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Association Of Hepatitis G With Unknown Persistent Elevated Liver Enzyme

2465 words - 10 pages

Introduction:
Asymptomatic elevated liver enzyme is a common problem in clinic and will endamege liver in long-term (1). In a survey on 1959 blood donors in Iran, 5.1% affected by asymptomatic elevated liver enzymes, which was persistent in half of them and common diagnosis was non-alcoholic steato-hepatitis (NASH) in 88%, hepatitis C in 7.7%, alcoholic and drug related liver injury in 1.9% (2). Another study on about two thousand people in Golestan province- north of Iran, found out that the prevalence of persistent elevated liver enzyme was 3.1% with unknown etiology in about 80%, hepatitis B in 9.3%, hepatitis C in 6.2%, alcoholic liver and fatty liver disease in 4.6% and 2% , ...view middle of the document...

We aimed to investigate association of HGV infection with unknown persistent elevated liver enzyme.
Materials and Methods:
In a case-control study the patients with persistent elevated serum aminotransferase were evaluated for HGV infection. The Subjects were military staff with elevated liver enzymes documented in health monitoring program of army personnel in Ebne-Sina Army Hospital of Hamadan -west of Iran- during September 2009 -October 2010. Cut off point for elevated liver enzyme was considered equal or more than 40 international unit per liter for alanine aminotransferase (ALT ≥ 40 IU/L) (17). In the first step, as to the previous study in Iran (2, 3, 17, and 18) all of the subjects were evaluated for:
1. Viral hepatitis by detecting of HBs antigen and HCV antibody using ELISA method on 5 ml of serum sample.
2. Non Alcoholic Fatty liver disease (NAFLD) using abdominal sonography by an expert radiologist.
3. History of alcohol or hepatotoxic drug consumption.
4. History of a recent or symptoms/signs of an ongoing infectious process such as cold, fever, sore throat, myalgia, arthralgia, diarrhea, abdominal pain and vomiting.
Items 3 and 4 were evaluated by corresponding author and a trained general physician, co-worker of this survey by history taking and physical examination. By any of above as being excluded from the study.
In the second and final step the remaining subjects were followed for 6 months without any intervention after which the liver enzymes were measured again. The patients with permanent ALT ≥ 40 IU/L were selected as case group. The control group was the patients referred to orthopedic and gynecologic clinics of the same hospital with normal liver function tests in routine labs. After filling in the informed consent form by participants, 5 ml of serum samples from both case and control members were taken and sent to a private laboratory for HGV infection diagnosis, hence they used Cortez 4th generation kit (manufactured in USA) and HGV anti-E2 was detected by ELISA with 99.8% sensitivity. After entering the data in SPSS 18.0 software (USA), it analyzed by Fisher’s exact test, Student’s t-test, and multivariate logistic regression at the 0.05 significance level.
Results:
In the first stage of the study, 173 patients recruited with ALT ≥ 40 IU/L. 58 patients excluded due to exclusion criteria (Figure 1).


Figure 1- Reasons of patients with elevated liver transaminases exclusion (N = 58)

After 6 months follow-up of 115 remained subjects, 35 patients still had ALT ≥ 40 IU/L which were selected as the case group and compared with 59 members of the control group. The mean age of cases and controls were 34.9 ± 8.5 and 40 ± 12.3 years, respectively. Demographic characteristics of study population were as follow (Table 1):

Among the entire cases and controls, there was just one HGV anti E2 positive in the case group (2.9%) whereas all controls were HGV negative. No significant statistic difference of HGV infection was...

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