What do elevated enzymes mean? What are liver enzymes, and what does their increased concentration in the blood indicate? Enzyme activity in various pathologies of the liver and biliary tract

Blood tests for liver enzymes are performed very often. This is not surprising, because the liver is one of the largest glands in the human body. She takes part in metabolic processes, blood purification from toxins and poisons is carried out, control over the biochemical process set is carried out. Most of these changes occur due to enzymes that are synthesized by the liver.

The presence of liver enzymes in the blood is constant. They are indispensable to humans. If the human body is affected by some kind of pathology, then enzymes show an increase or decrease, which is very important. Biochemistry for presence liver enzymes required for differential diagnosis.

Before moving on to blood tests for enzymes, it is worth understanding what it is. What plasma enzymes are generally secreted. Enzymes are used by the human body to carry out metabolic processes. Contains enzymes in the hepatobiliary system. Due to the presence of microsomal liver enzymes on a permanent basis, the organ functions normally.

Mitochondria contain enzymes that are important for the liver in terms of energy metabolism. For the most part, enzymes can be broken down; in part, excrement components, such as bile, are used for excretion.

Blood biochemistry is able to determine the performance of a particular enzyme. You can perform such biochemical studies at any time. Blood can also be checked with special rapid tests. On this moment such biochemistry is important because enzyme tests are needed to draw the clinical picture.

Against the background of a number of diseases, an increase in liver enzymes or their decrease can be observed. Since the liver performs a variety of functions, it is not surprising that enzymes are different. Three options can be distinguished, varying in the field of activity:

secretory;
excretory;
indicator.

Speaking of the first type of enzymes, it is represented by two types. These are prothrombinase and cholinesterase. Enzymes of this group work with blood. The norm is determined during folding. If the plasma enzymes of this type are lowered, you should pay attention to possible problems with cookies gallbladder or its channels.

Only alkaline phosphatase can be attributed to the second type. These enzymes are released along with bile, which means that the output is carried out in the form of a stool. When alkaline phosphatase is increased, it is worth considering checking the bile ducts.

Blood enzymes of the indicator type can rise sharply against the background of the destruction of hepatocytes. We are talking about liver cells, which, under the influence of a number of diseases, cease to exist. This type includes such variants as AST, ALT, GGT, LDH and GlDH. These substances are present in the cytosol or mitochondria. AST and ALT can also be considered microsomal liver enzymes. However, not all enzymes have diagnostic value.

Most often, biochemistry determines AST, ALT, GGT, LDN and alkaline phosphatase in the blood. The rate of these substances can tell a lot about the state of affairs. An analysis for pancreatic or liver enzymes should be deciphered by a doctor who, taking into account the data obtained, will immediately make a diagnosis or send you for additional examinations. Usually this is an ultrasound or x-ray, maybe a stool test. In severe cases, a hepatic puncture may be required.

When some liver enzyme increased, but the norm is not seriously exceeded, and biochemistry found a single deviation, about any terrible diagnosis there is no speech. Perhaps you recently ate something of poor quality or drank alcohol. If there is a regular drug treatment, it affects the liver, affecting the level of the enzyme. You need to start worrying if high rate revealed by the results of the study.

Why Enzymes Grow

An increase in liver enzymes can be due to many reasons. Doctors speak of a small increase as a fluctuation that is natural, which can be explained by drug therapy or the use of low-quality products. Liver in human body can be considered a kind of biochemical laboratory that immediately responds to any changes environment, intake of poor-quality food or water.

However, it is important to emphasize that quite often, especially if the indicators have increased several times, we are talking about the presence of some kind of liver disease. Due to biochemical studies, doctors can more accurately isolate the factor that provoked the corresponding changes.

It happens that with the growth of liver enzymes, people are faced with the course of treatment with drugs that are detrimental to the liver. These can be painkillers or statins, which help the blood to remove excess cholesterol from the body. Alcohol is also considered a factor that increases such indicators, especially if it is used often and uncontrollably. Against the background of obesity, an increase in the corresponding substances can also occur.

If, after passing the tests, a significant increase in alanine aminotransferase, indicated by a reduction in ALT, is indicated as a result, then we can talk about improper hepatic or pancreatic glandular work. These are hepatitis, pancreatitis, alcohol intoxication. In addition, a number of ailments of an oncological nature have such a picture.

Elevated levels of aspartate aminotransferase or AST can tell the doctor about problems with the skeletal muscles or myocardium. Patients often come with a corresponding mark in the test results, survivors of myocardial infarction, myocarditis infectious nature or myopathy.

With a simultaneous increase in both indicators, the reason may lie in the intake of a number of drugs and drugs plant origin. This situation is faced by people sitting on statins, sulfonamides and paracetamol. Some plants cannot be excluded from risk factors. These are skullcap, Alexandrian leaf and ephedra.

What pregnant women need to know

When liver enzymes are elevated during pregnancy, indicators are not always about some kind of pathology. The thing is that during the period of gestation female body undergoing major changes. The mother's organs have to work on two fronts, which affects their condition.

During pregnancy, ALT and AST can reach up to 31 U / l. If toxicosis is present at the same time, then in the period from 28 to 32 weeks there is an increase in these numbers. Usually the first two trimesters now and then show a slight overstepping, but this is not considered a problem. Everything is explained increased load on the liver.

In this case, GGT indicators can reach up to 36 U / l. In the period from 12 to 27 weeks of pregnancy, there is some increase, which is considered normal. At strong increase level, inflammation in the liver or pathology of the biliary system may be present, and gestational diabetes mellitus is also expressed.

Talking about the norm alkaline phosphatase, its level can reach up to 150 units. At the same time, against the background of active fetal growth, which starts from the 20th week until the moment of delivery, there is a slight increase in numbers. A serious change in the level of alkaline phosphatase is observed when taking a large amount of ascorbic acid, drugs antibacterial spectrum, with a lack of calcium and phosphorus in the body.

What to do when you get promoted

An increase in any of the liver enzymes can only be considered as a symptom, and not as a direct pathology that requires treatment. In most cases, the doctor can easily determine the root cause of the increase and select measures that can correct this indicator.

If you passed blood biochemistry as a preventive measure, and it showed an increase in enzymes, then you should go for a consultation with a therapist. Your doctor may recommend additional tests to determine the underlying cause.

First of all, regardless of the cause, the patient will be advised to correct his nutritious diet. The main task of such a therapeutic diet is to reduce the load on the liver, reduce the level of body fat in it, remove toxins and toxins.

For a liver diet, an increased amount of vegetables is important. You can make salads from spinach, kale, greens. It is important to adjust the amount of foods that contain antioxidants. Add avocados and some nuts to your usual diet, the liver will be grateful to you.

The daily menu should contain at least 50 grams of dietary fiber. It's about fiber. With the help of such substances, the body is able to eliminate "bad" cholesterol and normalize the functioning of the biliary system. A lot of fiber contains fruits, nuts, cereals, legumes.

As part of treatment, it is important to receive and enough squirrel. The fact is that it is the substances of the protein order that are considered the necessary basis, which allows you to restore damaged hepatocytes. However, the doctor must deal with the definition of a specific protein norm. It is important in the process of treatment to adhere to the correct drinking regime. Drink up to two liters of fluid per day.

enzymes

By the activity of which one can judge the state of the entire organ. Determination of the activity of enzymes that are associated with the work of the liver is called

enzyme diagnostics liver diseases.

