Re: transaminases

Posted By FB on February 01, 1999 at 20:50:49:

In Reply to: Re: transaminases posted by HFHSM.D.-D.M. on January 31, 1999 at 14:30:52:






In chronic hepatitis and other liver disorders, ALT and AST values seem to
fluctuate over many years, sometimes even to normal with one
blood test, then back up again with another and back and so on.
I know the value of the enzymes do not correlate well with
severity of damage, but my question is what is the relation
between the blood test results and the *timing* of damage.
That is, are the values elevated *after* inflammation/injury
to the liver has taken place - and if so how long after - or simultaneous
with injury, or perhaps oddly, detectable in blood even
before injury?
Thanks much.



_____
Dear FB:
Your questions are excellent ones but they are very complicated and I doubt that I can give you the sort of precise answer you want.  Sometimes, when one of my readers asks a question like this she/he has a specific concern and it can be easier if the reader tells me what the specific concern is.  I will try to make a few comments that may be helpful to you.  
As you have pointed out in a knowledgeable way, the actual level of liver enzymes (ALT/AST)  are not always as meaningful as we would like and do not always correlate with the amount of liver damage present.  While you are generally better off having low enzymes than high, plenty of patients with low enzymes have advanced disease and plenty of people with high enzymes have early disease.  We often look to the liver biopsy to tell us how much damage is present in the liver.  
Now you ask a more sophisticated question.  You ask about an individual whos liver enzymes are bouncing around.  You want to know if there is more damage taking place when the livers are high and less damage taking place when the enzymes are low.  This is an extremely difficult question to answer and I dont have the answer.  It might even involve a patient allowing us to biopsy them a different times with different levels of enzyme elevations.  Few patients would let us do that and Im not eager to ask any of my patients to do that.  Even if we did this we might not get an answer.  
I will say this, in the absence of marked alcohol use or other medical problems, we think of hepatitis C as a slow. progressive disease.  As a general rule, we feel the virus progresses in an orderly manner and does not have dramatic changes in its pace of progression.  If someone has had the virus for 20 years and has very little damage on their biopsy, we dont expect the patient to suddenly develop an aggressive, rapidly progressive disease over the next two years.  Again, this assumes an individual is not drinking or does not have other medical conditions that can accelerate the hepatitis C.
I hope this information is helpful to you at some level.  As I said your question is a complex one, and I do not want to give you an answer that we do not have.  Good luck with you situation. If you have any additional questions or concerns, you can post them through MEDHELP or contact us directly at Henry Ford.  The direct number to our liver clinic is: [phone].  At Henry Ford, we have a very active group of hepatologists with a strong interest in the care and research of hepatitis C.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question physician when you have a question pertaining to your health.