Klinický význam mírně zvýšených hodnot α−fetoproteinu v séru u pacientů s chronickou hepatitidou C a B

Czech version

Authors: J. Stránský ¹; H. Kopřivová ²; M. Hořejšová ³; J. Stříteský ⁴
Authors‘ workplace: I. interní klinika 3. lékařské fakulty UK a FN Královské Vinohrady, Praha, přednosta prof. MUDr. Jiří Horák, CSc. ¹; Ústav biochemie a patobiochemie 3. lékařské fakulty UK a FN Královské Vinohrady, Praha, přednosta doc. MUDr. Petr Čechák, CSc. ²; II. interní klinika 3. lékařské fakulty UK a FN Královské Vinohrady, Praha, přednosta prof. MUDr. Michal Anděl, CSc. ³; Ústav patologie 1. lékařské fakulty UK a VFN, Praha, přednosta prof. MUDr. Cyril Povýšil, DrSc. ⁴
Published in: Vnitř Lék 2005; 51(4): 409-413
Category: Original Contributions

Overview

Alfa-fetoprotein (AFP) is a fetal serum glykoprotein, which is mostly found in hepatocelular carcinoma but its moderate elevated level was evidenced also in acute and chronic viral hepatitis. The authors evaluated the clinical importance of alfa-fetoprotein moderate elevated levels in serum of 125 adults with chronic hepatitis B (N = 40) and C (N = 85). Morphological finding in the liver was verified by liver biopsy in 75%.

Results:
An average score of histological activity index in anti-HCV positive individuals with cirrhosis was higher than in chronic hepatitis (p < 0.05), and correlated with AFP concentration and AST activity in serum (both p < 0.01). The average AFP concentration in serum in patients with chronic hepatitis was lower than in patients with cirrhosis (p < 0.05) and more correlated with AST activity (p < 0.01) than ALT (p < 0.05) and low number of thrombocytes (p < 0.01). There were not found out any statistical differences between patients with chronic hepatitis and cirrhosis and levels of AFP in the chronic hepatitis B patients which were mostly normal.

Conclusion:
The results suggest that the moderate elevation of AFP levels in serum in patients with chronic hepatitis C is probably the sign of chronic hepatitis change to cirrhosis.Therefore it is important to recommend antiviral treatment to these patients if they are not drug users or alcoholics. Monitoring of AFP levels is more useful in chronic hepatitis C than B.

Key words:
alfa-fetoprotein – chronic hepatitis C – chronic hepatitis B

Sources

1. Alpert E, Feller ER. α-fetoprotein (AFP) in benign liver disease. Gastroenterology 1978; 74(5): 856–858. 2. Bayati N, Silverman AL, Gordon SC. Serum alpha-fetoprotein levels and liver histology in patients with chronic hepatitis C. Amer J Gastroent 1998; 93(12): 2452–2456.

3. diBisceglie AM, Hoofnagle JH. Elevations in serum alpha-fetoprotein levels in patients with chronic hepatitis B. Cancer 1989; 64: 2117–2120.

4. Cedrone A, Covino M, Caturelli E et al. Utility of α-fetoprotein (AFP) in the screening of patients with virus-related chronic liver disease: does different viral etiology influence AFP levels in HCC? Hepato- Gastroenterol 2000; 47: 1654–1658.

5. Degos F, Christidis C, Ganne-Carrie N et al. Hepatitis C virus related cirrhosis: time to occurrence of hepatocellular carcinoma and death. Gut 2000; 47: 131–136.

6. Desmet VJ, Gerber M, Hoofnagle JH et al. Clasification of chronic hepatitis: diagnosis, grading and staging. Hepatology 1994; 19: 1513–1520.

7. Goldstein NS, Blue DE, Hankin R et al. Serum alpha-fetoprotein levels in patients with chronic hepatitis C. Relationship with serum alanine aminotransferase values, histologic activity index, and hepatocyte MIB-1 scores. Amer J Clin Pathol 1999; 111(6): 811–816.

8. Gramenzi A, Andreone P, Fiorino S et al. Impact of interferon therapy on the natural history of hepatitis C virus related cirrhosis. Gut 2001; 48: 843–848.