Types of changes in enzyme activity in various diseases There are three main types of changes in enzyme activity that are characteristic of all types of general pathological processes in the body:

increased activity of enzymes that are constantly present in the blood
a decrease in the activity of enzymes that are constantly present in the blood
the appearance in the blood of enzymes that are normally absent

What enzymes are used to diagnose diseases of the liver and biliary tract The state of the liver can be assessed by the following enzymes:

aminotransferases (AST and ALT)
lactate dehydrogenase (LDH)
alkaline phosphatase (AP)
glutamate dehydrogenase (GlDH)
sorbitol dehydrogenase (SDH)
γ-glutamyltransferase (GGT)
fructose monophosphate aldolase (FMPA)

Sensitivity of enzyme diagnostics in liver diseases The high sensitivity of enzyme diagnostics is explained by the fact that the concentration of the enzyme in liver cells ( hepatocytes) is 1000 times higher than in blood. Enzymodiagnostics has importance to detect liver damage without jaundice (eg, drug damage, anicteric viral hepatitis, chronic liver disease).
Types of enzymes - membrane, cytoplasmic and mitochondrial

Enzymes can be located in the membrane, cytoplasm or mitochondria of hepatocytes. Each enzyme has its own strict place. Easily damaged enzymes are found in the membrane or cytoplasm of hepatocytes. This group includes lactate dehydrogenase, aminotransferases and alkaline phosphatase. Their activity increases in the clinically asymptomatic phase of the disease. With chronic liver damage, the activity of mitochondrial enzymes increases (

mitochondrion- cell organelle), which include mitochondrial AST. With cholestasis, the activity of bile enzymes, alkaline phosphatase, increases.

Alanine aminotransferase (ALT, AlAT) - normal, result in liver diseases

The normal activity of ALT in the blood of men is 10-40 U / l, in women - 12-32 U / l.

antibiotics

A sharp increase in ALT activity by 5-10 times or more is an undoubted sign of acute liver disease. Moreover, such an increase is detected even before clinical symptoms appear (jaundice, pain, etc.). An increase in ALT activity can be detected 1-4 weeks before the onset of the clinic and appropriate treatment can be started, preventing the disease from developing fully. The high activity of the enzyme in this acute illness liver after manifestation clinical symptoms does not last long. If normalization of enzyme activity does not occur within two weeks, this indicates the development of massive liver damage.

Determination of ALT activity is a mandatory screening test for donors.

Aspartate aminotransferase (AST, AST) - norms, result in liver diseases The maximum activity of AST was found in the heart, liver, muscles and kidneys. Normal at healthy person AST activity is 15-31 U/l in men and 20-40 U/l in women.

AST activity increases with necrosis of liver cells. Moreover, in this case, there is a directly proportional relationship between the concentration of the enzyme and the degree of damage to hepatocytes: that is, the higher the activity of the enzyme, the stronger and more extensive the damage to hepatocytes. An increase in AST activity also accompanies acute infectious and acute toxic hepatitis (poisoning with heavy metal salts and some drugs).

The ratio of AST/ALT activity is called de Ritis coefficient. The normal value of the de Ritis coefficient is 1.3. With liver damage, the value of the de Ritis coefficient decreases.

Detailed information about biochemical analysis blood for enzymes, read the article: Blood chemistry

Lactate dehydrogenase (LDH) - the norm, the result in liver diseases LDH is a widespread enzyme in the human body. The degree of its activity in various bodies in descending order: kidneys>heart>muscles>pancreas>spleen>liver>serum. There are 5 isoforms of LDH present in the blood serum. Since LDH is also found in erythrocytes, the blood for the study should not contain traces of hemolysis. In plasma, LDH activity is 40% lower than in serum. The normal activity of LDH in the blood serum is 140-350 U / l.

In what pathologies of the liver is the content of isoforms increased Due to the wide prevalence of LDH in various organs and tissues, an increase in the total activity of LDH does not of great importance for differential diagnosis various diseases. For diagnostics infectious hepatitis use the determination of the activity of LDH isoforms 4 and 5 (LDG4 and LDH5). In acute hepatitis, LDH5 activity in blood serum increases in the first weeks. icteric period. An increase in the total activity of LDH4 and LDH5 isoforms is detected in all patients with infectious hepatitis in the first 10 days. At cholelithiasis without blockage of the bile ducts, no increase in LDH activity was detected. With myocardial ischemia, there is an increase in the activity of the total fraction of LDH due to the phenomenon of stagnation of blood in the liver.

Alkaline phosphatase (AP) - the norm, the result in liver diseases Alkaline phosphatase is located in the cell membrane of the tubules of the bile ducts. These cells of the tubules of the bile ducts have outgrowths that form the so-called brush border. Alkaline phosphatase is located in this brush border. Therefore, when the bile ducts are damaged, alkaline phosphatase is released and enters the bloodstream. Normally, the activity of alkaline phosphatase in the blood varies depending on age and gender. So in healthy adults, the activity of alkaline phosphatase lies in the range of 30-90 U / l. The activity of this enzyme increases during periods of active growth - during pregnancy and in adolescents. Normal indicators of alkaline phosphatase activity in adolescents reach 400 U / l, and in pregnant women - up to 250 U / l.

In what pathologies of the liver is the content of With the development of obstructive jaundice, the activity of alkaline phosphatase in the blood serum increases by 10 or more times. Determination of ALP activity is used as a differential diagnostic test of obstructive jaundice. A less significant increase in the activity of alkaline phosphatase in the blood is also detected in hepatitis, cholangitis, ulcerative colitis, intestinal bacterial infections and thyrotoxicosis.

Glutamate dehydrogenase (GlDH) - the norm, the result in liver diseases Normally, glutamate dehydrogenase is present in the blood in small amounts, since it is a mitochondrial enzyme, that is, it is located intracellularly. The degree of increase in the activity of this enzyme reveals the depth of liver damage.

An increase in the concentration of glutamate dehydrogenase in the blood is a sign of the onset of dystrophic processes in the liver caused by endogenous or exogenous factors. TO endogenous factors include liver tumors or liver metastases, and exogenous - toxins that damage the liver ( heavy metals, antibiotics, etc.), and infectious diseases.

Schmidt coefficient Together with aminotransferases, the Schmidt coefficient (KSH) is calculated. KSh \u003d (AST + ALT) / GlDG. With obstructive jaundice, the Schmidt coefficient is 5-15, with acute hepatitis - more than 30, with metastases of tumor cells in the liver - about 10.

Sorbitol dehydrogenase (SDH) - the norm, the result in liver diseases Normally, sorbitol dehydrogenase is detected in the blood serum in trace amounts, and its activity does not exceed 0.4 U/L. The activity of sorbitol dehydrogenase increases 10-30 times in all forms of acute hepatitis. Sorbitol dehydrogenase is an organ-specific enzyme that reflects damage to hepatocyte membranes during primary development acute process or exacerbation of a chronic one. γ-glutamyltransferase - norms, in which liver pathologies the content is increased This enzyme is found not only in the liver. The maximum activity of γ-glutamyltransferase is detected in the kidneys, pancreas, liver and prostate. In healthy people, the normal concentration of γ-glutamyltransferase in men is 250-1800 nmol / l * s, in women - 167-1100 nmol / s * l. In newborns, the activity of the enzyme is 5 times higher, and in premature babies it is 10 times higher.

The activity of γ-glutamyltransferase increases in diseases of the liver and biliary system, as well as in diabetes. The highest activity of the enzyme accompanies obstructive jaundice and cholestasis. The activity of γ-glutamyl transferase in these pathologies increases by 10 or more times. When the liver is involved in a malignant process, the activity of the enzyme increases by 10-15 times, in chronic hepatitis - by 7 times. γ-glutamyl transferase is very sensitive to alcohol, which is used for differential diagnosis between viral and alcoholic liver lesions.

