High liver enzymes. What are liver enzymes, and what does their increased concentration in the blood indicate? Excretory and secretory enzymes

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Reasons for the increase

cirrhosis;
fatty liver hepatosis;
myocardial infarction;
heart failure.

violation of appetite;
itching of the skin;
yellowness of the sclera and skin;

Indicators during pregnancy

Hepatic transaminases - what is it? Reasons for increased enzyme levels

Slightly overestimated levels of hepatic transaminases are quite common. Taking medications, a polluted environment, food saturated with nitrates, pesticides and trans fats cannot but affect normal functioning organs. Hence, there are deviations from the norm of hepatic parameters. When a person feels that pain and discomfort in the liver area go beyond the permissible threshold, then this is an undoubted reason to find out the reasons for this behavior of the body.

The role of hepatic transaminases in the human body

Transaminases are special enzymes (proteins) that play an important role in the transamination process. This term refers to the transfer of an amino group from an amino acid molecule to a keto acid molecule, without the formation of ammonia. Simply put, these are proteins that provide metabolism within the cell. Their increase always indicates the presence of problems with the health of internal organs.

The very name "transaminase" has long been outdated, and was replaced by "aminotransferase". But nevertheless, in practice, the outdated term is more firmly rooted and is more actively used by doctors than keeping up with the times.

In medical practice, two groups of hepatic transaminases are usually distinguished:

ALT - glutamate pyruvate transaminase (alanine aminotransferase). This enzyme is found in many cells of internal organs: liver, lungs, brain, kidneys, pancreas and others. Normally, the percentage of ALT in the blood is small. However, with liver disease, its concentration increases significantly.
AST - glutamate oxaloacetate transaminase (aspartate aminotransferase). The AST enzyme is found in the cells of the myocardium, kidneys, pancreas, lungs, etc. Its highest concentration is observed in the liver. Therefore, AST protein indicators are fundamental in the diagnosis of hepatitis C.

The reasons for the increase in the content of hepatic transaminases

Indicators of transaminases throughout life are actively creeping up, then normalized. It may depend on the lifestyle and living conditions, age, gender, body weight and, most importantly, on the state of health. There are a number of diseases that provoke a surge in the active formation of ALT and AST enzymes:

Alcoholic toxic hepatitis (ABP - alcoholic liver disease, diffuse inflammatory process of the liver).
Viral hepatitis A, B, C, D and E.
Cirrhosis of the liver. Reconstruction of the liver structure, death of hepatocytes, replacement of normal tissues with fibrous seals and nodes due to the influence of damaging factors.
Steatosis (hepatosis). Inflammation of the liver against the background of the accumulation of adipose tissue, with its subsequent degeneration.
Exposure to toxins and drugs.
Autoimmune hepatitis. A chronic inflammatory process in the liver of an unknown nature.
Hemochromatosis (bronze diabetes or pigmented cirrhosis). Disease of a hereditary nature, expressed in the violation of metabolic processes of iron and its excessive accumulation in cells.
Α1-antitrypsin deficiency. A genetic disease in which there is a failure in the production and excessive accumulation of the α1-antitrypsin protein in the liver.
Wilson-Konovalov's disease. Heavy hereditary disease, expressed by the excessive accumulation of copper in the liver and the inability to remove it from the body.

Norms of ALT and AST in the blood

To determine the level of these enzymes, it is used biochemical analysis venous blood. To get the most accurate results, blood collection is carried out in the morning on an empty stomach. Before the analysis, a person should refrain from eating for 8 hours. As a rule, the norm for gender and age varies:

for women, the level of ALT and AST should not exceed 31 U / l;
for men, the ALT level should have values up to 45 U / L, and AST - up to 47 U / L;
for children: ALT - up to 50 U / L, AST - up to 55 U / L.

De Ritis coefficient

The Italian scientist Fernando de Ritis made a significant contribution to the study of liver enzymes. His research showed that not only individual indicators of ALT and AST markers, but also their ratio, have an important diagnostic meaning. The scientist has developed a formula by which the coefficient is calculated that determines the type of disease:

where k is the coefficient. de Ritis;

Numerous studies have shown that the formula can serve as a significant element of diagnosis, but only if the values of its constituent markers exceed the normal range:

if the value of the de Ritis coefficient is less than one (to 1) - it is inherent in the group of viral hepatitis;
if k≥1, chronic hepatitis and dystrophic hepatic diseases are suspected;
if k≥2, alcoholic liver damage is characteristic.

How to reduce ALT and AST values?

Since the increase in the parameters of the enzymes alanine aminotransferase and aspartate aminotransferase is caused, in most cases, by some kind of disease, the solution to the problem is a complete cure for the disease. Therefore, you should not ask the question "how to reduce the indicators", because they will accept normal values when the reason for their increase is eliminated.

Alertness and mindfulness to the state own health- an important component of a happy and long life. At the first symptoms and suspicions, consult a specialist. Let the suspicion turn out to be unconfirmed, and the time wasted, but you will be sure that order and stability reign in your body.

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What does an increase in the level of liver enzymes indicate?

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

Liver health affects the general condition of a person, his appearance and even his psyche. In everyday life, this organ is subject to serious stress, which harms it even before the onset of any symptoms. 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 quite common. This could be the result of taking medication or a build-up of toxins. After all, the liver reacts to the state of the environment and to low-quality products, and to water. If discomfort is felt in the right hypochondrium, you should go for a consultation with a doctor in order to identify the causes. Liver enzymatic test results can help specialists identify possible diseases. An increased activity of liver enzymes may indicate a serious illness, such as hepatitis.

Many diseases are capable of influencing the increase in liver enzymes. After examining and analyzing the symptoms and signs that accompany elevated enzyme levels of medications taken, a specialist will be able to identify the cause of this.

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

Of course, the most common causes are certain diseases. 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.

Determination 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 and does not signal major problems. In addition, it should be remembered that the rate may differ slightly from person to person and depends on gender, height and weight.

A significant deviation from the norm indicates inflammation, or the destruction of liver cells, which provokes the release of certain chemicals into the blood, including liver enzymes. A routine biochemical blood test will indicate an increase in the level of an enzyme.

The most common increase in the blood of the enzymes 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 small 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 of the inflammatory process in the liver.

Aspartate aminotransferase is involved in amino acid metabolism. The enzyme is present in nerve tissue, skeletal muscles, heart and kidney tissues. AST is most active in the liver, and its level is used to diagnose the presence of hepatitis C.

When diagnosing diseases and assessing the level of elevated liver enzymes, not only 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 erythrocytes, bilirubin may increase, which is accompanied by yellowing of the skin and eye sclera.

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

Treatment of elevated enzyme levels

Since an increase in the level of liver enzymes is a consequence of its inflammation or damage, then first of all the doctor tries to find the cause of this condition, from which it is necessary to get rid of. That is, 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 of the body.

Most often, with such diseases, a diet is recommended that excludes fatty, smoked, salty, spicy foods. It is also advised to exclude the use of alcohol, coffee and carbonated drinks. You should eat more organic food, dairy products.

