecting hepatitis activity and hepatocellular damage in CHC patients. There was a non-significant correlation between a -GST and serum HCV-RNA level indicating that plasma a -GST could not reflect the degree of viremia in these patients. The present data showed that a -GST has the highest sensitivity, specificity and accuracy (84%, 90% and 90%, respectively) for the diagnosis of parenchymal disintegrity and hepatocellular damage associated with chronic HCV infection followed by ALT (68%, 85% and 80%, respectively) then AST (62%, 75% and 68%, respectively). This may indicate that a -GST gives better results than ALT and AST and may be preferred to them for monitoring hepatocellular damage associated with HCV infection. In conclusion, plasma a -GST determination appeared to be a sensitive, specific and non-invasive biochemical marker for detecting hepatocellular damage and may have a role in the follow up of CHC patients.