Determination of the activity of this enzyme is the most sensitive screening test, which is preferable to the determination of the activity of aminotransferases (AST and ALT) or alkaline phosphatase.

Informative determination of the activity of γ-glutamyltransferase and liver diseases in children.

Fructose-monophosphate-aldolase (FMFA) - the norm, the result in liver diseases

It is normally found in trace amounts in the blood. Determination of FMFA activity is used to diagnose acute hepatitis. However, in most cases, the determination of the activity of this enzyme is used to identify occupational pathology in people who work with chemicals that are toxic to the liver.

In acute infectious hepatitis, the activity of fructose-monophosphate-aldolase increases tenfold, and when exposed to toxins in low concentrations (chronic poisoning toxins) - only 2-3 times.

Enzyme activity in various pathologies of the liver and biliary tract The ratio of increases in the activity of various enzymes in some pathologies of the liver and biliary tract presented in the table.

Note: - slight increase in enzyme activity, - moderate, - strong rise enzyme activity, - no change in activity.

Read more about liver diseases in the articles: Hepatitis, Cholelithiasis, Cirrhosis of the liver So, we have reviewed the main enzymes, the determination of the activity of which can help in the early diagnosis or differential diagnosis of various liver diseases. Unfortunately, not all enzymes are used in clinical laboratory diagnostics, thereby reducing the range of pathologies that can be detected in the early stages. Given the pace of development of science and technology, it is possible that in the coming years, methods for determining certain enzymes will be introduced into the practice of medical and diagnostic institutions of a wide profile.

How is a biochemical blood test for the liver performed? This question is often asked by patients.
The liver performs a number of important functions in the human body. Thanks to his anatomical structure it carries out a large number of biochemical reactions. The process of synthesis and excretion takes place in the liver a large number enzymes, the activity of which can be used to draw a conclusion about the work of the whole organism.

Arises increased activity enzymes present in the blood.
In the blood, a decrease in the state of enzyme activity can be observed.
Liver enzymes cannot be detected in the blood in a laboratory analysis, that is, all indicators are normal.

Types of blood tests for enzymes

To diagnose liver disease, the patient needs to donate blood for this type of enzyme study:

Aminotransfers.
Lactate dehydrogenase.
Alkaline phosphatase.
Glutamate dehydrogenase.
Sorbitol dehydrogenase.
Y-glutamyltransferase.
Fructose monophosphate aldolase.

Enzymes can be located anywhere in an organ, for example, in the membrane, cytoplasm, or mitochondria of hepatocytes. But it is worth remembering that everyone has their own habitat. If there is a slight damage to the enzyme in the membrane or cytoplasm, then this case includes the appearance of indicators such as lactate dehydrogenase, aminotransferase and alkaline phosphatase.

In the chronic process of liver damage, their activity increases, which leads to the formation of mitochondria, that is, cell organelles. During cholestasis, there is a process of increasing the activity of bile enzymes, that is, alkaline phosphatase.

Before a patient takes a biochemical blood test for research, it is necessary to follow a number of clear rules before the procedure.

The blood sampling process itself takes about 2 minutes, and pain he won't deliver to you. To accurately determine the outcome of the laboratory research you need to follow the following rules:

A biochemical blood test for the liver is taken on an empty stomach.
During dinner before the day of blood donation, you can not drink coffee and tea, and 2 days before the date of the scheduled procedure, it is not recommended to eat fatty foods and drink alcoholic beverages.
On the eve of the test, it is not recommended to visit baths and saunas, try to avoid heavy loads.
A blood test should be taken in the early morning before the start of medical procedures.
As soon as you crossed the laboratory, then try to sit for 15 minutes before taking the analysis. This is necessary so that the body can return to normal and calm down.
In order for the analysis to obtain correct data on the content of sugar in the blood, the doctor must warn the patient that you can not brush your teeth, drink tea in the morning.
Try to refrain from drinking coffee in the morning.
Try to stop taking hormonal, antibiotics and diuretics, as well as other medications the day before.
14 days before the biochemical blood test, you can not take drugs that help reduce the concentration of lipids in the blood.
If it happens that you are required to retake the test, then try to do it where you already took it.

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Indicators of liver enzymes in the blood

Aminotransfers. This indicator displays problems in the heart, kidneys and liver. Aminotransfer is considered a normal activity factor in the male population from 15 to 31 U / l, and in the female - 20-40 U / l. The activity of such enzymes is observed during the development of liver necrosis. If this indicator goes off scale, then this means that extensive damage to hepatocytes occurs. Increased activity is observed in infectious and acute toxic hepatitis. The ratio of this type of enzyme is usually called the de Ritis ratio. If such indicators are present in the liver, then this may indicate that the organ is significantly damaged.

Lactate dehydrogenase. This type of enzyme is very well distributed in the human body. It can be found in blood serum, mainly this indicator for serum is 5 isoforms. This indicator is contained in erythrocytes, and the normal indicator for this environment is from 140 to 350 U / l.
With acute hepatitis, a process of isoform activity occurs, and such an indicator can be easily seen in the first 10 days upon detection of this disease. If the patient suffers from cholelithiasis, then the activity of lactate dehydrogenase in the blood will practically not be visible.

Alkaline phosphatase. The level of such an indicator directly depends on the age, gender and condition of the patient. In healthy people, the level of this enzyme ranges from 30 to 90 U/L. But during pregnancy and transitional age adolescents are in the process of their growth. So, in adolescents, the level of alkaline phosphatase reaches up to 400 U / l, and in pregnant women - 250 U / l.

Glutamate dehydrogenase. This enzyme is found in the liver minimum quantity, and by its presence it is possible to determine the degree of disease of the organ. If there is an increase in the concentration of the enzyme, this may indicate that the process of organ dystrophy begins. One of these indicators is the Schmidt coefficient, it is calculated by the formula:

Schmidt coefficient = (Aminotransfers + Lactate dehydrogenase) / Glutamate dehydrogenase.

During the manifestation of jaundice, its rate is from 5 to 15 U / l, acute hepatitis - more than 30, with metastases - up to 10.

Sorbitol dehydrogenase. Normally, this indicator has a value of up to 0.4 U / l. If an increase in such an enzyme many times over is found, then this means the development of acute hepatitis.

Y-glutamyltransferase. In a healthy person, this indicator is equal to: in men - from 250 to 1800, and in women - 167-1100 nmol / s * l. In newly born children, this indicator exceeds the norm by 5 times, and in premature babies - by 10 times.

Fructose monophosphate aldolase. This indicator occurs in large quantities. Determination of its activity occurs during the diagnosis of acute hepatitis. Very often, this indicator is used to determine the pathology of people working with toxic and chemical substances. During the development of infectious hepatitis, this indicator increases tenfold, and during exposure to toxins, it decreases from 2 to 3 times.

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Thymol blood test for the liver

This type of diagnosis is a biochemical test that can be used to determine the ability of the liver to synthesize protein.

Mostly large cluster Plasma proteins can be found in the liver. With the help of them, the liver is able to perform a number of functions:

Protein is able to maintain the correct blood pressure, as well as its constant volume in the body.
He certainly takes part in blood clotting.
It is capable of transporting cholesterol, bilirubin, and medicinal medicines- salicylates and penicillin.

A valid value is the result of the analysis from 0 to 5 units. In the process of developing an organ disease, this indicator can increase tenfold. In the very first moments of the development of the disease, it is necessary to do a blood test, this moment must also be taken into account in the icteric condition of the skin. With the development of hepatitis A, this figure increases significantly.

