Alanine Aminotransferase as the First Test Parameter for Wilson’s Disease
| Autor: | Tomoo Fujisawa, Yasuaki Tatsumi, Akihiko Okumura, Ayano Inui, Koichi Kato, Hisao Hayashi, Kazumasa Watanabe, Ayako Kato |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Hepatology biology business.industry Wilson’s disease Chronic active hepatitis Ceruloplasmin Disease medicine.disease Gastroenterology Asymptomatic Wilson's disease Internal medicine ATP7B Alanine aminotransferase medicine biology.protein Original Article Liver damage medicine.symptom business |
| Zdroj: | Journal of Clinical and Translational Hepatology |
| ISSN: | 2310-8819 2225-0719 |
| DOI: | 10.14218/jcth.2019.00042 |
| Popis: | Background and Aims: The liver is the first organ affected by toxic copper in the classical and severe hepatic forms of Wilson’s disease (WD). Because their associated chronic liver damage is mostly asymptomatic, an intervention using a special test including serum alanine aminotransferase (ALT) activity is needed for detecting WD. Methods: Using the modified international criteria for the diagnosis of WD, 45 patients were selected from the collective databases of our institutions, and 7 infants were reviewed from the literature. Two patients had the severe hepatic form, with normoceruloplasminemia and no mutations in ATP7B. The rapid ALT change during hemolytic anemia was adjusted for a baseline. The diagnostic potential of the ALT test was assessed from the age-dependent natural course of the liver damage of WD. Results: The natural course had three stages. ALTs were still low in some infants younger than 4 years-old. They were high in all children between the ages of 4 and 8 years-old; then, they reduced to low levels in some patients over 9 years of age. The high ALT stage represents chronic active hepatitis, and the subsequent low ALT stage is due to silent cirrhosis. The hepatic copper content is a reliable but invasive test, while urinary copper secretion is an alternative, non-invasive test for copper toxicosis of WD. The serum ceruloplasmin and ATP7B analyses are subtype tests of WD. The response to anti-copper regimens is the final test result. Conclusions: ALT could be the first parameter to test to detect WD in children between the ages of 4 and 8 years. |
| Databáze: | OpenAIRE |
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