In addition to drugs that directly treat the disease, 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 carry out some of its functions. But do not forget that any drugs should be prescribed by a specialist. There are often cases when self-treatment and taking medications to cleanse the liver lead to the opposite consequences.

What are liver enzymes, their diagnostic value and normal values?

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ALT ratio. AST = 1 (the level of alanine aminotransferase is higher or equal to aspartate aminotransferase) indicates acute hepatitis. If ALT. AST is higher than 2.1, then this ratio indicates alcoholic illness. AST ratio. ALT above 1 (AST exceeds ALT) indicates cirrhosis.

An increase in the activity of AST and ALT occurs with necrosis of hepatocytes of any etiology, obstructive jaundice, fatty degeneration. Decreased activity is characteristic of extensive necrosis, cirrhosis.

In addition, these liver enzymes play an important role in determining the hepatotoxicity of drugs. So, AST and ALT increase during prolonged use of anticoagulants, barbiturates, hormonal contraceptives, antiepileptic drugs, ascorbic acid, codeine, morphine, erythromycin, gentamicin, lincomycin. A decrease in activity is observed during pregnancy.

What other liver function tests are there?

In addition to the main AST and ALT, the level of GGT, ALP, LDH is determined.

GGT rate - up to 40 U / l. GGT is found in large quantities in addition to the main organ, in the kidneys, pancreas, and the walls of the bile ducts. Determination of GGT is a particularly sensitive test in pregnancy and in children. An increase in GGT activity is observed in hepatitis, cirrhosis, tumors, in cholestasis, alcohol intoxication, obstructive jaundice, cholangitis.

Dynamics of ALT, AST, GGT, ALP depending on age

Decreased GGT activity - with decompensated cirrhosis. GGT is a highly sensitive indicator, especially in the case of toxic effects. If the analysis is done and the levels of aminotransferases are normal, then the GGT values will be increased.

The rate of alkaline phosphatase is up to 270 U / l. It is also contained in bone tissue, walls bile ducts, kidneys. An analysis is made in case of dysfunction of the hepatobiliary system.

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An increase in the indicator occurs with cholestasis, obstructive jaundice, biliary cirrhosis, hepatitis. Increase during pregnancy (in the third trimester), with the use of hepatotoxic drugs. If you make an analysis, and the level of alkaline phosphatase is low, then this indicates the use of glucocorticosteroids.

The norm of lactate dehydrogenase is up to 250 U / l. There are several LDHs, so LDH 1-2 is in the myocardium and erythrocytes, LDH 5 - in the liver, LDH 4-5 in skeletal muscles. In case of dysfunction of the hepatobiliary system, an analysis is made for LDH 5. An increase in activity is observed in acute hepatitis, obstructive jaundice, and tumors. There is also an increase in activity during pregnancy, massive exercise.

The most indicative in the disease of the hepatobiliary zone are aminotransferases, but in biochemical analysis it is also important to determine alkaline phosphatase, lactate dehydrogenase, gamma-glutamyl transpeptidase.

Changes in indicators should be monitored during pregnancy. The norm in this case will indicate increased result as some indicators are decreasing. During pregnancy, a woman needs to be examined several times per trimester.

To recognize a pathology, you need to know what is the norm in one or another enzyme. This is of great diagnostic value.

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

Liver enzymes (enzymes) maintain consistency in the body, acting in a manner imperceptible to humans. With development pathological conditions the level of liver enzymes changes up or down, which is important feature and is used in differential diagnostics.

Enzyme groups

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

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

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

ALT is produced by 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 when long-term treatment pain medications, statins (drugs that are used to remove "bad" cholesterol from the body), sulfonamides, Paracetamol. The provoking factors can 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 in the blood test for liver enzymes the indicators are increased, this signals the following pathological conditions:

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

Signs of increased 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;
violation 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 assessing the level of all 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 indicator of bilirubin, which is the pigment in bile, is assessed. Clarification of its numbers is important for cholecystitis, gallstone disease, cirrhosis, lamblia, vitamin B12 deficiency, alcohol poisoning, 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 affects not only the general condition, but also the laboratory indicators.

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.

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

The rate of alkaline phosphatase is up to 150 U / l. The active growth of the fetus from 20 weeks until the moment of delivery causes an increase in the enzyme numbers. Alkaline phosphatase levels change with the intake of large doses of ascorbic acid, antibacterial drugs, with a lack of calcium and phosphorus.

Acceptable values of the main important enzymes are shown in the table.

Patient management tactics

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 fat deposits in it, remove toxins and toxins.

It is important to increase the amount of vegetables you eat. Spinach, collard greens, lettuce, dandelion greens are considered especially useful. You also need to increase the amount of foods consumed, which contain antioxidants (avocados, nuts).

The daily menu must contain at least 50 g 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:

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

Treatment includes the intake of a sufficient amount of protein, because it is the protein substances that are considered the necessary basis for the restoration of damaged hepatocytes. However, how much of 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 hepatic mechanism for processing proteins.

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

Taking herbs and supplements

Herbal medicine has a beneficial effect on the liver and allows you to reduce the pathological parameters of enzymes. Treatment consists in the use of herbal teas. It is important to consult with your doctor about the possibility of such events.

Useful herbal ingredients:

Turmeric should be added to food, 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 the diagnostics it is found pathological process, which was the reason for the increase in liver enzymes, it must be treated. A qualified specialist will select a therapy regimen for a patient according to a specific clinical case.

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

The liver is important body, on the correct functioning of which the well-being and health of a person depends. Enzymes are liver enzymes that are involved in biochemical processes in the body.

This organ produces several types of enzymes:

The concentration of enzymes in the blood changes if:

the organ in question is damaged;
the development of pathologies is observed.

A biochemical blood test is one of effective methods diagnostics of liver diseases. Many enzymes produced by this organ enter the bloodstream. In some pathologies, the amount of some elements in the blood plasma decreases, while others increase.

A blood test for liver disease helps doctors narrow the circle of pathologies, if necessary, send the patient for an additional examination, and make a diagnosis. The method shows in what concentration in the blood serum enzymes of each of the 3 groups are present:

Secretory - some of them are involved in the process of cholinesterase and blood clotting. With pathologies, their concentration decreases.
Excretory are excreted in the bile. In case of violations in the work of the organ, their level increases.
Indicator functions perform intracellular functions, are located in mitochondria (ASAT, GDH), cytosol of cells (ALAT, LDH, ASAT). Their concentration in the blood serum increases with liver damage. The norm of ALAT is 5-43 U / l, and AsAT is 5-40 U / l. The value of the first indicator can increase 20-100 or more times in acute parenchymal hepatitis. AsAT activity increases slightly.

In the blood of liver diseases, the concentration of indicator enzymes increases:

Doctors, conducting a liver examination, take into account the ALT and AST indicators. First rate:

With hepatitis, the ALT concentration increases sharply before symptoms appear. Therefore, a timely examination allows you to quickly start treatment.

The concentration of this substance increases with damage to hepatocytes. ALT and AST readings are a diagnostic method called the de Ritis ratio (DRr). Physicians determine their ratio to select an effective treatment regimen. ALT to AST should normally be 1: 3.