During development toxic hepatitis thymol test will be positive. This occurs due to the fact that the process of damage to the liver tissue occurs, and therefore there is a toxic effect of substances on the liver. In cirrhosis, liver cells are replaced connective tissue, there is a violation of the function of the entire organ and its protein-synthetic ability. At this point, the biochemical test is positive.

During obstructive jaundice, there is a violation of the outflow of bile. In this case, the thymol test shows a negative result. If during the development of the disease the liver tissue is affected, then such a test becomes positive.

The liver performs neutralizing, protein-synthetic and other functions. With her diseases, her activity changes. With the destruction of part of the hepatocytes (liver cells), the enzymes contained in them enter the bloodstream. All these processes are reflected in the biochemical study of the so-called liver tests.

Main functions of the liver

The liver is a vital organ. If its functions are violated, the whole organism suffers.

The liver performs vital functions, in particular:

deletes harmful substances from the blood;
converts nutrients;
saves useful minerals and vitamins;
regulates blood clotting;
produces proteins, enzymes, bile;
synthesizes factors to fight infection;
removes bacteria from the blood;
neutralizes toxins that have entered the body;
maintains hormonal balance.

Liver disease can significantly undermine human health and even cause lethal outcome. That is why it is necessary to consult a doctor in time and pass an analysis for liver tests when such signs appear:

weakness;
fast fatiguability;
unexplained weight loss;
icteric shade of the skin or sclera;
swelling of the abdomen, legs and around the eyes;
darkening of urine, discoloration of feces;
nausea and vomiting;
permanent liquid stool;
heaviness or pain in the right hypochondrium.

Indications for research

Liver tests provide information about the condition of the liver. They are defined in the following cases:

diagnosis of chronic diseases, such as hepatitis C or B;
monitoring for possible side effects of certain medications, particularly antibiotics;
monitoring the effectiveness of therapy for already diagnosed liver disease;
determination of the degree of cirrhosis of this organ;
the patient has heaviness in the right hypochondrium, weakness, nausea, bleeding and other symptoms of liver pathology;
necessity surgical treatment for any reason, as well as pregnancy planning.

Many studies are used to evaluate liver function, but most of them are aimed at determining any one function, and the results do not reflect the activity of the entire organ. That is why the following liver tests have received the greatest use in practice:

alanine aminotransferase (ALT or ALT);
aspartate aminotransferase (AST or AST);
albumen;
bilirubin.

The level of ALT and AST increases when the liver cells are damaged as a result of the disease of this organ. Albumin reflects how well the liver synthesizes protein. The level of bilirubin shows whether the liver copes with the function of detoxifying (neutralizing) toxic metabolic products and removing them with bile into the intestines.

Changes in liver tests do not always mean that the patient has a disease of this organ. Only a doctor can evaluate the result of the analysis, taking into account complaints, anamnesis, examination data and other diagnostic tests.

Most common liver tests

ALT and AST are the most important indicators that allow, in combination with the patient's complaints and data from other research methods, to evaluate the work of the liver.

Liver tests are the determination of specific proteins or enzymes in the blood. A deviation from the norm of these indicators may be a sign of liver disease.

ALT

This enzyme is found inside hepatocytes. It is necessary for protein metabolism, and when cells are damaged, it enters the bloodstream. Its increase is one of the most specific signs of the breakdown of liver cells. However, due to the characteristics laboratory determination not with all pathology, its concentration increases. So, in persons with alcoholism, the activity of this enzyme is reduced, and the analysis yields false normal values.

AST

In addition to hepatocytes, this enzyme is present in the cells of the heart and muscles, so its isolated determination does not provide information about the state of the liver. Most often, not only the level of AST is determined, but also the ratio of ALT / AST. The latter indicator more accurately reflects damage to hepatocytes.

Alkaline phosphatase

This enzyme is found in the cells of the liver, bile ducts and bones. Therefore, its increase may indicate damage not only to hepatocytes, but also to blockage of the bile ducts or, for example, a fracture or bone tumor. It also rises during the period of intensive growth in children; an increase in the concentration of alkaline phosphatase is also possible during pregnancy.

Albumen

It is the main protein synthesized by the liver. It has many important features, such as:

keeps fluid inside blood vessels;
nourishes tissues and cells;
transports hormones and other substances throughout the body.

A low level of albumin indicates an impaired protein-synthetic function of the liver.

Bilirubin

The concept of "total bilirubin" includes the sum of indirect (non-conjugated) and direct (conjugated) bilirubin. During the physiological breakdown of red blood cells, the hemoglobin contained in them is metabolized with the formation of indirect bilirubin. It enters the liver cells and is neutralized there. In hepatocytes, indirect bilirubin is converted into harmless direct bilirubin, which is excreted in the bile into the intestine.

An increase in indirect bilirubin in the blood indicates either an increased breakdown of red blood cells (for example, with hemolytic anemia), or a violation of the neutralizing function of the liver. An increase in the content of direct bilirubin is a sign of impaired patency of the biliary tract, for example, gallstone disease, when part of this substance does not come out with bile, but is absorbed into the blood.

Execution of the study

If necessary, the doctor gives special instructions about which drugs should be stopped before taking a blood test. It is usually recommended not to take for 2-3 days oily and fried food, if possible, refuse to take medication.

Blood sampling is carried out in the treatment room from the cubital vein in the usual way.

Complications are rare. After taking a blood sample, you may experience:

hemorrhage under the skin at the site of the vein puncture;
prolonged bleeding;
fainting;
infection of the vein with the development of phlebitis.

After taking blood, you can lead a normal life. If the patient feels dizzy, it is better for him to rest a little before leaving the clinic. The test results are usually ready the next day. According to these data, the doctor will not be able to say exactly what kind of liver disease is present, but he will draw up a further diagnostic plan.

Evaluation of results

In the form of a blood test, the concepts of "general", "indirect", "direct bilirubin" may appear. Deviation from the norm of any of the indicators is a sign of some pathological process in the liver or the body as a whole.

The normal content of the studied parameters may differ in different laboratories and is noted on the result form. However, there are guidelines.

ALT: 0.1-0.68 µmol/L or 1.7-11.3 IU/L.
AST: 0.1-0.45 µmol/l or 1.7-7.5 IU/l.

The reasons for the increase in the level of both enzymes:

sharp or chronic hepatitis, cirrhosis, fatty degeneration of the liver;
inflammation of the bile ducts;
obstructive jaundice (for example, with cholelithiasis);
cancer or toxic injury this body;
acute fatty degeneration in pregnant women;
severe burns;
hemolytic anemia;
Infectious mononucleosis;
side effects of anticoagulants, anesthetics, oral contraceptives;
muscle injury, dermatomyositis, myocardial infarction, myocarditis, myopathies.

Causes of an increase in ALT with a normal or slightly elevated level of AST:

infarction of the lung or mesentery;
acute pancreatitis;
the action of chloroform, carbon tetrachloride, vitamin C, dopegyt, salicylates and the poison of the pale toadstool.

The ratio AST / ALT is called the de Ritis coefficient, it is equal to 1.33. In case of liver pathology, it decreases, in diseases of the heart and muscles it increases by more than 1.

Alkaline phosphatase: 0.01-0.022 IU/l.

