The study on the histologic findings in the patients of chronic liver disease with normal levels of serum alanine aminotransferase(ALT) and aspartate aminotransferase(AST) over 6months

Jeong, Jin Woong; Choi, Chun Sik; Yoo, Young Jo; Hong, Eun Kyoung; Park, Moon Hyang; Lee, Min Ho

Abstract

BACKGROUND: Although abnormal serum alanine aminotranferase(ALT) and aspartate aminotransferase (AST) clearly indicates certain disease in the liver, normal reversion of serum ALT and AST during the disease process, after the histologic diagnosis of chronic hepatitis, does not ensure that the patients liver would be normal. We considered a partial remission of chronic hepatitis as the levels of serum ALT and AST were persistently normal over 6 months or more, and studied how the histologic findings in the partial-remitted patients of chronic hepatitis would change. MATERIALS: Twenty-three agreed to rebiopsy in the patients of chronic hepatitis with normal level of serum ALT and AST over 6 months. The histologic findings between the first and second liver-biopsied specimens were compared, and the classification of their morpholgy was translated with Batts and Ludwigs new scoring system of chronic hepatitis divided into grade and stage.
RESULTS
The grading scores of the first and second biopsy were 2.70 +/- 0.16 and 1.48 +/- 0.14, respectively, and the grading scores of the second biopsy decreased significantly than of the first biopsy (p=0.000); 18 cases(78.1%) were improved, but none was aggravated. The staging scores of the first and second biopsy were 1.870.19 and 1.430.22, respectively, and the staging scores of the secand biapsy also decreased significantly than of the first biopsy (p=0,020); 14 cases (61.2%) were unchanged, 8 cases (34.5%) were improved, but 1 case (4.3%) was aggravated. The stage-improved cases were 7 in the patients of chronic viral hepatitis B, and 1 in the patient of chronic viral hepatitis C, and viral loads of them disappeared. Three cases (13.0%) of them changed into no fibrosis, and 2 cases of them (8.7%) with severe fibrosis improved to mild fibrosis. But, although the levels of serum ALT and AST were persistently normal over average 16 months, grading and staging scores decreased over 2 points in 21.0% and 13.0%, respectively, and the case of which both grading and staging scores improved to normal was only 4.3%.
CONCLUSION
Serum ALT and AST level were well correlated with grading. However, the correlation between serum ALT and AST level and staging was poor, even though the triggering factors of chronic hepatitis had been disappeared. Then, we recommand close follow-up and treatment to lessen the fibrogenic reaction of the liver in them.