If, after evaluating the results of a blood test for AST and ALT, an accurate diagnosis cannot be made, then additional tests are performed to check the liver. To do this, determine the concentration:

Normally, GGT indicators are up to 38 U / L (for women) and up to 55 U / L (for men). An increase in concentration by more than 10 times is observed in diabetes and diseases of the biliary tract. The rate of GLDH is up to 3 U / L (for women) and up to 4 U / L (for men). The concentration increases with severe poisoning, oncology, infectious processes... LDH norm - 140-350 U / l.

ALP (alkaline phosphatase) is involved in the digestion process and is excreted in the bile. Normally, its concentration in the blood serum is 30-90 U / L (in men it can reach 120 U / L). With an increase in the intensity of metabolic processes, the level of alkaline phosphatase increases to 400 U / L.

Bad blood tests are not a cause for panic. After the diagnosis is made, the doctor prescribes treatment, taking into account the characteristics of the course of the disease and the patient's body. One of the drugs that are prescribed to normalize enzymes is Galstena. You cannot self-medicate by taking medication without consulting a qualified professional. Folk remedies use on the recommendation of the attending physician.

Transaminases are microsomal enzymes that are found in all cells and are required for aminotransferase. Thanks to them, the exchange of nitrogen-containing compounds with carbohydrates occurs. Transaminase ALT is active in the liver and AST in muscle tissue. An increase in the level of these substances in the blood is observed in liver pathologies (viral hepatitis) and myocardial infarction.

With hepatitis, the patient may have no jaundice, the level of bilirubin is normal, but the concentration of transferases increases. This may indicate the following pathologies:

obstructive jaundice;
tumor processes in the liver;
cholestasis;
acute viral, toxic or chronic hepatitis.

Due to myocardial infarction, the level of aminotransaminases can increase 20 times in a few days, and with angina pectoris, their concentration does not change. The amount of aminotransaminases in the blood can temporarily increase with gout, extensive muscle injuries, myopathies, burns, myositis, diseases associated with the breakdown of erythrocytes.

DR indications (de Ritis coefficient) help in the diagnosis of the following pathologies:

viral hepatitis - DR up to 1;
chronic hepatitis or liver dystrophy - DR 1 and higher;
alcoholic liver disease (hepatitis, fatty degeneration or cirrhosis of the liver) - DR 2 and higher, and blood albumin up to 35 g / l;
myocardial infarction - DR above 1.3.

Diagnosis of liver cirrhosis and hepatitis C includes a biochemical blood test. With its help, doctors determine:

bilirubin level;
the concentration of liver enzymes;
whey protein content.

bilirubin (1.7-17 μmol / l);
SDG (up to 17 units);
AST, ALT (up to 40 units);
fructose-1-phosphataldolase (up to 1 unit);
urokinase (up to 1 unit).

Bilirubin increases with cirrhosis of the liver. 3 indicators are taken into account (measured in μmol / l):

direct fraction (norm - up to 4.3);
indirect fraction (norm - up to 17.1);
the sum of fractions (the norm is up to 20.5).

A blood test for cirrhosis of the liver additionally involves determining the level of alkaline phosphatase (the norm is up to 140 units), γ-GGT (the norm for women is up to 36 units, for men - up to 61 units), albumin (normally up to 50 g / l). A coagulogram (special test) is recommended. The liver synthesizes a large number of proteins that affect blood clotting. Patients predisposed to liver pathologies need to know:

The elimination of the causes that led to an increase in the concentration of the former allows to normalize the level of enzymes. Additional tests may be required for liver cirrhosis and other pathologies. What tests need to be passed is determined by the attending physician.

except drug treatment, patients are advised to adjust their nutrition:

exclude salty, fatty, spicy and smoked meats from the diet;
give up coffee and alcohol;
include dairy products and organic food in the menu;
take hepatoprotectors.

Timely tests for liver cancer allow you to quickly start treatment.

In an advanced state, the disease can cause death. Having found symptoms of cirrhosis, you can not self-medicate. It is recommended to seek help from a doctor, pass required analyzes with liver cancer. This condition is dangerous during pregnancy. During this period, the patient should be under constant medical supervision (liver examination). If necessary expectant mother will need to go to preservation or carried out drug interruption pregnancy.

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Transaminases, or transferases, are catalytic enzymes chemical reactions nitrogen metabolism, the main task of which is the transport of amino groups for the formation of new amino acids. Biochemical processes that require their participation are carried out mainly in the liver.

The transit movement of transaminases in the blood normally does not affect the test result; quantitatively, their concentration for women and men, respectively, is up to 31 and 37 U / L for ALT and 31 and 47 U / L for AST.

Hepatic transferases determined in standard laboratory tests:

alanine aminotransferase, or alanine transaminase (ALT);
aspartate aminotransferase, or aspartic transaminase (AST).

On the level of enzymes with healthy liver are influenced by characteristics such as age ( increased value in newborns), gender(the rate of transaminases in the blood in women is lower than in men), overweight (there is a slight increase in transaminases).

Reasons for fluctuations in AST, ALT indicators

Transaminases in the blood of a healthy person do not show activity; a sharp increase in their level is an alarming signal. It is worth knowing that the increase in indicators is not always triggered by liver disease. AST is used as a marker of heart muscle damage in myocardial infarction; concentration also increases with a severe attack of angina pectoris.

Therefore, the determination of the enzymatic activity of transaminases cannot be attributed to specific tests. But at the same time, AST and ALT are reliable and sensitive indicators of liver damage in the presence of clinical symptoms or anamnestic data on the transferred disease.

An increase in the activity of hepatic transaminases applicable to liver pathology is observed in the following cases:

1. Necrosis of hepatocytes (liver cells).

Necrosis is irreversible process, during which the cell ceases to exist as a structural and functional unit of tissue. The integrity of the cell membrane is violated and the cellular components come out, which leads to an increase in the concentration of biologically active intracellular substances in the blood.

Massive necrosis of hepatocytes provokes a rapid and multiple increase in hepatic transaminases. For the same reason, significantly pronounced cirrhosis of the liver is not accompanied by enzymatic hyperactivity: there are too few functioning hepatocytes for their destruction to cause the growth of AST and ALT.

Indicators of transaminases correspond to the norm, although the process is already in the stage of decompensation. ALT is considered a more sensitive indicator in liver diseases, therefore, with appropriate symptoms, first of all, attention is paid to its level.

Necrotic changes in liver tissue are observed in acute and chronic hepatitis different etiology: viral, toxic (in particular, alcoholic and medicinal), acute hypoxia, which occurs as a result of a sharp drop blood pressure in shock.

The release of enzymes directly depends on the number of affected cells, therefore, the severity of the process before carrying out specific research assessed by the quantitative level of transaminases AST and ALT and an increase in comparison with the norm.

However, to determine further tactics, an additional examination is required along with a biochemical blood test in dynamics.

2. Cholestasis (bile stasis).

Despite the fact that a violation of the outflow of bile can occur on different reasons, its prolonged stagnation in conditions of preserved secretion by hepatocytes leads to overstretching, metabolic disturbances, and, at the end of the pathological chain, to necrosis.

