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Serum glutathione S-transferase B1 activity as an index of liver function in cystic fibrosis
J M Rattenbury1, C J Taylor, P K Heath
1Department of Paediatrics, Children's Hospital, Western Bank, Sheffield.
Insights
Serum glutathione S-transferase B1 (GST B1) may be a superior marker for detecting liver disease in cystic fibrosis (CF) patients compared to traditional liver function tests and ultrasound.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Biochemical Markers
Background:
- Cystic Fibrosis (CF) is associated with an increased risk of liver disease.
- Conventional liver function tests (LFTs) and ultrasound have limitations in early detection.
- Serum glutathione S-transferase B1 (GST B1) is a sensitive indicator of hepatocellular function.
Purpose of the Study:
- To evaluate serum GST B1 as a tool for identifying liver disease in children with CF.
- To compare the efficacy of GST B1 with conventional LFTs and ultrasound.
Main Methods:
- A three-year study involving 60 children with CF.
- Assessment included clinical evaluation, ultrasound, LFTs, and serum GST B1 measurement.
- Reference ranges for GST B1 were established in a pediatric control group.
Main Results:
- Mean serum GST B1 levels were significantly higher in CF patients (9.0 µg/l) than in controls (2.4 µg/l).
- Elevated GST B1 (>4.55 µg/l) was observed in most CF patients with clinical signs of liver dysfunction.
- GST B1 identified hepatic dysfunction missed by conventional LFTs and ultrasound in some patients.
Conclusions:
- Elevated serum GST B1 activity shows promise as a more sensitive predictor of hepatic dysfunction in CF.
- Conventional LFTs and ultrasound have limitations in detecting liver disease in CF patients.
- GST B1 may offer improved early identification of liver complications in CF.
Aims:
To evaluate serum glutathione S-transferase B1 (GST B1), a highly sensitive test of hepatocellular function, as a means of identifying liver disease in patients with cystic fibrosis (CF).
Methods:
The presence of liver disease was sought over a three year period in 60 children with CF, using a combination of clinical assessment, ultrasound examination, conventional biochemical tests of liver function (LFTs), and measurement of GST B1.
Results:
Reference ranges for serum GST B1 were established in a paediatric control population. The 95% value (4.55 micrograms/l) was similar to the upper limit of normal previously derived in adults. Mean (SE) serum GST B1 activities were higher in the CF population (9.0 (1.14) micrograms/l) than in age matched controls (2.4 (0.15) micrograms/l). Ten patients with CF showed clinical signs of liver dysfunction. All but one had a serum GST B1 > 4.55 micrograms/l. Twelve other patients had elevated LFTs without clinically evident liver dysfunction, six had abnormal ultrasound scans and two showed both of these anomalies. Thirty patients with CF had neither biochemical, ultrasonographic nor clinical signs of liver disease. On review three years later, clinically important liver disease was reaffirmed in eight of the 10 index cases and had become apparent in a further eight, all of whom had elevated GST B1 activities. Five (36%) of the patients with elevated LFTs and two (33%) with isolated ultrasound changes continued to show these abnormalities.
Conclusions:
The limitations of conventional LFTs and ultrasound scans were evident from this study. The results suggest that elevated GST B1 activities may be a better predictor of hepatic dysfunction in CF than conventional LFTs.