Recently, a friend who likes to run marathons called me and said that because of the epidemic, he had not run several marathons. He had taken a short break for a year. I felt very comfortable after finishing, but a few days later, in the physical examination, I found that the liver function indicator, aspartate aminotransferase, appeared in red.

He had suffered from hepatitis before and was very worried about whether there was a problem with his liver, so he hurried to the hepatobiliary department to register. The doctor looked at his report and asked him if there was any strenuous exercise during his physical examination? He told himself that he had run a long distance, and the doctor said that his abnormal indicators were related to strenuous exercise. Although the doctor said it, he was still worried and asked me if I would really do this. Since this question is asked, let’s talk about it today.

What does abnormal alanine aminotransferase and aspartate aminotransferase mean?

Aspartate aminotransferase (AST or GOT) and alanine aminotransferase (ALT or GPT), commonly known as liver function indexes, are representative indexes showing whether there is inflammation in the liver, so they can also be called liver inflammation indexes. However, the two indices represent different meanings.

Alanine aminotransferase and aspartate aminotransferase are actually an enzyme, which usually exists in liver cells. When the liver is inflamed and liver cells are necrotic, these two enzymes will be released from liver cells into the blood. At this time, the blood test is performed. An index anomaly will be detected. The normal value is generally below 40U/L (the standards of each hospital are slightly different), which can be tested by drawing blood, and the most basic physical examination also includes this test.

Aspartate aminotransferase is also present in muscles and can be elevated with excessive exercise

However, in addition to liver cells, aspartate aminotransferase also exists in muscle (striated muscle), myocardium, and red blood cells, so there are other possibilities for aspartate aminotransferase elevation, which may be hemolysis, overuse of muscles leading to rhabdomyolysis, or even myocardial infarction.

If the result of blood drawing is that only aspartate aminotransferase is elevated, but aspartate aminotransferase is not high (normal), the possibility of hemolysis and myocardial infarction is also ruled out; when the doctor asks, if there has been relatively strenuous exercise before blood drawing, it can almost be inferred It is caused by excessive exercise and muscle damage.

The increase in aspartate aminotransferase caused by muscle damage caused by this strenuous exercise may persist for hours or days, returning to normal as the muscle gradually repairs. Although it is not a problem with the liver, it is not a good thing to cause muscle damage due to excessive exercise. Therefore, it is recommended that you should consider your own physical fitness when exercising in moderation.

Elevated alanine aminotransferase is inflammation of liver cells

On the contrary, if the test result is elevated alanine aminotransferase, regardless of whether the aspartate aminotransferase level is high or not, because alanine aminotransferase only exists in the liver, it can be directly determined that it is caused by inflammatory stimulation of liver cells rather than other organ diseases. If you get such a test report, the next step should be to seek medical attention to find out the cause of liver inflammation.

In China, the most common cause of elevated liver transaminase levels is chronic hepatitis virus, and the second is non-alcoholic fatty liver or alcoholic fatty liver caused by drinking. Other less common factors include infection with hepatitis A virus, autoimmune disease, or eating drugs or foods that can cause liver inflammation.

Abnormal transaminases must seek medical attention to find the cause

What should I do if the liver function transaminase data is elevated? Why is it going up?

If you have this question, the most important thing is to seek the diagnosis and treatment of a hepatobiliary specialist. The doctor will determine why the index will rise, whether it needs treatment or follow-up observation. Don’t guess and judge by yourself, and don’t take certain drugs or foods by yourself. , in an attempt to make the index fall. Because there are many reasons for abnormal liver function index, the treatment methods are different.

For example, if it is hepatitis B virus-induced liver inflammation, it depends on whether it meets the requirements for hepatitis B treatment? If it is caused by hepatitis C virus, it can be treated with oral hepatitis C drugs, and the cure rate is more than 98%. If the doctor evaluates that medication is not necessary for the time being, it is recommended to continue follow-up examinations, follow the time recommended by the doctor for reexamination, and then draw blood to check the value changes. The frequency of examinations also varies from person to person.

A normal transaminase value does not mean that the liver is ok

If the two transaminase indexes are abnormal, you must seek medical attention to find the cause, but what if the indexes are normal? It does not mean that there is no problem with the liver. It is necessary to look at the values ​​of other test items and whether the abdominal ultrasound examination is normal to make a conclusion. In other words, to know whether the liver is healthy or not, it is not enough to just check the liver function.

Clinically, it is true that some lesions have liver fibrosis, liver cirrhosis or liver cancer, but alanine aminotransferase and aspartate aminotransferase do not increase. This is because the current liver cell inflammation problem is just not serious, or even there is no inflammation, so we cannot rely on this alone. The two indexes to judge the health of the liver still need to be matched with abdominal ultrasound and other inspection items.

The severity of liver disease cannot be determined solely by the liver inflammation index

In addition, the higher the transaminase value, does it mean that the liver disease is more serious? Not quite. These two indices are a signal of abnormal health, telling us that liver cells are dying and how serious is the liver disease? It also needs to be combined with other check values.

Liver disease severity was more correlated with the following items, including: Albumin, clotting time

(prothrombin time, PT), total bilirubin (Total Bilirubin), these three are indicators of the severity of liver disease, in addition to the abdominal ultrasound examination to see if there is cirrhosis or liver tumors.

For example, with alanine aminotransferase 600 and 60, which one has more severe liver disease? The answer is not necessarily, it also depends on the total bilirubin value. If the former is lower than the latter, the latter is a more serious problem.

From liver fibrosis to cirrhosis, normal or abnormal transaminases are possible

We often say that hepatitis, cirrhosis, and liver cancer are a trilogy of liver diseases. From hepatitis to cirrhosis, it will go through the process of liver fibrosis. When the inflammation of the liver is severe or has been inflamed for a long time, the human body does not produce normal liver tissue to repair it. Damaged liver replaces normal liver tissue with fibrous tissue, resulting in liver fibrosis. The initial stage of liver fibrosis still has a chance of reversal. Once it progresses to a certain stage, cirrhosis will be formed, which is difficult to reverse at this time, that is to say, once the liver is hardened, it cannot be softened.

However, in the process of liver fibrosis progressing to liver cirrhosis, the liver inflammation may be relieved, so the transaminase released from liver cells is not so much, and the test value will show normal, and it is easy to mislead people at this time. I thought the liver had gotten better. This is why the health of the liver cannot be judged by transaminase alone, nor the severity of liver disease can be judged by the level of these two indices alone.

Therefore, it is necessary to remind patients with chronic viral hepatitis to follow up regularly, and to do a complete liver examination at least every six months, including blood test for liver function, alpha-fetoprotein abdominal ultrasound examination, and taking antiviral drug treatment according to the doctor’s instructions. For patients with hepatitis C, it is recommended to treat as soon as possible. The sooner the hepatitis C virus is eradicated, the risk of liver cirrhosis and liver cancer can be reduced in the future.

In addition, high work pressure and staying up late will cause the liver transaminase index to increase?

Colds, staying up late, heavy workload, not fasting during blood drawing, etc., will not cause abnormal transaminase index, so do not attribute abnormal transaminase index to these factors.