3. Dystrophic changes.

Dystrophy is a violation of tissue metabolism. It accompanies inflammation in one way or another; as its variety, the replacement of necrotic areas with connective tissue, which constitutes the pathogenetic basis of liver cirrhosis, can be considered.

Among the reasons for the increase in transaminases, fatty degeneration of the liver (alcoholic fatty hepatosis) is indicated.

Genetic diseases are also important, for example, Wilson-Konovalov disease (hepatolenticular degeneration), characterized by excessive accumulation of copper.

4. Neoplasms.

Liver tumors, both benign and malignant, destroy the surrounding tissue as they grow, causing inflammation. This is reflected in a persistent increase in liver transaminases.

A similar effect is exerted by metastases - tumor cells brought in with the flow of blood or lymphatic fluid, which form secondary tumor foci in the liver tissue.

6. Medicinal effects.

To date, science has the data of numerous studies, which have proven that drugs cause increased transaminases. These include:

The increase in transaminases does not depend on the form of the drug; tablets, like intravenous infusion, can adversely affect the liver or cause false activity of AST and ALT, which is due to the specifics of their determination in blood serum.

Symptoms

Despite the variety of causes, liver diseases have a number of similar symptoms, accompanied by an increase in hepatic transaminases:

weakness, lethargy that appears suddenly or persists for a long time;
nausea, vomiting, regardless of whether there is a connection with food intake;
decreased appetite or no appetite at all, aversion to certain types food;
pain in the abdomen, especially when localized in the right hypochondrium, epigastrium;

an increase in the abdomen, the appearance of a branched network of saphenous veins;
icteric coloration of the skin, sclera of the eyes, visible mucous membranes of any degree of intensity;
excruciating obsessive itching of the skin, aggravated at night;
discoloration of discharge: darkening of urine, acholic (discolored) feces;
bleeding of mucous membranes, nose, gastrointestinal bleeding.

With hepatitis B, predominantly alanine transaminase is increased, hyperenzymemia is observed several weeks before the onset of signs of the disease.

Importance in diagnosis

To determine the characteristics of liver pathology according to the level of hyperenzymemia, a special scale is used. The increase in hepatic transaminases is divided as follows:

The peak of transaminase activity in acute viral hepatitis is observed in the second - third week of the disease, after which it decreases to normal values of ALT and AST within 30-35 days.

In a chronic course without exacerbation, hyperenzymemia is not characterized by sharp fluctuations, and remains within the range of a moderate or insignificant increase. In the latent (asymptomatic) phase of liver cirrhosis, transaminases are most often within normal limits.

It is important to pay attention if hepatic transaminases are elevated in isolation or in combination with other indicators of the biochemical spectrum: bilirubin, gamma-glutamyl transpeptidase, alkaline phosphatase, since the combination of the growth of indicators indicates a specific pathology or narrows the range of probable causes.

Subhepatic (mechanical) jaundice, acute hepatic failure may be accompanied by an increase in the level of bilirubin with a simultaneous normal or low concentration of AST and ALT. This phenomenon is called bilirubin aminotransferase dissociation.

An increase in transaminases in children is often caused by infection with the hepatitis virus, a drug-induced liver injury. Dangerous pathology found in childhood, is Reye's syndrome. As a result of the use acetylsalicylic acid(aspirin), acute hepatic encephalopathy develops, a life-threatening condition.

For the purpose of in-depth diagnostics, they use the de Ritis coefficient, which is the ratio of the transaminases AST and ALT. The norm is 1.33. If the de Ritis coefficient is less than 1, this is regarded as a sign of an infectious and inflammatory lesion of the liver.

For acute viral hepatitis, for example, it is 0.55-0.83. Achievement of a level equal to 2 and higher suggests a presumptive alcoholic hepatitis or necrosis of the heart muscle.

Significance in therapy

An increased content of transaminases in the blood is, in most cases, an unfavorable sign, evidence that liver cells are being destroyed.

Hyperenzymemia can be re-detected some time after the normalization of the parameters. As a rule, this indicates the beginning of a new or relapse of the existing pathological process and renewed necrosis of hepatocytes.

How to lower transaminases? The level of AST and ALT is only a reflection of the presence of the disease; therefore, a return to normal values can be achieved only with adequate diagnosis and treatment of the detected pathology. High and extremely high levels of enzymes necessitate hospitalization and immediate additional examination.

It includes general clinical blood tests, a detailed biochemical blood test with the determination of electrolytes, glucose, as well as instrumental methods - electrocardiography, ultrasound and / or computed tomography of the abdominal organs.

If necessary, perform ELISA ( linked immunosorbent assay) to search for antibodies to hepatitis viruses or PCR (polymerase chain reaction) to determine the DNA or RNA of viruses.

The transaminase test is sensitive to changes in the liver, so it can be used to assess the effectiveness of the therapy in combination with other laboratory and instrumental methods.

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Enzyme groups

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

Indicator. These enzymes show the presence of organ pathology in the form of destruction of its cells. These include AST (aspartate aminotransferase), ALT (alanine aminotransferase), GGT (gamma glutamyl transferase), GDG (glumate dehydrogenase), LDH (lactate dehydrogenase). The first two enzymes are most commonly used for diagnostic processes.
Secretory (cholinesterase, prothrombinase). Participate in supporting the work of the blood coagulation system.
Excretory (representative - alkaline phosphatase). It is found in the 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 monitored by a biochemical blood test. AST is an endogenous enzyme produced inside hepatocytes. It is 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 there are no visible symptoms yet.

Reasons for the increase

Enzymes can increase with long-term treatment with pain medications, statins (drugs that are used to remove "bad" cholesterol from the body), sulfonamides, Paracetamol. The provoking factors can 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 in the blood test for liver enzymes the indicators are increased, this signals the following pathological conditions:

Signs of increased 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;
violation of appetite;
itching of the skin;
yellowness of the sclera and skin;
frequent bruising, nosebleeds.

Excretory and secretory enzymes

Indicators during pregnancy

Indicators of GGT - 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, with gestational diabetes mellitus.

The rate of alkaline phosphatase is up to 150 U / l. The active growth of the fetus from 20 weeks until the moment of delivery causes an increase in the enzyme numbers. The level of alkaline phosphatase changes with the intake of large doses of ascorbic acid, antibacterial drugs, with a lack of calcium and phosphorus.

Norm

Acceptable values of the main important enzymes are shown in the table.

Patient management tactics

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:

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

Taking herbs and supplements

Useful herbal ingredients:

astragalus;
dandelion;
thistle.

Turmeric should be added to food, which reduces the manifestations of inflammatory processes, and garlic, which has an antitumor effect. Antioxidant-rich dietary supplements may be used with your doctor's approval.

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 a patient according to a specific clinical case.

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

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01 Essence of the problem

The liver produces the following enzymes: secretory, indicator and excretory. When liver enzymes exceed allowable rate, or their level becomes less than the norm, this indicates that either there is a pathology in the body, or the liver is damaged. Based on a blood test, doctors can determine what pathologies occur in the body, and with some additional studies, they can make an accurate diagnosis.

