Disrupted liver function most often does not manifest itself for quite a long time and the diagnosis becomes belated. Treatment in this case is often already ineffective. To assess the state of the liver at an early stage, blood biochemistry is of great importance, or rather, determining the level of activity of hepatic transaminases. These liver enzymes (enzymes) are called indicator. Their activity is an accurate assessment of the state of the organ.
What is this?
Hepatic transaminases - what is it? These are special liver proteins (enzymes), they perform transamination in cells, that is, they provide metabolism inside them. "Transaminases" - today the term is obsolete, the modern name is "aminotransferases".
Properties of transaminases
Transamination is one of the processes of nitrogen metabolism, in which new amino acids are synthesized through the transit of amino and keto acids without isolationammonia. This was covered in 1937 by scientists M. G. Kritzman and A. E. Braunshtein.
At the same time, direct and reverse reactions occur, i.e., the reversible transfer of amino groups from an amino acid to a keto acid. Vit is required as a coenzyme. Q6.
The name of hepatic transaminases (and there are 2 of them) is determined by the name of the acid itself involved in the transit of the amino group: if it is aspartic, then the enzyme is called aspartate aminotransferase (AST or AsAT), and if it is alanine, then it is alanine aminotransferase (ALT or AlAT). Each of them has its own characteristics.
Role in the body
Increased activity of hepatic transaminases - what is it? This is an increase in their level and it always speaks of necrosis of organ tissues and the presence of diseases. AST (aspartate aminotransferase) is an enzyme that is sensitive to changes in the myocardium, liver and brain. If their cells are intact and functioning normally, AST does not increase.
ALT (alanine aminotransferase) - an enzyme that is the main indicator of liver changes.
Indicator norms
Transaminase levels differ by sex and age. Normally, their number in women is 31 for ALT and AST; in men, ALT -37 U / l, and AST - 47 U / l.
Principles of diagnosis
Aminotransferases are found in all cells of the body, but they are concentrated in the liver and heart. Therefore, the insufficiency of these organs is fastereverything can be judged by the level of these enzymes.
It can be concluded, speaking about the activity of hepatic transaminases, that these are peculiar markers of inflammation. The fact is that the symptoms of pathology appear only after 2 weeks, but the death of cells in various diseases in an acute form (inflammation, cirrhosis or MI) leads to a sharp release of these enzymes into the blood, which can be used to judge the presence of a problem.
T. e. aminotransferases resemble leukocytes in the speed of their appearance, but it is impossible to determine the nature of the pathology from them.
These are not specific tests, but reliable indicators of liver and heart pathologies. The combination of signs that the doctor produces helps to determine the range of diseases and narrow it down. For example, an increase in ALT + bilirubin is usually noted with cholecystitis.
Reason for increase
Hepatic transaminases are elevated with the development of hepatic and cardiac pathologies. This can be very dangerous. They say:
- hepatitis (any form);
- Reye's syndrome - hepatic encephalopathy due to aspirin intake;
- steatosis;
- fibrosis;
- cirrhosis;
- cholestasis;
- tumors;
- metastases from other organs to the liver;
- Wilson's disease or hepatocerebral dystrophy (congenital disorder of copper metabolism);
- myocardial infarction (in which hepatic transaminases are always persistently elevated);
- parasitic invasions, because in the course of their life, parasites secretetoxins with destruction of hepatocytes;
- liver injury also leads to cell necrosis.
In cholestasis, bile stasis leads to overstretching of liver cells, their metabolism is disturbed and, in the final chain of disorders, the cells undergo necrosis.
Fatty liver also causes normal liver cells to be destroyed and replaced with fatty ones. In cirrhosis, cells become necrotic and are replaced by coarse connective tissue. Tumors destroy not only hepatocytes, but also surrounding tissues, causing their inflammation.
Proven toxic processes in the liver after prolonged use of drugs, and an increase in transaminases occurs when using any form of release of the drug - both tablets and infusions are equally harmful. Among them:
- analgesics, statins, antibiotics;
- anabolic steroids;
- NSAID;
- "Aspirin", "Paracetamol", MAO inhibitors ("Selegiline", "Imipramine");
- hormones;
- sulfonamides;
- barbiturates;
- cytostatics, immunosuppressants;
- iron and copper preparations also necrotize liver tissue.
So far we have been talking about persistent enzyme increases. But there is another type of increase - periodic.
Periodic or transient increase in liver transaminase activity can also be caused by other extrahepatic pathologies. It can occur with acute pancreatitis, hypothyroidism, obesity, mononucleosis, muscle injuries, burns, myodystrophy, bronze diabetes.