Reasons for the increase:

hepatitis, cirrhosis, liver cancer;
cholangitis;
neoplasm of the gallbladder;
liver abscess;
primary biliary cirrhosis;
metastatic liver disease;
bone fractures;
hyperparathyroidism;
Cushing's syndrome;
Ewing's sarcoma;
tumor and metastatic lesions of bones;
ulcerative colitis;
microbial intestinal infections eg dysentery;
thyrotoxicosis;
the effect of drugs for anesthesia, albumin, barbiturates, dopegyt, NSAIDs, nicotinic acid, methyltestosterone, methylthiouracil, papaverine, sulfonamides.

Albumin: the norm in serum is 35-50 g / l.

Reasons for the decline:

starvation and other causes of protein malabsorption in the body;
acute and chronic hepatitis, cirrhosis;
malignant tumors;
severe infectious diseases;
pancreatitis;
diseases of the kidneys, intestines, skin (burns);
cystic fibrosis;
a significant increase in activity thyroid gland;
Itsenko-Cushing's disease.

Bilirubin: total 8.5-20.5 µmol/l, direct 2.2-5.1 µmol/l.

Causes of an increase in the level of total bilirubin:

hepatitis, cirrhosis, liver tumors;
hemolytic anemia;
fructose intolerance;
Crigler-Najjar or Dubin-Johnson syndrome;
Gilbert's disease;
neonatal jaundice.

Causes of an increase in direct bilirubin in the blood:

jaundice of mechanical origin;
various hepatitis;
cholestasis;
the action of androgens, mercazolil, penicillin, aminoglycosides, sulfonamides, oral contraceptives and nicotinic acid;
Dubin-Johnson or Rotor syndrome;
decreased activity of the thyroid gland in newborns;
abscess in the liver tissue;
leptospirosis;
inflammation of the pancreas;
liver dystrophy in pregnant women;
intoxication with the poison of the pale toadstool.

Causes of an increase in indirect bilirubin in the blood:

anemia of hemolytic origin;
prolonged compression syndrome;
Crigler-Najjar syndrome, Gilbert's disease;
erythroblastosis;
galactosemia and fructose intolerance;
paroxysmal hemoglobinuria;
Botkin's disease (hepatitis A);
leptospirosis;
thrombosis of the veins of the spleen;
the action of benzene, vitamin K, dopegyt, anesthetics, NSAIDs, nicotinic acid, tetracycline, sulfonamides, fly agaric poison.

Biochemical syndromes

Changes in liver tests are possible with different pathology. To highlight liver damage, doctors use the appropriate biochemical syndromes:

cytolytic (decay of hepatocytes);
inflammatory (inflammation, including autoimmune nature);
cholestatic (stagnation of bile).

The cytolytic variant of the lesion is expected with an increase in ALT and AST. To confirm it, additional tests are used for the content of fructose-1-phosphate aldolase, sorbitol dehydrogenase, ornithylcarbamoyl transferase, succinate dehydrogenase.

The concentration of ALT and AST can determine the activity of hepatitis and cirrhosis:

If an autoimmune process is suspected, signs of a mesenchymal-inflammatory lesion are determined:

an increase in thymol test more than 7 at. e.;
decrease in sublimate test less than 1.6 at. e.;
an increase in gamma globulins above 18 g / l or 22.5%.

In case of liver pathology without an autoimmune component, these samples may not change.

Cholestatic syndrome is associated with damage to the walls of the bile ducts. It can be suspected with an increase in the amount of alkaline phosphatase and bilirubin. For diagnostics, additional indicators are used:

gamma-glutamyl transpeptidase (normal 0-49 IU / l);
total cholesterol (normal 3.3-5.2 µmol / l);
LDL cholesterol (normal 1.73-3.5 µmol/l);
VLDL cholesterol (normal 0.1-0.5 µmol/l).

Interpretation of a biochemical blood test can be difficult, even for an experienced doctor. That is why self-diagnosis based on the results of liver tests is not recommended. You should consult a gastroenterologist and undergo additional diagnostics liver conditions (ultrasound, CT, MRI, blood and urine tests, hepatitis markers and other studies).

A specialist at the Moscow Doctor clinic talks about AlAT and AsAT:

ALT and AST in a biochemical blood test

The liver is one of the largest glands in the human body. It is involved in metabolic processes, cleanses the blood of toxic and toxic substances, controls a number of biochemical processes. Most of these changes occur due to enzymes synthesized by the gland itself.

Liver enzymes (enzymes) maintain constancy in the body, acting in a way that is invisible to humans. With the development pathological conditions the level of liver enzymes changes up or down, which is an important sign and is used in differential diagnosis.

Based on the characteristics of the synthesis and action, all liver enzymes are divided into several groups:

Indicator. These enzymes show the presence of an organ pathology in the form of destruction of its cells. These include AST (aspartate aminotransferase), ALT (alanine aminotransferase), GGT (gamma-glutamyl transferase), GDH (glumatate dehydrogenase), LDH (lactate dehydrogenase). The first two enzymes are most commonly used for diagnostic processes.
Secretory (cholinesterase, prothrombinase). Participate in the support of the blood coagulation system.
Excretory (representative - alkaline phosphatase). It is found in bile components. During research, this enzyme shows the work of the biliary system.

ALT and AST

These are microsomal liver enzymes, the level of which is controlled by a biochemical blood test. AST is an endogenous enzyme produced inside hepatocytes. It is also synthesized by cells of other organs, but in smaller quantities (heart, brain, kidneys, intestinal tract). A change in the level of the enzyme in the blood indicates the development of the disease, even if visible symptoms are not yet available.

ALT is produced by the cells of the liver, heart muscle, kidneys (a small amount). It is determined by a blood test in parallel with the first enzyme. An important diagnostic point is the clarification of the ratio of ALT and AST.

Reasons for the increase

An increase in liver enzymes can be insignificant, arising from the intake of a number of drugs or the accumulation of toxic substances in the body, or pronounced, appearing with the development of diseases.

Enzymes can increase long-term treatment painkillers, statins (drugs that are used to remove "bad" cholesterol from the body), sulfonamides, Paracetamol. Provoking factors may be the intake of alcoholic beverages and the abuse of fatty foods. This includes long-term use of herbal medicine (ephedra, skullcap and hay grass can increase the level of liver enzymes in a blood sample).

If the blood test for liver enzymes is elevated, this indicates the following pathological conditions:

Signs of elevated enzyme levels

Such manifestations may not have visual symptoms or be accompanied by a number of complaints from the patient:

decreased performance, constant fatigue;
abdominal pain syndrome;
loss of appetite;
itching of the skin;
yellowness of the sclera and skin;
frequent bruising, nosebleeds.

Excretory and secretory enzymes

A blood test for enzymes involves not only an assessment of the level of the well-known ALT and AST, but also other enzymes. Alkaline phosphatase, GGT have an important diagnostic value. The level of these enzymes goes beyond the normal range in pathologies of the biliary system, for example, in cholelithiasis, tumor processes.

Together with these enzymes, the rate of bilirubin, which is a bile pigment, is evaluated. Clarification of its numbers is important for cholecystitis, cholelithiasis, cirrhosis, giardia, vitamin B12 deficiency, poisoning with alcohol, toxic substances.

Indicators during pregnancy

During the period of bearing a child, a number of changes occur in a woman's body. Her organs and systems begin to work for two, which is reflected not only in the general condition, but also in laboratory parameters.

The level of ALT and AST during pregnancy is up to 31 U / l. If toxicosis develops at 28-32 weeks of gestation, the numbers increase. The first two trimesters may be accompanied by a slight overshoot, which is not considered a problem, since the load on the liver during this period becomes maximum.

GGT indicators - up to 36 U / l. It may increase slightly from 12 to 27 weeks of pregnancy, which is the norm. The level increases strongly against the background of inflammatory processes of the liver, pathology of the biliary system, and with gestational diabetes mellitus.

