When many people get the results of liver function tests, they find that their transaminases are high and they begin to be nervous, always thinking that they have hepatitis or some more serious liver disease. In fact, elevated aminotransferases do not indicate that you must have hepatitis. So, what causes elevated transaminases? Do further tests need to be done?
Aminotransferase is an aminotransferase present in liver cells. Under normal circumstances, the content of aminotransferase in the blood is relatively low, not more than 40 U / L, after the liver cells are damaged, the aminotransferase will be released into the blood, therefore, elevated aminotransferase can be used as a signal of liver disease. There are many types of transaminases, and the assessment of liver function is mainly based on alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and the normal ratio of the two is about 1.15. ALT is mainly distributed in hepatocyte cytoplasm, AST is mainly distributed in hepatocyte mitochondria, and a few are distributed in cytoplasm. When the causative factors lead to hepatocyte degeneration and increased cell membrane permeability, the main ALT is released from the cells; and when the liver cells are seriously damaged and necrotic, the AST in the mitochondria is released, resulting in a significant increase in serum AST. Therefore, the determination of serum AST, ALT level, and AST/ALT ratio is beneficial for the diagnosis and differentiation of liver dysfunction.
<h1 class="pgc-h-arrow-right" data-track="3" > viral hepatitis</h1>
The elevation of viral hepatitis, ALT and AST in the active phase is more obvious, and the proportion of elevation is often ALT greater than 300U/L, AST is greater than 200U/L, and the ratio of the two is less than 1. In the first 1 to 2 weeks after infection with the hepatitis virus, elevation of transaminases reaches a peak.
In China, due to the high rate of hepatitis B virus infection, so chronic hepatitis B is the main cause of long-term, repeated elevation of transaminases, such patients with elevated transaminases to ALT mainly, and the ratio of AST to ALT is often <1, combined with virological examination is easy to quickly and clearly diagnose. However, it should be noted that the degree of elevated aminotransferases cannot be used as an indicator of the severity of liver function impairment. If there is a mild elevation of transaminases, it is best to add two-and-a-half tests for hepatitis B (hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B e antigen, hepatitis B e antibody, hepatitis B core antibody).
<h1 class="pgc-h-arrow-right" data-track="3" > alcoholic liver</h1>
Long-term drinking of alcohol is very clear for the damage to the liver, after drinking liver function tests will find elevated transaminases. For long-term heavy drinkers, AST/ALT>2 suggests alcoholic liver disease, and AST/ALT>3 is more diagnostic.
Mild fatty liver disease rarely causes liver dysfunction, but cases of elevated aminotransferases in moderate to severe fatty liver disease are common. The possibility of nonalcoholic fatty liver disease should be highly considered when AST/ALT levels are mildly elevated. Unlike alcoholic liver disease, in general, the ALT of nonalcoholic fatty liver disease is higher than the AST level of daily aminotransferases rarely > 300U/L.
<h1 class="pgc-h-arrow-right" data-track="3" > drug-induced liver damage</h1>
Drug-induced liver injury (DILI) refers to liver damage induced by various prescription or over-the-counter chemical drugs, biological agents, traditional Chinese medicines, natural medicines, health care products, dietary supplements and their metabolites and even excipients, also known as drug-induced liver disease. In the course of drug use, DUE to the drug itself and / or its metabolites, or due to the hypersensitivity or tolerability of the drug by a special constitution to lead to the occurrence of DILI, is the most common and serious adverse reaction. Therefore, those who take drugs for a long time need to check liver function regularly. Most patients have complete recovery of liver function after discontinuation of liver-injury drugs.
<h1 class="pgc-h-arrow-right" data-track="3" > serious infection</h1>
Some serious infectious diseases or ischemic diseases can cause elevated aminotransferases, such as tuberculosis, myocarditis, hyperthyroidism, influenza, pyelonephritis, etc., but most of these conditions will be accompanied by some more serious symptoms.
In addition, staying up late, overworking, or exercising can lead to elevated transaminases, which are physiological.
In short, when the transaminases are found to be elevated, do not rush to the conclusion of "liver disease", first recall whether you have excessive exercise, drinking, taking medicine and other phenomena before the examination, or combine whether you have a history of hepatitis. If it is only slightly elevated, it can be rechecked again after a week of light diet, alcohol cessation, smoking cessation, regular work and rest, and it can also be combined with liver color ultrasound after the elevation is found to see if there is tumor, cirrhosis, fatty liver or gallbladder disease.
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