Liver Biopsy in Patients Infected with Chronic Hepatitis
C and Persistently Normal Serum ALT LevelsM. Sadik Memon, Akber Memon, M. Hanif Ghani, Noman Khan, Naresh K Khatri,
Siraj Memon, Ubaidullah Soomro, Mukhtar A Mirza and Wasim Jafri.
INTRODUCTION: Approximately 30 to 40% of patients with Chronic Hepatitis “C” (CHC) have
persistently normal serum alanine aminotransferase (ALT) levels. Historically, these patients
have been classified as healthy or asymptomatic and have not received any treatment for CHC
infection. However, definition and clinical significance of persistently normal ALT in CHC have
been recently revised as new information on liver disease which is now getting available.
AIMS: To evaluate the histological feature of liver of patients suffering from CHC with persistently
normal ALT levels.
METHODS: In this prospective observational study we recruited consecutive patients infected
with CHC with persistently normal ALT since last six months, visited our hepatology clinic from
September 2004 to April 2005.The METAVIR scoring system was used for liver histology grading
(degree of inflammation) and staging (degree of fibrosis).
RESULTS: A total of 55 patients were recruited from outpatient clinic with normal ALT during a
follow up of six months. Mean age of these patients was 36.7± 9.78 years; out of these 39
(70.9%) were male. All these patients were diagnosed to have hepatitis C by HCV RNA PCR
method. There were 24 (43.6%) patients with stage (fibrosis) equal or greater than 2 and 33
(60%) had biopsy grade equal or greater than 2. Eighteen (32.7%) patients had steatosis on liver
biopsy. Twelve patients with stage > 2 had steatosis while 6 patients with stage < 2 had steatosis
CONCLUSION: There was no correlation found between the transaminase level and biopsy
scores. Approximately 44 % of the patients have fibrosis equal to or greater than stage 2. The
extent of steatosis is directly related to the biopsy score of the patients.
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