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THE SIGNIFICANCE OF CYTOLYSIS SYNDROME IN CHILDREN
The measurement of aminotransferases levels has become part of the routine biochemical tests done in children regardless of their clinical symptoms. Aminotransferases (ALT, AST) are tissue necrosis markers which change in both hepatic and extra-hepatic conditions. The aim of this study was to establish the etiology and clinical significance of the cytolysis syndrome without cholestasis in children hospitalized for various pediatric conditions. The study group consisted of 394 children (aged between 1.5 months and 16 years)with elevated values of ALT, AST. The investigation protocol applied included history, full physical examination, complete biological investigations, viral markers and liver ultrasounds.Depending on the aminotransferases values as compared to the normal value (NV), the patients were included in 3 study subgroups: 222 patients with slightlyelevated transaminases values (< 2xNV) (subgroup I), 164 patients with ALT and AST values between 2-3xNV (subgroup II) and 8 patients with TGP, TGO values > 3 x NV (subgroup III). The ALT and AST values were determined monthly during the first 3 months, and then every 2 to 6 months. In all groups the etiology was dominated by acute bacterial (respiratory, urinary, digestive) and viral (Epstein Barr, Citomegalovirus infection) conditions. Other causes of cytolysis syndrome were nutritional and metabolic diseases (obesity, mellitus diabetes, phenylketonuria, cystic fibrosis, congenital hypotiroidism). The etiology remained unclear in 20.31% of the cases, yet the transaminase values returned to normal after 6 months with diet and hepatoprotective therapy. Slightly elevated ALT andASTvalues do not require thorough investigations, as they usually return to normal within the first three months. On the other hand, mildly and severe increases, which persist after three months therapy require further investigation to determine the etiology (viral infections, autoimmune, nutritional and metabolic diseases).
Key words: aminotransferases, cytolysis syndrome, child