Radioimmunoassay of serum glycocholic acid, standard laboratory tests of liver function and liver biopsy findings: comparative study of children with liver disease.

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Abstract
Serum glycocholic acid (SGC) was measured by radioimmunoassay in 277 samples from 122 children with hepatobiliary disorders and from 23 healthy age-matched controls, In patients with hepatobiliary disease, the SGC was more frequently abnormal (83%) than values for serum albumin (7%), prothrombin time (17%), bilirubin (22%), alkaline phosphatase (45%), aspartate transaminase (57%) and .gamma.-glutamyl transpeptidase (63%). The cumulative frequency of abnormality of these 6 tests was equal to that of SGC alone. SGC concentrations were raised in 13 patients in whom all other tests of liver function were normal. Two of these had clinical and histological evidence of liver disease, while 4 had biopsy-proven hepatic fibrosis or cirrhosis and 2 of 3 with chronic active hepatitis in remission subsequently relapsed. Four patients have as yet, no other clinical or biochemical evidence of continuing liver disease. SGC was normal in 7 children with abnormal aspartate transaminase or .gamma.-glutamyl transpeptidase in whom there is strong suspicion of significant hepatic disease. A wide range of values of SGC was found with marked overlap between the values found in the different diseases entites studied. The SGC value was related to the serum concentration of aspartate transaminase and .gamma.-glutamyl transpeptidase, but not to other tests of liver function. Serum glycocholic acid concentration was considered in relation to the severity of histological abnormality in 25 percutaneous liver biopsies. The extent of the rise in SGC was related to the presence or degree of histological severity of edema in the portal tracts, disruption of the limiting plate, parenchymal fibrosis and hepatocellular necrosis, but not to other histological features. The very high incidence of abnormal SGC values found in this study does suggest that in an ordinary in-patient and out-patient service SGC determination is a practical and sensitive indicator of the presence of significant liver disease but for its comprehensive identification aspartate transaminase and .gamma.-glutamyl transpeptidase must also be determined.