The norm of alkaline phosphatase is up to 150 U / l. Active growth of the fetus from the 20th week until the moment of delivery causes an increase in the numbers of the enzyme. The level of alkaline phosphatase changes against the background of taking large doses of ascorbic acid, antibacterial drugs with calcium and phosphorus deficiency.

Norm

Permissible indicators of the main important enzymes are indicated in the table.

Patient management

When determining elevated liver enzymes, the doctor prescribes a number of additional examinations to clarify the patient's condition. Immediately, the specialist recommends that the patient begin treatment with a correction of the diet. The goal is to reduce the load on the liver, reduce the level of fatty deposits in it, remove toxins and toxins.

It is important to increase the amount of vegetables in the body. Spinach, kale, greens, lettuce, dandelion greens are considered especially useful. You also need to increase the amount of foods consumed, which include antioxidants (avocados, nuts).

The daily menu should contain at least 50 g of dietary fiber, in particular fiber. Such substances cleanse the body of "bad" cholesterol and contribute to the normalization of the biliary system. Fiber rich foods:

Treatment includes the intake of a sufficient amount of protein, because it is precisely proteins are considered a necessary basis for the restoration of damaged hepatocytes. However, how much it should be present in the daily diet, the doctor will tell you. It is important not to consume too much, so as not to overload the liver's protein processing mechanism.

You need to drink enough pure water. You need to drink up to 2 liters of fluid daily: on an empty stomach, before each meal, before physical activity and after it, before evening rest.

Taking herbs and supplements

Phytotherapy favorably affects the state of the liver and reduces the pathological parameters of enzymes. Treatment consists in the use of teas based on herbal ingredients. It is important to consult with your doctor about the possibility of such events.

Useful herbal ingredients:

astragalus;
dandelion;
thistle.

In food, you need to add turmeric, which reduces the manifestations of inflammatory processes, and garlic, which has an antitumor effect. With the permission of a doctor, you can use nutritional supplements rich in antioxidants.

Treatment of diseases

If during diagnostics it is found pathological process, which was the cause of the increase in liver enzymes, it must be treated. Qualified specialist will select a therapy regimen for the patient according to a specific clinical case.

Liver enzymes play significant role in a number of processes occurring in the human body. Their diagnostic value is the ability to detect diseases and pathological conditions in the early stages.

The liver is one of the largest glands in the human body. It participates in metabolic processes, cleanses the blood of toxic and poisonous substances, and controls a number of biochemical processes. Most of these changes occur due to enzymes synthesized by the gland itself.

Liver enzymes (enzymes) maintain constancy in the body, acting in a way that is invisible to humans. With the development of pathological conditions, the level of liver enzymes changes up or down, which is an important sign and is used in differential diagnosis.

Enzyme groups

Based on the characteristics of the synthesis and action, all liver enzymes are divided into several groups:

Indicator. These enzymes show the presence of an organ pathology in the form of destruction of its cells. These include AST (aspartate aminotransferase), ALT (alanine aminotransferase), GGT (gamma-glutamyl transferase), GDH (glumatate dehydrogenase), LDH (lactate dehydrogenase). The first two enzymes are most commonly used for diagnostic processes. Secretory (cholinesterase, prothrombinase). Participate in the support of the blood coagulation system. Excretory (representative - alkaline phosphatase). It is found in bile components. During research, this enzyme shows the work of the biliary system.

ALT and AST

Reasons for the increase

Enzymes can increase with long-term treatment with painkillers, statins (drugs that are used to remove "bad" cholesterol from the body), sulfonamides, Paracetamol. Provoking factors may be the intake of alcoholic beverages and the abuse of fatty foods. This includes long-term use of herbal medicine (ephedra, skullcap and hay grass can increase the level of liver enzymes in a blood sample).

If the blood test for liver enzymes is elevated, this indicates the following pathological conditions:

viral inflammation of the liver (hepatitis); cirrhosis; fatty hepatosis of the liver; primary malignant liver tumor; secondary tumor processes with the formation of metastases in the gland; inflammation of the pancreas; myocardial infarction; infectious myocarditis; heart failure.

Signs of elevated enzyme levels

Such manifestations may not have visual symptoms or be accompanied by a number of complaints from the patient:

decreased performance, constant fatigue; abdominal pain syndrome; loss of appetite; itching of the skin; yellowness of the sclera and skin; frequent bruising, nosebleeds.

Excretory and secretory enzymes

Indicators during pregnancy

Norm

Permissible indicators of the main important enzymes are indicated in the table.

Patient management

fruits; nuts; cereals; berries; legumes; leafy green vegetables.

Treatment includes the intake of a sufficient amount of protein, because it is protein substances that are considered the necessary basis for the restoration of damaged hepatocytes. However, how much it should be present in the daily diet, the doctor will tell you. It is important not to consume too much, so as not to overload the liver's protein processing mechanism.

You need to drink enough clean water. Every day you need to drink up to 2 liters of fluid: on an empty stomach, before each meal, before and after physical activity, before evening rest.

Taking herbs and supplements

Useful herbal ingredients:

astragalus; dandelion; thistle.

Treatment of diseases

If during the diagnosis a pathological process is detected, which was the reason for the increase in liver enzymes, it must be treated. A qualified specialist will select a therapy regimen for the patient according to a specific clinical case.

Liver enzymes play a significant role in a number of processes occurring in the human body. Their diagnostic value is the ability to detect diseases and pathological conditions in the early stages.

The liver is one of the most important organs human, cleansing the body of toxic substances and helping the process of digestion. But at the same time, it is unpretentious, can withstand fairly large loads and is able to recover quickly.

Liver health affects general state person, on his appearance and even the psyche. IN Everyday life this organ is subject to serious stresses that harm it even before any symptoms appear. Elevated liver enzymes just indicate the presence of an excessive load on this biochemical laboratory of the human body.

Reasons for the increase

A slight increase in the level of liver enzymes in the blood is a fairly common phenomenon. This may be the result of medication or the accumulation of toxins. After all, the liver reacts both to the state of the environment and to poor quality products, and on the water. If discomfort is felt in the right hypochondrium, it is worth going for a consultation with a doctor in order to identify the causes. The results of liver enzyme tests will help specialists identify possible diseases. Increased activity of liver enzymes may indicate serious diseases, such as hepatitis.

Many diseases can affect the increase in liver enzymes. After studying and analyzing the symptoms and signs that accompany the increased level of enzymes taken by drugs, the specialist will be able to identify the cause of this.

Quite often, the value of liver parameters is increased due to the intake of certain medications. For example, painkillers or statins used to control cholesterol levels. Alcohol abuse or obesity can also affect the amount of enzymes in the blood.

Of course, the most common causes certain diseases become. Among them are hepatitis A, B and C, and heart failure, cirrhosis and liver cancer, mononucleosis and inflammation of the gallbladder, pancreatitis and hypothyroidism, and many others.

Identification of the content of liver enzymes in the blood

The fact that liver enzymes are elevated is most often detected during a preventive blood test. In many cases, this is a temporary slight increase that does not signal serious problems. In addition, it should be remembered that the norm may differ slightly from person to person and depends on gender, height and weight.

A significant deviation from the norm indicates inflammation or destruction of liver cells, which provokes the release of some chemical substances including liver enzymes. A routine biochemical blood test will indicate an increase in the level of a particular enzyme.