For example, if the liver enzymes of the secretory group are increased or decreased, then blood coagulation pathologies are likely to be present. If the functioning of the organ is disrupted, then the level of excretory enzymes increases, and the indicator enzymes are responsible for the processes inside the cell, when the liver is damaged, their level increases, and the level increases with parenchymal hepatitis.

02 Classification of enzymes

When examining the liver, the indicators of AST, ALT, GGT, LDH and ALP are most often considered:

gamma glutamyltransferase - GGT;
lactate dehydrogenase - LDH;
alkaline phosphatase - alkaline phosphatase.

The most informative indicators are AST, ALT. The norm of AST and ALT for women should not exceed 31 units, for men ALT - 45 units, AST - 47 units. We must not forget that the rate of indicators will change in accordance with the age of the patient, therefore the above indicators are very arbitrary. As for children, in this case, the age of the child also matters in determining the norm. Deciphering of blood tests should be carried out by a competent specialist.

03 Symptoms of increased indicators

If a high level of liver enzymes is found in the blood, then the patient may not feel this in any way. Sometimes with diseases of the human liver, weakness, pain in the abdominal cavity, loss of appetite, and severe fatigue may be troubling. There may be itching and a yellow skin tone, the sclera of the eyes may also turn yellow. With a decrease in blood clotting, hematomas of undetermined origin may occur.

If disorders occur in the pancreas, the person may experience painful sensations, sometimes the patient complains of dyspeptic disorders - an increase in the formation of gas, undigested pieces of food are observed in the feces, the feces become more fatty.

04 What measures should be taken?

An increase in the blood levels of liver enzymes should alert a person. This phenomenon should be considered solely as a symptom that requires additional diagnostic measures. Therefore, having found high enzymes in the analysis, it is necessary to consult a therapist.

Most often, doctors recommend following a diet, food should be fractional, portions - small, food - healthy. It is necessary to give up salty, fatty, smoked, spicy foods, it is worth refraining from coffee, carbonated drinks and alcohol. It is advisable to consume more fermented milk products and organic foods. You can take any medications and hepatoprotectors if your doctor recommends them. These drugs are good at repairing damaged liver cells and helping the organ to perform its functions.

How to eat with liver damage? Fatty and heavy foods negatively affect the liver, this organ needs a lot of greens - lettuce, spinach. Inflammatory processes in the liver reduce walnuts, avocado helps to remove harmful substances from the body. Useful in garlic and fermented milk products.

It is advisable to introduce foods with a high fiber content into the diet - legumes, fruits, berries, cereals. Due to the fact that the liver processes a large amount of fat, its condition may deteriorate, foods that are rich in fiber increase the work of the gallbladder, and more bile is secreted, which significantly reduces the load on the liver during the breakdown of fats. It is recommended to eat foods that contain vitamin C - rose hips, citrus fruits.

You also need to consume more fluids, water helps to remove toxins from the liver, so you need to drink at least 2 liters per day. You can drink pure water, or you can brew herbal teas, for example, from milk thistle, dandelion root, astragalus. Green tea is also very beneficial for the liver.

If the doctor recommends taking medications - hepatoprotectors, then it is very important to heed this recommendation and purchase Allochol, Essentiale, Phosphoglyph or Galstena - they will help bring enzyme indicators back to normal and restore damaged organ cells.

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Role in the body

An increase in the level of these enzymes occurs due to the death of cells in the internal organs and indicates the presence of abnormalities in the work of the body. There are two types:

AST (Aspartanin-Transferase) - a specific enzyme, sensitive to changes in the heart muscle, liver, brain. Bye cellular structure these organs are not disturbed, the level of AST in the blood will be within normal limits.
ALT (ALanin-Transferase) is an enzyme that is a major indicator of liver disease.

As simple and accessible as possible about liver markers in the video below

Analysis

Indications for analysis

The reason for donating blood for the detection of transaminases may be the symptoms of the disease, which causes an increase in the level of the enzymes ALT and AST. For example, hepatitis, heart attack, gastrointestinal diseases. The attending physician will definitely send for analysis if the following symptoms are found:

Chest pains on the left side and irregular heartbeat.
Pain in the right side of the abdomen (in the hypochondrium).
Weakness, fatigue.
Discoloration of the skin (jaundice).
Enlargement of the abdomen in babies.
Long-term reception medications that can provide Negative influence to work the liver.
Suspected trauma to internal organs.
Evaluation of the effectiveness of treatment.
Toxic poisoning.

Preparation for analysis

To obtain a reliable result, the following rules must be observed:

Blood is donated on an empty stomach, preferably in the morning.
It is allowed to drink only ordinary boiled water.
Do not take any medications 10 days before the test.
For a couple of days, you need to exclude junk food (fried, sweet, salty) and alcohol from your diet.
Recommended reduce physical activity to a minimum.

Indicator standards

Indicators differ depending on gender and age:

Reasons for elevated enzyme levels: ALT and AST

ALT and AST levels rise in the blood when the tissue of the organ for which they are responsible, mainly the liver, gastrointestinal tract and heart muscle, is damaged. A more detailed list of reasons for an increase in enzyme levels is presented below:

Hepatitis of any etymology (ALT is the main diagnostic indicator).
Oncological diseases of the liver.
Benign liver tumors.
Diseases associated with damage to the heart muscle (for this reason, a simultaneous increase in ALT and AST is also observed).
During pregnancy, the level of ALT in the blood slightly increases, such deviations should not cause concern. But if during pregnancy there is a simultaneous increase in the level of ALT and AST, then a diagnosis of liver function is necessary.
A neglected form of pancreatitis (ALT rises).
Taking medications: warfarin, paracetomol, hormonal drugs(this may be the reason for increased performance)
Congenital liver pathologies in infants (increased GGT and ALT).

How to reduce indicators

It is possible to reduce the amount of ALT and AST enzymes in the blood only by eliminating the underlying disease that caused the deviation from the norm. When the damaged organ fully regains its functions, it will stop releasing transaminases into the blood. Traditional medicine can help the diseased organ to cope with the pathology faster and to treat it.

Nutritional recipes to normalize the liver and heart:

Dissolve half a teaspoon of turmeric and a tablespoon of honey in a glass of water. Take three times a day.
Oatmeal with milk will help cleanse the liver of accumulated toxins.
Freshly squeezed beet juice.
Remove cholesterol will help delicious dessert from boiled pumpkin and honey.

What are liver function tests

Liver tests combine species laboratory analyzes aimed at identifying possible liver diseases.

Include quantification liver enzymes and bilirubin in the blood:

ALT (alanine aminotransferase).
AST (aspartate aminotransferase).
GGT (gammagrutanyltransferase).
ALP (alkaline phosphatase).
Total bilirubin.

Prophylaxis

Liver disease can be prevented by a special diet that includes foods rich in vitamin D in your diet: milk, eggs, apples, sea fish, caviar, buckwheat and oat groats... Eating healthy, plant-based foods can help your liver become more resistant to disease and remove dangerous toxins. Eliminate fatty and salty foods from your diet so as not to overload the liver.
Give up bad habits: alcohol and tobacco smoking.
Avoid exposure to toxins. They can easily penetrate the body, having a detrimental effect on the liver.
Do not self-medicate. Uncontrolled intake of antibiotics may not bring the indicators back to normal, but, on the contrary, significantly weaken the liver function.