Slight increase in livertransaminases are quite common. It can be triggered by poor ecology, the intake of certain foods rich in, for example, nitrates, pesticides, trans fats. In any case, a deviation from the norm of enzymes in the form of their increase requires a visit to a doctor and a complete examination. Especially when added heaviness and pain in the right hypochondrium.
Ritis ratio
Italian scientist Fernando de Ritis proposed a different approach to assessing the activity of transaminases. In other words, in addition to the quantitative calculation of each enzyme, the ratio of enzymes relative to each other should also be determined - the Ritis coefficient.
The ratio of 0.9-1.7 is not a disease, usually the indicator is 1.33. If the ratio fluctuates around 0-0.5, then this indicates the carriage of hepatitis of viral etiology.
When the values are 0.55-0.83, one can think about an exacerbation of hepatitis. In other words, the coefficient <1 indicates infection and inflammation.
If K≧1 - this will indicate liver dystrophy and chronic hepatitis; K≧2 - hepatitis has an alcoholic etiology, or it indicates the development of myocardial infarction. The de Ritis coefficient is based on the fact that although ALT and AST are considered hepatic transaminases, ALT has a greater concentration in the liver, and AST is distributed in almost equal amounts in the heart and liver.
Symptomatic manifestations of disorders
It should be noted that the symptoms of these disorders are always the same, regardless of the type of pathology. With an increase in liver transaminases, the symptoms are:
- chronic lethargy and fatigue;
- attacks of sudden weakness; loss of appetite and nausea for no reason;
- aching stomach pains;
- heaviness in the right hypochondrium;
- bloating and gas;
- generalized nocturnal skin itching;
- nosebleeds;
- darkening urine and acholic feces;
- possible yellowing of the skin;
- Reduced activity and drowsiness are common.
Even if one symptom is noted, it does not interfere with visiting a doctor. The timeliness of treatment will allow you to get rid of the disease completely. Otherwise, the pathology becomes neglected and often irreversible.
Classification
To determine the level of hyperenzymemia, a special scale is used:
- Moderate degree - the level is slightly increased. This is possible with hepatitis of alcoholic or viral origin.
- Average - indicators increased by 6 times from the norm - necrotic processes in the liver.
- High level - an increase in the norm by 10 times or more - liver ischemia.
An acute condition caused by a disease causes transaminase activity: for example, in hepatitis, hyperfermentemia is noted on the 14-20th day of illness, and then within a month, the indicators decrease to normal.
In the chronic course of the disease, during the period of remission, hyperenzymemia is not observed and the indicators are moderately or slightly increased. Late-stage cirrhosis will not show an increase in transaminases.
Fordiagnosis, the doctor should evaluate not only the increase in transaminases, but also their combination with other criteria. These indicators significantly narrow the range of pathologies. For example, jaundice or acute liver failure necessarily cause an increase in bilirubin. In this case, the concentration of enzymes may increase slightly. This is called bilirubin aminotransferase dissociation. Such subtleties can only be determined by a specialist. Therefore, self-diagnosis and self-treatment are excluded.
Excessive levels of hepatic transaminases or hyperfermentemia is an indicator of trouble in the liver, indicating necrosis of liver cells. This state can occur again, changing the normalization. This usually indicates the onset of a new inflammation or a relapse of a chronic pathology.
What to do with an increase in aminotransferases?
This question is inappropriate, because the elimination of the causative pathology will also reduce the level of enzymes. There is no need to invent other ways. High transaminase numbers indicate the need for urgent additional research and hospitalization.
In addition, may be assigned:
- various blood tests;
- electrolyte balance;
- ECG;
- ultrasound;
- CT.
If it is necessary to determine the DNA of viruses in hepatitis, PCR is performed, as well as ELISA for antibodies. Since these tests are expensive, they are not ordered without appropriate reasons.
By getting rid of the root causes, it is possible to reduceliver enzyme levels. In this case, the restored body system will stop the release of transaminases into the blood.
As an additional therapy, you can use folk remedies. It is important to coordinate all actions related to treatment with a specialist in advance. Before use, it is necessary to be examined and identify the exact causes. To improve the liver can help:
- Oatmeal. Oatmeal helps cleanse the body of harmful substances.
- Pumpkin will help lower cholesterol levels. To prepare it, you need to boil it by adding honey beforehand.
- Drink a glass of water with 5 g of turmeric and 10 g of honey three times a day.
- Beetroot juice is also very good for the liver. Consume it after meals 3 times a day.
Value for treatment
The liver function test is sensitive to liver disease, so it is often used in conjunction with other studies to evaluate progress in therapy.
Liver diseases with hyperenzymemia always require their monitoring in dynamics and appropriate therapy. Doctors take into account that the norm of enzymes does not always indicate recovery. Latent cirrhosis, for example, is characterized by a normal content of enzymes in the blood. Therefore, you need to be examined and treated by a doctor.
