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. |