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What are the different groups of liver enzymes?

It is customary to differentiate liver enzymes by groups. Allocate:

Secretory substances. These include prothrombinase and cholinesterase. These molecules have the function of blood clotting. If a patient has a deficiency, it means that there are abnormalities in the work of the gallbladder, its ducts and liver.
Indicator molecules of blood. They are made up of such compounds as: AST, ALT, LDH. Such substances are part of blood cells. If the organs are not functioning properly, their values in the blood are increased.
Excretory group or alkaline phosphatase. This liver enzyme is formed in gallbladder and its ducts. When the process of bile secretion has a pathology, the content of enzymes of this group increases.

Which ones are used more often in research?

For liver enzymes modern medicine diagnoses many diseases.

The amount of substances contained in the liver is quite large. However, to identify diseases, it is enough to investigate only a few of them. The most common for research are such biochemical signs as:

alanine transaminase (AST);
alanine aminotransferase (ALT);
gammalutamyl transpeptidase (GGT);
lactate dehydrogenase (LDH);
alkaline phosphatase (ALP).

Each of the above components can indicate the presence of certain diseases. After the analysis has been carried out, the results are evaluated by the attending physician and a diagnosis can be made. Evaluation takes place in accordance with established general content standards. Each result has certain units of measurement: units / L, μmol / L, mol / L.

Transaminase ratio

AST is a substance that is produced in the cells of the liver and in some other organs of the body. These include: lungs, brain, pancreas, heart muscles and muscle fibers. ALT is formed in the blood by hepatocytes. If there are pathologies in the functioning of any of these components, their content in the blood rises. To identify deviations in early periods development of ailments, conduct a biochemical study. This will make it possible to correctly identify the disease and prescribe effective treatment.

Changes in these indices may indicate a dysfunction of both the liver and the heart. To make the diagnosis accurately, the de Ritis coefficient is used. If the signs of transaminases are normal, its calculation is useless. However, if the activity of liver enzymes fluctuates, its value will help to correctly assess the patient's condition. Such a coefficient is calculated by determining the partial ratio of these two indices. The result is considered normal in the range of 0.9-1.8. When the upper limit is increased, it indicates cardiac abnormalities. If the indicator is lower, these are symptoms of liver disease.

To obtain more accurate data in the detection of liver diseases, the ratios of the level of transaminases in the de Ritis coefficient with the processes taking place in the body were studied. The following interpretation of the results was found out:

1 - speaks of the development of viral hepatitis;
1-2 - dystrophy of the hepatic gland or chronic form jaundice;
more than 2 - destructive processes in the liver due to alcohol abuse.

Norms for adults and children

To identify existing deviations, it is important to know general norms AST ALT activity. There are different ways laboratory research using various reagents. The main methods for detecting liver failure are optical and the Reitman-Frenkelal reaction. Results vary according to gender and age differences in patients. In optical biochemistry, the following values are used: men - 40-41 IU, women - 34-35 IU, babies - 50 IU. For the RF reaction: men - 0.1-0.5 h / ml, women - 0.1-0.4 h / ml, babies - 0.2-0.5 h / ml.

When no significant violations were detected during biochemical analysis, they talk about healthy and correct functioning of the heart muscle and biliary system... If there are strong fluctuations in the indices, it is recommended to study the data in relation to other markers. In particular, to determine the de Ritis coefficient.

Alanine aminotransferase is a special enzyme that indicates liver function. Its amount in the blood is usually measured in units per liter (U / L), and the content in the body changes with age and differs among representatives of different sexes. Normal markers in babies change as follows:

babies - no more than 49;
up to 6 months - more than 56;
up to 12 months - 54;
1-3 years - 33;
3-6 years old - 29;
v adolescence- maximum 39.

The younger generation may experience slight deviations in the content of the indicator. V early age such deviations are permissible, since the characteristics of the growth of the organism are individual. Subsequently, the amount of enzymes in the blood will stabilize and become normal. Adults have established markers for healthy body functioning. For men, this is considered an index of 45, and for women - 34.

What is the reason for the increase in transaminases

ALT marker

If the maximum threshold for its value in the blood is increased, they speak of destructive processes in the liver tissues. Markers can grow depending on various factors, such as:

Development of serious diseases in the form of oncology, cirrhosis, hepatitis. When medication, allergic, alcohol and other types of overdose are present in the cells, ALT intensively passes into the blood fluid. And during the examination, large deviations from the level of normal indicators are observed. The dependence of the substances is as follows: the more developed the disease, the greater the increase in indices.
Myocardial infarction, which is characterized by the presence of zones of death in the area of the heart muscle, which is the reason for a jump in the level of enzymes.
Other disorders of the functional work of the heart increase the amount of ALT in the blood serum, and indicate destructive processes.
Severe trauma. They can be wounds or burns, muscle damage.
Acute pancreatitis, which is characterized by inflammation in the area of the pancreas.

AST marker

AST activity is manifested in pathologies of the heart muscle, diseases of the pancreas, when there is liver failure. Enzyme jump reasons:

Myocardial infarction. One of the most common reasons for an increase in AST content. The indicators are usually greatly increased - up to several tens of units.
Heart failure, characterized by the presence of inflammation. For example, postoperative condition, carditis and myocarditis.
Severe abnormalities in the liver, such as hepatitis (drug, allergic, alcoholic, toxic, viral), hepatic cirrhosis, oncology.
The presence of traumatic injuries and burns.
Pancreatitis of various forms.

The liver enzyme hypersecretion is usually counterbalanced by taking appropriate medications.

It is possible to reduce the level of secreted enzymes when the cause of the disease is eliminated. Therefore, you should start with curative therapy... Subsequently, to determine the effectiveness of the treatment, it is necessary to do repeated biochemistry. If the therapy was prescribed correctly, the markers should come to normal condition... Sometimes special drugs are enough to lower the indices. These are such medicines as "Heptral", "Hofitol", "Duphalac". They should be used only after consulting a doctor, then he will monitor the patient's condition. This is important because most drugs have serious contraindications that require attention and consideration. Such a course is symptomatic, that is, it does not eliminate the main reason for the deviations. If this indicator is lowered during treatment, after the end of therapy, the level of activity of the substances can increase again.

It is recommended to further investigate the relevant organs, the deviations of which are indicated by an increase in the norm. After dysfunction is identified and a diagnosis is made, treatment will be prescribed. When all the prescriptions are fulfilled, the symptoms will go away and the markers will return to normal. It is important to realize that an increase in the level of transamenase molecules is a consequence of violations. When obtaining results, you cannot do without the advice of a specialist.

Additional liver tests

To identify pathologies, secondary meanings of violations are also used. One of them is considered GGT - it is concentrated in the kidneys, in the bile ducts and in the pancreas. Permissible value for enzyme - 40 units / l. It plays an important role in studying the condition of children and pregnant women. An increase in its activity indicates the formation of tumors, cell death, alcohol poisoning, cholestasis, hepatitis, cholangitis. Another example is ALP - the substance is found in the bile ducts, kidneys, and bone tissue. Its norm is 270 units / l. This value is considered for violations of the gallbladder and in the biliary system.

