Introduction

Alpha- fetoprotein, glycoprotein (MW 7000) that is synthesized in yolk sac in early fetal life. The serum level begins to fall before birth and reach a value of less than 10ng/ml within first few weeks of life. Serum AFP can be elevated in some disease state particularly hepatocellular carcinoma (HCC). The aim of the study was to establish any correlation of AFP level and selected test of liver cell function and integrity measured serially in patients with acute viral hepatitis. Each liver function test by itself is neither highly specific nor specific but when interpreted together may provide the clinician with useful information about patient’s liver and may also indicate other health issue such as malnutrition and bone disease. As the liver is involved in excretory, synthetic and metabolic functions. LFT may be ordered by clinicians as a standard order for nonspecific symptoms. LFTs are commonly used in clinical practice to screen for liver disease, monitor the progression of known disease and monitor the effect of potentially hepatotoxic drugs. Alanine transaminase (ALT) and aspartate transaminase (AST) are sensitive indicators of hepatocellular injury, but they lack specificity as they are also present in muscle (cardiac and skeletal).1 In hepatocyte cytoplasm AST is more abundant than ALT. In plasma AST is cleared more rapidly (t1/2 16-18 hours) than ALT (t1/2 42-48 hours). These aminotransferases may be increased in patients presenting with cirrhosis, alcoholic hepatitis, viral hepatitis and cholestasis. Albumin and prothrombin reflect liver synthetic function. The aminotransferases AST and ALT are normally <30-40 units/l. Elevation of amino transferases greater than eight times the upper limit of normal reflect either acute viral hepatitis, ischemic hepatitis or drug or toxin induced liver injury. ALP (alkaline phosphatase) is a hydrolytic enzyme serine protease acting optimally at pH 10. ALT catalyzes reversible transamination between L-alanine and alpha-ketoglutarate to form pyruvate and L-glutamate as such having an important role in gluconeogenesis and amino acid metabolism. The reaction is reversible but equilibrium of ALT reaction favours the formation of L-alanine. ALT enzyme activity is primarily found in liver but its activity although much lower. HCC is the fifth most common cancer worldwide and a leading cause of cancer death2 The incidence of HCC is two to three-fold higher among men than it is among women. The major risk factor for development of HCC is infection with HBV or HCV.1 Clinical features of HCC usually do not occur until late in course of disease, when the tumor is large and resection is impossible.3 Nonspecific signs and symptoms such as fever, malaise, anorexia and anemia are common and jaundice may occur with central tumor that obstruct biliary drainage. Treatment is usually not possible with advanced HCC, there has been much interest in screening high risk individuals. Small tumors detected by screening may be treatable by resection of part of the liver or liver transplantation.4 The most common screening programs use plasma tumor markers or imaging studies. The most widely used tumor marker is AFP. Recently more specific L3 isoform has also been used.5 Use of higher cut off value of AFP than upper reference limit improves clinical specificity of total AFP at expense of clinical sensitivity.6 Tumors often produce one or another tumor marker.

Materialsa and Methods

Direct enzymatic colorimetric method is mainly used in the clinical test.

Result & Discussion

Figure 1

The graph marked with ** indicate they are statistically significant to the study (p value<0.05 for AFP and p value<0.001 for other parameters

HCC is the fifth most common cancer worldwide and a leading cause of cancer death. Treatment is usually not possible with advanced HCC occurs due to failure of not doing proper screening at appropriate time. Small tumors detected by screening may be treatable by resection of part of liver or liver transplantation.7 The most common screening programme use plasma tumor markers or imaging studies.8 The most widely used tumor marker is AFP. Use of higher cutoff value of AFP than upper reference limit improves clinical specificity of total AFP at expense of clinical sensitivity. In the case control study of serum AFP level on liver function parameters where elevated level of AFP (p value <0.05), SGOT (p value <0.001), SGPT (p value <0.001), ALP (p value <0.001) in liver disease patients.

AFP as a biomarker in early diagnosis of HCC concluded that HCC is characterized by more in male incidence than female.

From the graph it is clear that there is marked elevation in the mean of ALP, SGPT, SGOT and ALP in HCC patients than control patients.

Our results also indicated a risk of developing HCC with respect to AFP level in liver disease patients with elevated liver function parameters.

In early findings also reported that AFP is useful not only for diagnosis but also a prognostic indicator in patients with HCC.2

Clinical utility of AFP –L3 where incidence of HCC was significantly higher in patients with elevated AFP-L3% than in those with elevated AFP.9

Conclusion

50 hepatocellular carcinoma patients and 40 control subjects were studied. From the study it is concluded that LFT and AFP are comparatively elevated in HCC.10 Treatment is usually not possible with advanced HCC due to failure of not doing proper screening at appropriate time which is rectified by early diagnosis and monitoring of HCC are possible with the help of tumor marker AFP.11

Source of Funding

None.

Conflict of Interest

None.