9. Gupta S, Bent S, Kohlwes J. Test char acteristics of alpha-fetoprotein for detecting hepatocellular carcinoma in patients with hepatitis C. A systematic review and critical analysis. Ann Intern Med 2003; 139(1): 46–50.

10. Chu CW, Hwang SJ, Luo JC et al. Clinical, virologic, and pathologic significance of elevated serum alpha–fetoprotein levels in patients with chronic hepatitis C. J Clin Gastroenterol 2001; 32(3): 240–244.

11. Imaeda T, Doi H. A retrospective study on the patterns of sequential fluctuation of serum alpha-fetoprotein level during progression from liver cirrhosis to hepatocellular carcinoma. J Gastroenterol Hepatol 1992; 7: 132–135.

12. Ishak K, Baptista A, Bianchi L et al. Histological grading and staging of chronic hepatitis. J Hepatol 1995; 22(6): 696–699.

13. Knodell RG, Ishak KG, Black WC et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981; 1: 431–435.

14. Kubicka S, Rudolph KL, Hanke M et al. Hepatocellular carcinoma in Germany: a retrospective epidemiological study from a low-endemic area. Liver 2000; 20: 312–318.

15. Liaw YF, Tai DI, Chen TJ et al. Alphafetoprotein changes in the course of chronic hepatitis: relation to bridging hepatic necrosis and hepatocellular carcinoma. Liver 1986; 6: 133–137.

16. Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2001; 34: 1225–1241.

17. Oka H, Tamori A, Kuroki T et al. Prospective study of α-fetoprotein in cirrhotic patients monitored for development of hepatocellular carcinoma. Hepatology 1994; 19(1): 61–66.

18. Park GJ, Lin BP, Ngu MC et al. Aspartate aminotransferase : alanine aminotransferase ratio in chronic hepatitis C infection: is it a useful predictor of cirrhosis? J Gastroenterol Hepatol 2000; 15(4): 386–390.

19. Raedle J, Roth WK, Oremek G et al. α-fetoprotein and p53 autoantibodies in patients with chronic hepatitis C. Dig Dis Sci 1995; 40(12): 2587–2594.

20. Stránský J, Vodák M, Zichová M. Vyšetřování alfa-fetoproteinu u chronických nosičů HBsAg. Vnitř Lék 1988; 34(11): 1076–1081.

21. Stránský J, Zichová M, Vodák M. Assessment of alpha-fetoprotein in chronic HBsAg carriers and in HBsAg negative cirrhosis of the liver. Sborn Lék 1993; 94(4): 311–315.

22. Stránský J, Rýzlová M, Stříteský J et al. U chronické infekce virem hepatitidy C (HCV) progresi jaterní fibrózy lépe předpovídá aktivita aspartátaminotransferázy (AST) než alaninaminotransferázy (ALT). Vnitř Lék 2002; 48(10): 924–928.

23. Stránský J, Horák J, Stříteský J. Clinical significance of elevated serum alpha-fetoprotein (AFP) levels in chronic hepatitis C and B. Hepatology 2002; 36(4): 554A (abstrakt 1566).

24. Sugimoto, M., Itsukaichi, T., Ishii, K. et al. Marked increase in serum α-fetoprotein level in cirrhosis: a case report. Amer J Gastroent 1987; 82(1): 69–71.

25. Taketa K. α-fetoprotein. Reevaluation in hepatology. Hepatology 1990; 12(6): 1420–1432.

26. Theise ND, Hytiroglou P, Ferrell L et al. Macroregenerative nodules in cirrhosis are not associated with elevated serum or stainable tissue alpha-fetoprotein. Liver 1995; 15(1): 30–34.

27. Weinberg DS, Malet PF. Chronic hepatitis C and markedly elevated serum α-fetoprotein: complete response to treatment with α-interferon. Amer J Gastroent 1994; 89(8): 1253–1254.

28. Yuen MF, Yuan HJ, Hui CK et al. A large population study of spontaneous HBeAg seroconversion and acute exacerbation of chronic hepatitis B infection: implications for antiviral therapy. Gut 2003; 52(3): 416–419.