The most common increase in blood enzymes is alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

Alanine aminotransferase is an enzyme that promotes the production of alanine, which is necessary for the formation of proteins in the body. ALT is present in trace amounts in most cells of the body. In the case of liver damage, its level is greatly increased. It can be used to determine the activity inflammatory process in the liver.

Aspartate aminotransferase is involved in amino acid metabolism. The enzyme is found in nervous tissue skeletal muscles in the tissues of the heart and kidneys. AST is most active in the liver, and the presence of hepatitis C is diagnosed by its level.

When diagnosing diseases and assessing the level of elevated liver enzymes, not only the indicators of each of them are important, but also the ratio of ALT and AST activity.

With viral damage to the liver or with excessive death of red blood cells, bilirubin may increase, which is accompanied by yellowing of the skin and eye sclera.

To control other enzymes that may be needed to more accurately determine the causes of any changes, it is necessary to take specific liver tests.

Treating elevated enzyme levels

Since an increase in the level of liver enzymes is a consequence of its inflammation or damage, the doctor first of all tries to find the cause of this condition, which must be eliminated. That is, the treatment is not aimed at reducing the level of enzymes in the blood as such, but at eliminating the disease that caused such a reaction in the body.

In addition to drugs that treat the disease directly, hepatoprotectors are also prescribed. These drugs repair already damaged liver cells and protect them from further damage. In addition, they facilitate the work of this body, helping to perform some of its functions. But do not forget that any drugs should be prescribed by a specialist. There are frequent cases when self-treatment and taking drugs to cleanse the liver, lead to opposite consequences.

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Questions and answers on: liver enzymes are elevated

2014-10-28 06:24:39

Elena asks:

Hello. I really need your help in diagnosing big problems with the liver, time is running out, and only bicyclol and ursosan from treatment.
In 2011, I entered into a second marriage (it was both a second marriage and a second sexual partner), which soon broke up. After a short period of time from strangers I found out. that the person has had hepatitis in the past. he had a hepatic coma, at the time of his acquaintance he was absolutely healthy (although he drank a little. He had contact with toxic substances at work), but had no complaints about the liver. In 2012, I passed the tests not for hepatitis B and C. For hepatitis C, everything was negative. Hepatitis B was positive only
Anti-HBc(sum) positive 1.08
Anti-HBe positive. 1.54. The rest of the tests were negative. According to the analyzes, ALT was slightly increased. and 3 times increased GGT. I went to the Infectious Diseases Hospital, and received an answer that I do not have hepatitis B. so there are only antibodies to it, but there is no Australian antigen and virus DNA. Although, according to information obtained on the Internet, the absence of Anti-HBs and the presence of low Anti-HBe indicate chronic hepatitis B.
After that, for 1.5 years three times PCR it was negative (sensitivity pcr system from 30 copies). I did not receive treatment.
Spring 2014
years, with random blood tests, an increase in Alat up to 180 was revealed (the norm is up to 31). GGt up to 300 (norm up to 31). I was hospitalized at the Institute of Gastroenterology in the city of Dnepropetrovsk. Infectionists again said not our diagnosis. As of April 2014, the analyzes are as follows:
Anti-HBe - 1.44 positive (norm less than 1)
Anti-HBc (sum) - 1.05pos. (norm less than 1)
Anti-HBs are negative.
HBsAg - 0.566 negative (norm less than 0.9)
HBe - 0.094 negative (norm less than 1)
PCR - negative (sensing system 30 copies).
According to ultrasound, the enlargement of the liver in the right lobe is 181 mm. left - 91 mm., the spleen is a little enlarged.
The diagnosis of autoimmune hepatitis was questioned. According to the analysis of antibodies to smooth muscles. soluble antigen of the liver and pancreas. antinuclear antibodies. liver and kidney microsomes were negative. AMAs were positive in general, with repeated AMAs they were already negative. Primary biliary cirrhosis was called into question. A liver biopsy was made - a complete answer: Diagnosis on the Mrtavi scale: severe widespread fatty hepatosis without signs of fibrosis (F 0). with weak activity (A1). According to the fibroscan at admission, there is no fibrosis. after biopsy - possibly weak fibrosis F 1 (6 units). The diagnoses of autoimmune hepatitis and primary biliary cirrhosis were dropped. She was treated with Gepadif, Reasorbilact. phosphogliv.heptral. Liver parameters decrease slightly, after the biopsy they increased. She was discharged with a diagnosis of steatohepatosis.
After discharge, she felt an increasing intoxication - hot flashes. sweating. On an outpatient basis, she again underwent a course of reasorbilact droppers, intravenous phosphogliv. By the way, phosphogliv helps me a lot, but tableted heptral does absolutely nothing. It is possible that there is an antiviral effect in phosphogliv, and heptral is more for drinking people. Considering her biopsy to be uninformative, she turned to the 3rd city hospital in Zaporozhye, the department of liver surgery. A second biopsy was taken and the biopsy was examined for hepatitis B virus DNA and hepatitis C virus RNA.
The results of PCR studies of Hep B DNA and Hep RNA. C not found. The pathomorphological diagnosis is very brief, although Professor Valery Alekseevich Tumansky was made by an experienced doctor.
The biopsy itself is detailed - Steatohepatitis with predominantly macrovesicular (partial microvesicular) fatty degeneration of approximately 90 percent of hepatocytes. This is the whole analysis. Well, the preparations are stained with hematoxylin and eosin. Wag-Gison method. Massson's three-color method.
Not a word about fibrosis, about the activity of the process. As far as I understand, the preparations were not dyed for the study of hepatitis B. maybe because I'm not being diagnosed, or the lab doesn't test for HBc in liver tissue.
The ultrasound picture worsened: the portal vein - 14 mm. splenic vein - 9 mm. Liver right share 183 mm. left - 81 mm. Spleen - 131 x58 mm. An ultrasound is used to diagnose portal hypertension.
After the biopsy, at my request, hepamerz was again instilled with 2 pcs. .gepadif -4 pcs. reasorbilact.
At the moment, ALat 52 (the norm is up to 31). GGT 137 (norm up to 31). At the indicator of 137 GGT, it seemed to freeze. lower in any way, although the alat jumps.
According to other analyzes, the proteinogram is all normal. protein is normal. triglycerides are normal. cholesterol levels are normal. erythropoietin is normal. ferritinin increased to 179 (normal up to 150).
For four months of treatment, it was not possible to normalize ALT (jumps). and especially GGT - 137. The stomach is enlarged. the liver is baking. I am taking bicyclol. phosphogliv. ursosan.
I was diagnosed with fatty degeneration even before exposure to hepatitis B. I personally believe that I have chronic hepatitis B, my the immune system unable to cope with such a formidable virus. besides, at the time of contact with the virus, there was already a diagnosis of fatty degeneration. Liver parameters are elevated and not stabilized. because something causes hepatitis. I think the diagnosis of steatohepatitis with fatty degeneration is too sweet for my clinical picture.
I beg you to help me (I really trust your professionalism)
1. Make the correct diagnosis. Although I personally assume that I have advanced chronic hepatitis B, a infectious disease specialists say that there is no DNA of the virus in the blood and in the liver biopsy, there is no Australian antigen itself, and there is no virus. But the liver that already decently hurts.
2. Clarify the need for antiviral therapy. Although bicyclol is improving liver performance. But I do not quite trust this Chinese pill, which can only be obtained through the Internet and is very expensive.
3. Tell me, perhaps it is still necessary to pass some tests, although it is dangerous to do a liver biopsy for the third time within 4 months, I think. And why are the biopsy results so modest. Perhaps 90 percent of the fat covered the entire histological picture. A mess, of course, but three years of infection and two years of unsuccessful attempts to make a correct diagnosis do not add to the mind.
Concerning alcohol it is negative. never used drugs. Although she was often ill throughout her life, she took many antibiotics. female sex hormones, took immunomodulators (Allokin Alpha) never treated the liver. According to the doctors, I planted the liver myself medicines although all liver enzymes were normal at the time of infection. I have no contact with toxins at work.
Thanks in advance for your reply. Perhaps at least you will help to understand my confused clinical picture.

