Four aged female cases of liver cirrhosis probably developed from nonalcoholic steatohepatitis with histologically severe inflammation despite sustained normal serum ALT levels

Abstract

Four cases of liver cirrhosis with sustained normal serum ALT levels underwent liver biopsy for evaluation of etiology. They were all female aged from 60 to 81 (mean 70) year-old. They were all non-alcoholic and obese, and three of them were diabetic. HBs antigen and anti-HCV were negative in all cases. ANA was weakly positive (1 : 40 in three and 1 : 80 in one) and AMA was negative in all cases. Their serum AST/ALT levels (IU/l) were 30/27, 36/17, 33/20 and 47/23, respectively. Platelet counts (×10³/mm³) ranged from 98 to 124, and hyarulonic acid (normal, less than 50 ng/ml) ranged from 135 to 469. CT showed irregular liver surface with nodules formation, and liver biopsy showed active liver cirrhosis (F4/A2-3) in all cases. Although etiology of cirrhosis remained unclear, it was strongly suggested that their cirrhosis was developed from nonalcoholic steatohepatitis. In old female cirrhotic patients, active inflammation may present in such liver presumably developed from nonalcoholic steatohepatitis, even in cases with normal serum ALT levels.