Hepatic Hypertransaminasaemia of unknown Etiology Aclinico-pathological study

Abstract

Hepatic aminotransferases are sensitive indicators of liver cell injury. In some patients with persistent elevation of such enzymes; routine clinical, laboratory and serological data cannot establish the underlying causes. This study was designed to evaluate such patients both clinically and pathologically as a trial to reach the underlying etiology. Thirty patients with hepatic hypertransaminasaemia of unknown cause (18 females & 12 males), aged 18-50 years (mean age 37.7 4.6 years), together with ten controls (5 males & 5 females) [matched in age and body mass index with patients]; were included in this study. Both patients and controls were subjected to full history taking, clinical examination, estimation of blood glucose and lipid profile, liver function tests, serum iron & ferrtin estimation, hepatitis viral markers (HBs Ag HCV-Ab), anti Epstien Barr (EBV) and cytomegalovirus (CMV) antibodies, abdominal ultrasonography (U/S)and needle liver biopsy (done only for 15 patients who approved undergoing it. The study revealed that 18 patients had non alcoholic fatty liver disease NAFLD (bright liver on U/S), eleven patients out of them underwent liver biopsy that showed simple hepatic steatosis in four of them and non alcoholic steatohepatitis (NASH) in the other seven patients. Most of the eighteen patients with NAFLD were obese, diabetic and hypertensive. Four patients had positive serology for autoimmune hepatitis and two patients had positive serology for cytomegalovirus infection. All patients had normally ranged serum iron & ferritin. The remaining six patients had normal hepatic U/S and negative serology for different hepatic viruses; four of them underwent liver biopsy that revealed simple hepatic steatosis in two of them and non alcoholic steatohepatitis (NASH) in the other two patients. Conclusion & recommendation: Non alcoholic fatty liver disease (NAFLD) was found to be the commonest cause of unexplained hepatic hypertransamina-saemia. However, we must be minded with less frequent causes like autoimmune hepatitis and cytomegalovirus infection. Needle liver biopsy and possibly MR imaging of the liver are important investigational techniques for patients with hepatic hypertransaminasaemia associated with normal serum iron & ferrtin levels, negative serology of (autoimmune hepatitis & various hepatic viruses), normal hepatic ultrasonography; to diagnose those with occult hepatic steatosis among them. Estimation of HBV-DNA & HCV- RNA by (PCR) could be required for precise exclusion of HBV & HCV infection. Large-scale studies are recommended to verify these findings