Liver enzymes, or enzymes, are very important for the normal functioning of the human body, they take part in metabolic processes. When their normal level changes, this indicates the development of any diseases in the body, which can often threaten not only health, but also human life.

The essence of the problem

The liver produces the following enzymes: secretory, indicator and excretory. When liver enzymes exceed the permissible norm, or their level becomes less than the norm, this indicates that either there is a pathology in the body, or the liver is damaged. Based on a blood test, doctors can determine what pathologies occur in the body, and with some additional studies, they can make an accurate diagnosis.

Ast in the blood

Enzyme classification

When examining the liver, the indicators of AST, ALT, GGT, LDH and ALP are most often considered:

gamma glutamyltransferase - GGT;
lactate dehydrogenase - LDH;
- ALF.

Aspartate aminotransferase elevated what does it mean

Symptoms of increased rates

If violations take place in the pancreas, a person may experience painful sensations, sometimes the patient complains of dyspeptic disorders - an increase in the formation of gas, undigested pieces of food are observed in the feces, the feces become more fatty.

What measures should be taken?

How to eat with liver damage? Fatty and heavy foods negatively affect the liver, this organ needs a lot of greens - lettuce, spinach. Walnuts reduce inflammation in the liver, avocado helps to remove harmful substances from the body. Useful in garlic and fermented milk products.

Enzymes (enzymes) are specific proteins that are involved in biochemical reactions, can speed up or slow down their course. The liver produces a large number of such compounds due to its important role in the metabolism of fats, proteins and carbohydrates. Their activity is determined by the results of a biochemical blood test. Such studies are important for assessing the condition of the liver and for the diagnosis of many diseases.

What it is?

Liver enzymes are a group of biologically active proteins that can be produced exclusively by the cells of this organ. They can be found on the inner or outer membrane, inside cells, or in the blood. Depending on the role of enzymes, they are divided into several categories:

hydrolases - accelerate the breakdown of complex compounds into molecules;
synthetases - take part in the reactions of synthesis of complex biological compounds from simple substances;
transferases - are involved in the transport of molecules across membranes;
oxidoreductases - are the main condition for the normal course of redox reactions at the cellular level;
isomerases - necessary for the processes of changing the configuration of simple molecules;
lyases - form additional chemical bonds between molecules.

IMPORTANT! The activity of enzymes is also influenced by the presence of other compounds (co-factors). These include proteins, vitamins and vitamin-like substances.

Liver enzyme groups

The localization of liver enzymes depends on their function in the processes of cell metabolism. So, mitochondria are involved in the exchange of energy, the granular endoplasmic reticulum synthesizes proteins, the smooth one - fats and carbohydrates, proteins-hydrolases are on the lysosomes. All the enzymes that the liver produces can be found in the blood.

Depending on what functions enzymes perform and where they are located in the body, they are divided into 3 large groups:

secretory - after secretion by liver cells, they enter the bloodstream and are located here in maximum concentration(blood clotting factors, cholinesterase);
indicator - normally contained inside cells and released into the blood only when they are damaged, therefore they can serve as indicators of the degree of liver damage in case of its diseases (ALT, AST and others);
excretory - excreted from the liver with bile, and an increase in their level in the blood indicates a violation of these processes.

Each of the enzymes is important to diagnose the condition of the liver. Their activity is determined when there is a suspicion of underlying liver pathologies and to assess the degree of damage to the liver tissue. To obtain a more complete picture, it may also be necessary to diagnose digestive enzymes, enzymes of the gastrointestinal tract, pancreas and biliary tract.

To determine liver enzymes, it is necessary deoxygenated blood collected in the morning on an empty stomach

Enzymes that are determined for the diagnosis of liver disease

Blood biochemistry is important stage diagnostics of liver diseases. All pathological processes in this organ can occur with the phenomena of cholestasis or cytolysis. The first process is a violation of the outflow of bile, which is secreted by hepatocytes. In the case of other disorders, the destruction of healthy cellular elements occurs with the release of their contents into the blood. By the presence and quantity of liver enzymes in the blood, it is possible to determine the stage of the disease and the nature of pathological changes in the organs of the hepatobiliary tract.

Cholestasis indicators

Cholestasis syndrome (difficulty in bile secretion) accompanies inflammatory liver diseases, impaired bile secretion and pathology of the biliary tract. These phenomena cause the following changes in biochemical analysis:

excretory enzymes are increased;
bile components are also increased, including bilirubin, bile acids, cholesterol and phospholipids.

The outflow of bile can be disrupted by mechanical pressure on the bile ducts (inflamed tissue, neoplasms, stones), narrowing of their lumen and other phenomena. The complex of characteristic changes in blood parameters becomes the basis for a more detailed study of the state of the gallbladder and biliary tract.

Cytolysis indicators

Cytolysis (destruction of hepatocytes) can occur with infectious and non-infectious hepatitis or with poisoning. In this case, the contents of the cells are released, and indicator enzymes appear in the blood. These include ALT (alanine aminotransferase), AST (aspartate aminotransferase), LDH (lactate dehydrogenase), and aldolase. The higher the indicators of these compounds in the blood, the more extensive the degree of damage to the organ parenchyma.

Determination of alkaline phosphatase

Alkaline phosphatase, which is found in the blood, may not only be of hepatic origin. A small amount of this enzyme is produced by the bone marrow. One can speak of liver diseases if there is a simultaneous increase in the level of alkaline phosphatase and gamma-GGT. Additionally, an increase in bilirubin indices may be detected, which indicates pathologies of the gallbladder.

Gamma glutamyl transpeptidase in the blood

GGT usually rises with alkaline phosphatase. These indicators indicate the development of cholestasis and possible diseases biliary system. If this enzyme is increased in isolation, there is a risk of minor damage to the liver tissue in the early stages of alcoholism or other poisoning. With more serious pathologies there is a simultaneous increase in liver enzymes.

The final diagnosis can only be made on the basis of comprehensive survey which includes ultrasound

Liver transaminases (ALT, AST)

ALT (alanine aminotransferase) is the most specific enzyme in the liver. It is found in the cytoplasm of other organs (kidneys, heart), but it is in the hepatic parenchyma that it is present in the greatest concentration. Its increase in the blood can indicate various diseases:

hepatitis, intoxication with liver damage, cirrhosis;
myocardial infarction;
chronic diseases of cardio-vascular system which are manifested by necrosis of areas of functional tissue;
muscle injury, injury or bruising;
severe pancreatitis - inflammation of the pancreas.

AST (aspartate dehydrogenase) is found not only in the liver. It can also be found in the mitochondria of the heart, kidneys, and skeletal muscle. An increase in this enzyme in the blood indicates the destruction of cellular elements and the development of one of the pathologies:

myocardial infarction (one of the most common causes);
liver disease in acute or chronic form;
heart failure;
trauma, inflammation of the pancreas.

