Aminotransferases in Chronic Active and Chronic Persistent Hepatitis

Chronic active hepatitis (CAH) and chronic persistent hepatitis (CPH), the two histologically distinct forms of viral hepatitis present with variable clinical features. So liver function tests play the key role in diagnosis and prognosis of these disorders. Among the liver function tests, determination of serum aminotransferases: aspartate aminotransferase (AST), alanine aminotransferase (ALT) and AST/ALT ratio are still popularly used. In fact over the transaminase tests no other enzymatic tests have any particular value. In infiltrative disorders there is damage to both mitochondrial and cytoplasmic membranes. Therefore there is a proportionally greater increase in plasma AST activity than ALT. This comparative study was carried out in the department of Biochemistry, Sir Salimullah Medical College, Dhaka from January 2007 to December 2007 to observe the role of aminotransferases and AST/ALT ratio in CAH and CPH. With prefixed inclusion and exclusion criteria a total of 44 age and sex matched subjects were purposively enrolled in the study. Out of them 20 were CAH and 24 were CPH. Serum AST, ALT and total bilirubin were measured and AST/ALT ratio were calculated. Mentioned parameters were compared between groups. Unpaired student's t-test and chi (x2) square test were done to detect the significant difference between the groups using SPSS version 12.0. Mean age of the study subjects in CAH and CPH group were 32.20 ± 10.65 years (20-50 years) and 32.83 ± 10.68 years (20-49 years) respectively. There was no significant difference regarding age and sex distribution between the groups (p > 0.05). Mean ± SD serum AST was 295.08 ± 153.77 IU/L and 73.38 ± 45.72 IU/L and ALT was 352.44 ± 206.95 IU/L and 121.01 ± 58.77 IU/L in CAH and CPH respectively and both were statistically highly significant (p < 0.01). Mean ± SD of AST / ALT ratio in CAH and CPH were 0.87 ± 0.14 and 0.59 ± 0.14 respectively and was highly significant (p < 0.01). There was no significant difference in serum bilirubin level between the groups (20.78 ± 14.16 ?mol/L vs. 19.25 ± 15.90 ?mol /L) (p > 0.05). DOI: http://dx.doi.org/10.3329/bmj.v41i2.18795 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 17-19

Urinary and Serum Pteridines in Liver Diseases

Summary The aim of this mini-review is to show the usefulness of pteridines as clinical markers. We assayed urinary neopterin and xanthopterin levels in liver disease. Total pterins were oxidized by active carbon to yield xanthopterin. Urinary neopterin levels were elevated in patients with chronic active hepatitis and in those with chronic persistent hepatitis but not in patients with alcohol-induced liver disease or in those with non-alcoholic fatty liver. Urinary xanthopterin levels were elevated in chronic active hepatitis and alcohol- induced liver disease, but not in chronic persistent hepatitis and non-alcoholic fatty liver. Urinary neopterin levels were high in infectious diseases involving activated cell-mediated immunity, and increased urinary xanthopterin reflects liver-cell damage. We also compared plasma neopterin values in anti-hepatits C virus antibody (anti-HCV) -positive or - negative donors with elevated alanine aminotransferase (ALT). Plasma neopterin values of anti-HCV-negative donors with elevated ALT were the same as those of healthy groups. These results show that the ALT elevation in anti-HCV-negative donors is attributable mainly to steatosis due to excess body weight and/or alcohol consumption, rather than viral infection. During the course of these studies, we were also able to identify esophageal carcinoma in the very early stage by measuring urinary pteridine levels. Our results indicate that pteridines are clinically useful indicators. In particular, neopterin may be used as a means of screening for unknown viral infection.