Responsible Sukhov Yuri Alexandrovich:

Hello, Elena. I hope you yourself understand that according to the fragmentary information provided by you, a full-fledged consultation will not work. I would suggest the following algorithm: an additional examination by an infectious disease specialist, a consultation with a gastroenterologist. council. Regards, Yu Sukhov.

2011-09-29 16:57:09

Natalia asks:

Hello dear doctors! 2 weeks ago, after the flu, I passed the tests. The blood is normal. All liver enzymes are normal. Billirubin is increased up to 20 for 6 years. Urine is normal. The doctor said that I had a borderline reaction to hepatitis b. I feel good. Sometimes it hurts. It is the left side, at the bottom of the ribs. I go in for sports, I do not observe any special deviations. But from that day on, I'm in a panic. maybe so and what to do? thanks in advance for your reply. Sincerely, Natalia

Responsible Consultant medical laboratory Synevo Ukraine:

Good day, Natalia. In order to decide on the presence or absence of hepatitis B, it is necessary to take tests for markers of hepatitis B and the DNA of this virus. And so you need to additionally conduct an ELISA blood test for HBsAg, IgM and IgG to HBsAg, antibodies to HBeAg and HbeAg itself, IgG to HBcAg and IgM to HBcAg, PCR to conduct a blood test for DNA of the hepatitis B virus. With the results of the tests, please contact advice, we'll figure it out. Be healthy!

2010-12-27 15:12:00

Catherine asks:

Good afternoon doctor! please help me figure it out. Pregnancy 37 weeks. Deadline for DA is January 21st. On December 3, everything began to itch terribly: arms, hands, legs completely, stomach. Has handed over analyzes on hepatic enzymes have been exceeded in 2 times. My doctor is antenatal clinic sent to hospital. I was in bed for 10 days, now I am in the hospital for day hospital diagnosed with cholestatic hepatosis of pregnant women. Passed everything necessary tests blood (hepatitis, jaundice), feces, abdominal ultrasound, urine. No pathology was found.
As to results of a blood on hepatic enzymes. Bilirubin, ALT, AST still remain elevated, but do not get worse, i.e. from normal values exceeded 2 times. But alkaline phosphatase (AP) in the following dynamics with reference indicators of the laboratory of the maternity hospital up to 98 units:
- On December 9, the AP was 198 units.

At home, they told me that their laboratory believes normal indicator AP up to 98 units.
Treatment: 3 tab. Ursosan per day. One tablet at 20 pm, the rest at 22 pm.

Question: is the last ALF result of December 24 critical for pregnant women, based on laboratory parameters? It turns out that the alkaline phosphatase is now increased by 2.7 times from normal value. And if not, what indicator should be considered critical? By how many times should ALP be increased for emergency delivery?

Responsible Selyuk Mariana Nikolaevna:

Good afternoon, Catherine!
We are not talking about emergency childbirth with an increase in the level of alkaline phosphatase. Because serum level alkaline phosphatase during pregnancy increases as a result of the formation of placental isoenzyme k III trimester. There are reports of significant increases in alkaline phosphatase levels during pregnancy, but this is uncommon. Alkaline phosphatase levels return to baseline by the end of the first postpartum month. An increase in the level of alkaline phosphatase during pregnancy has no clinical significance for assessing the health of the mother or fetus. . But, it must be remembered that the determination of the level of alkaline phosphatase, placental alkaline phosphatase and their ratio are one of modern methods assessment of the state of the placenta.

2010-11-26 15:42:55

Valeria asks:

Good afternoon. I was diagnosed with hepatitis C in 2008, genotype 1b. In the spring of 2010, I gave birth, the whole pregnancy ALT, AST were normal, PCR was a plus. In the summer I passed biochemistry - liver enzymes turned out to be elevated. Then I was prescribed bicyclol and choleretic fees. Bicyclol seems to make me sick. Maybe start drinking hepatoprotectors? Thanks for the answer.

Responsible Medical consultant of the portal "site":

Good afternoon, Valeria. Bicyclol is not a first-line drug for the treatment of viral hepatitis and may well cause such side effect like nausea. Hepatoprotectors are not part of antiviral therapy, although in some cases their use is justified by the desire to protect liver cells in conditions of viral infection and aggressive therapy. For today the best option therapy for viral hepatitis C is considered treatment with pegylated interferons. However, to start therapy, you need the help of a specialist. Find a hepatologist, get examined and, if there are no serious contraindications, plan standard antiviral therapy. If necessary, the doctor will recommend you hepatoprotectors. Be healthy!

2016-04-25 18:47:14

Anna asks:

Responsible Stadnitskaya Svetlana Valerievna:

Hello Anna! When diagnosing allergies, one determination of the IgE (immunoglobulin E) value is not enough. Specific antibodies of the IgE group should be established. To identify the causative allergen in modern laboratory conditions, it is possible to determine the immunoglobulin E in the blood to more than 600 allergens that cause allergic reactions in the human body. In diseases of the pancreas, itching common symptom, due to the fact that bile enters the bloodstream, there may also be "jaundice" of the skin. Therefore, to determine the diagnosis, I recommend that you contact a specialist gastroenterologist in combination with consultations of a Dermatologist and an Allergist, in order to exclude other diseases.

2010-08-13 02:24:09

Zoryan asks:

Hello, I am 32 weeks pregnant. When I was registered with a gynecologist at about 8-9 weeks, they took tests from me, including a biochemical blood test, and everything was like a "soldier". After 3-4 weeks, I changed the doctor and for some reason he decided to take all the tests again when you register and in the biochemical analysis showed too high ALT and AST levels (everything else was within the normal range). The doctor sent me to check the liver and its diseases, but I didn’t have hepatitis, and for 3 months the doctor took tests and these indicators fell, eventually reached the norm. But he insisted on going to a gastroenterologist, which I did a week ago (since I live in the USA and I had to wait in line for up to two months for public insurance) and I was very scared, because the doctor sent me to test for the Einstein-Barr virus (I never heard of him). My question is this: if AST and ALT transaminases are elevated, can we unambiguously talk about this virus or has it not yet been finally confirmed? I am very worried now, since it is already time to give birth, and here you have a torch infection that can affect the development of the fetus with a variety of consequences? And from what else can these enzymes rise? all other liver tests are normal, ultrasound-all organs (liver, pancreas, urinary) are within size.??? when ultrasound was done at 19 weeks, the fetus was very normal condition, screening at 16 weeks was also negative for different types CNS diseases in children. Should I be worried that the baby might not be born healthy? I also checked the amniotic fluid twice, is everything ok?

2009-02-12 14:36:10

Roma asks:

He completed the treatment of hepatitis C. He treated with Pegasis and Raferon and Copegus. Liver tests:
Billir.-11.0
Thymol.-3.7
ALT-1.52
AST-0.12
Phosphotase-1660.
Why elevated enzymes ALT after the end of treatment?
It is possible to judge by the analyzes that the virus is active in the oven?

Responsible Bondar Alexander Evgenievich:

Good afternoon. The effectiveness of antiviral treatment can be judged by the result of the PCR HCV RNA test. The increase in ALT may be due to other reasons.