Serum alpha-fetoprotein levels in patients with chronic hepatitis C - Relationships with serum alanine aminotransferase values, histologic activity index, and hepatocyte MIB-1 scores

Patients with chronic viral hepatitis and cirrhosis often have elevated ser um a-fetoprotein (AFP) values, the causes of which are unclear: We studied 81 patients with chronic hepatitis C and the relationships of serum AFP and alanine aminotransferase (ALT) values, hepatic histologic features, and he patocyte proliferation activity scores. Twenty-two patients had nil to mild fibrosis, 34 had moderate fibrosis, and 25 had marked fibrosis-cirrhosis. The mean serum AFP value was significantly greater in patients with more fi brosis. Serum ALT values were slightly greater in the marked fibrosis-cirrh osis patient group. The differences in the HAI and in hepatocyte MIB-1 scor es were not significant. Among all patients, increasing serum AFP values si gnificantly correlated with increasing ALT values. However, there were no s ignificant correlations with serum ALT or HAI and serum AFP values. There w as no association between serum AFP values and immunohistochemical staining for AFP within hepatocytes. These results suggest that elevated serum AFP values are the result of altered hepatocyte-hepatocyte interaction and loss of normal architectural arrangements. The presence of marked fibrosis or c irrhosis, a state of significant altered hepatocyte architecture, may be th e underlying cause of increased serum AFP, rather than necrosis or active r egeneration.