IMPORTANT! In the study of blood and the determination of transferases, the ratio between them (Ritis coefficient) matters. If it AST / ALS exceeds 2, we can talk about serious pathologies with extensive destruction of the liver parenchyma.

Lactate dehydrogenase

LDH belongs to cytolytic enzymes. It is not specific, that is, it is found not only in the liver. However, its definition is important in the diagnosis of icteric syndrome. In patients with Gilbert's disease ( genetic disease, which is accompanied by a violation of the binding of bilirubin), it is within normal limits. In other types of jaundice, its concentration increases.

How is the activity of substances determined?

A biochemical blood test for liver enzymes is one of the main diagnostic activities... This requires venous blood collected on an empty stomach in morning time... During the day before the study, it is necessary to exclude all factors that can affect the functioning of the liver, including the intake of alcoholic beverages, fatty and spicy foods. A standard set of enzymes is determined in the blood:

ALT, AST;
total bilirubin and its fractions (free and bound).

Some groups of medicines can also affect the activity of liver enzymes. They can also change normally during pregnancy. Before the analysis, it is necessary to notify the doctor about taking any medications and about a history of chronic diseases of any organs.

Standards for patients of different ages

For the treatment of liver diseases, a complete diagnosis must be carried out, which includes, among other things, a biochemical blood test. The enzyme activity is studied in combination, since different indicators may indicate different disorders. The table shows the normal values and their fluctuations.

Compound	Indicators of the norm
Total protein	65-85 g / l
Cholesterol	3.5-5.5 mmol / l
Total bilirubin	8.5-20.5 μmol / L
Direct bilirubin	2.2-5.1 μmol / l
Indirect bilirubin	Not more than 17.1 μmol / l
ALT	For men - no more than 45 units / l; For women - no more than 34 units / l
AST	For men - no more than 37 units / l; For women - no more than 30 units / l
Ritis coefficient	0,9-1,7
Alkaline phosphatase	Not more than 260 units / l
GGT	For men - from 10 to 70 units / l; For women - from 6 to 42 units / l

The ALS enzyme has the most important diagnostic value in cases of suspected hepatitis, fatty degeneration, or cirrhosis of the liver. Its values normally change over time. This compound is measured in units per liter. Normal indicators at different ages will be:

in newborns - up to 49;
in children under 6 months - 56 or more;
up to a year - no more than 54;
from 1 to 3 years old - up to 33;
from 3 to 6 years old - 29;
in older children and adolescents - up to 39.

Medicines accumulate in the liver parenchyma and can cause an increase in the activity of its enzymes

IMPORTANT! A biochemical blood test is an important, but not the only study that determines the state of the liver. They also carry out ultrasound and additional examinations if necessary.

Features of the definition during pregnancy

In the normal course of pregnancy, almost all enzyme indicators remain within normal limits. On later dates a slight increase in the level of alkaline phosphatase in the blood is possible - the phenomenon is associated with the formation of this compound by the placenta. Elevated liver enzymes can be observed with gestosis (toxicosis) or indicate an exacerbation of chronic diseases.

Changes in enzyme activity in cirrhosis

Cirrhosis is the most dangerous condition in which the healthy liver parenchyma is replaced by connective tissue scars. This pathology is not treated, since the restoration of the organ is possible only due to normal hepatocytes. In the blood, there is an increase in all specific and nonspecific enzymes, an increase in the concentration of bound and unbound bilirubin. Protein levels, on the other hand, decrease.

Special group - microsomal enzymes

Microsomal liver enzymes are a special group of proteins that are produced by the endoplasmic reticulum. They take part in the reactions of neutralizing xenobiotics (substances that are foreign to the body and can cause symptoms of intoxication). These processes take place in two stages. As a result of the first of them, water-soluble xenobiotics (with low molecular weight) are excreted in the urine. Insoluble substances undergo a series of chemical transformations with the participation of microsomal liver enzymes, and then are eliminated in the bile into the small intestine.

The main element that is produced by the endoplasmic reticulum of liver cells is cytochrome P450. For the treatment of some diseases, drugs-inhibitors or inducers of microsomal enzymes are used. They influence the activity of these proteins:

inhibitors - accelerate the action of enzymes, due to which the active substances of the drugs are faster excreted from the body (rifampicin, carbamazepine);
inducers - reduce the activity of enzymes (fluconazole, erythromycin and others).

IMPORTANT! The processes of induction or inhibition of microsomal enzymes are taken into account when selecting a treatment regimen for any disease. Simultaneous reception medicines these two groups are contraindicated.

Liver enzymes are an important diagnostic indicator for detecting liver disease. However, for a comprehensive study, it is also necessary to conduct additional analyzes, including ultrasound. The final diagnosis is made on the basis of clinical and biochemical analyzes of blood, urine and feces, ultrasound of the abdominal organs, if necessary - X-ray, CT, MRI or other data.

Liver enzymes (enzymes) maintain consistency in the body, acting in a manner imperceptible 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.

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

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

These are microsomal liver enzymes, the level of which is monitored by a biochemical blood test. AST is an endogenous enzyme produced inside hepatocytes. It is 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 there are no visible symptoms yet.

A healthy liver is the key to your longevity. This body carries out great amount vital functions. If the first symptoms of a disease of the gastrointestinal tract or liver were noticed, namely: yellowing of the sclera of the eyes, nausea, rare or frequent stools, you simply have to take action.

If in the blood test for liver enzymes the indicators are increased, this signals the following pathological conditions:

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

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; violation of appetite; itching of the skin; yellowness of the sclera and skin; frequent bruising, nosebleeds.

Acceptable values of the main important enzymes are shown in the table.

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

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

Useful herbal ingredients:

astragalus; dandelion; thistle.

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

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The liver enzymes, which are in its cells, carry out cleansing, transport and processing functions. Thanks to these substances, the liver can cleanse up to 100 liters of blood in an hour, transform or neutralize about a million molecules in a minute. If, for some reason, the cells are damaged, then the enzymes are released and their level in the blood rises.

Inside the hexagonal hepatic cell are the enzymes ALT and AST. Their indicators should not exceed a certain level of liver enzymes in the blood, otherwise this indicates the presence of a disease. If the amount of enzymes in the blood is still more than the norm, you should know that a unique organ is able to recover within 3 months, subject to the rules of nutrition and treatment.

Liver diagram

The first signs of the disease are heaviness, pain in the right side, nausea, weakness, chronic fatigue... In order to find out what is the reason, you need to pass tests for liver enzymes, as well as undergo additional examinations. An increase or decrease in indicators may indicate a disease.

The level of AST (aspartate aminotransferase) in women should not exceed 31 units in 1 liter of blood, in men - 41 units in 1 liter of blood; the norm of ALT (alanine aminotransferase) is from 10 to 40 units in 1 liter of blood. Aminotransferases are liver enzymes, thanks to which glycogen is synthesized, the connection between protein and carbohydrate metabolism. AST level can increase in acute or chronic hepatitis, cancer and the initial stage of cirrhosis, ALT - with a deficiency of lysosomal acid lipase, diabetes, viral hepatitis due to the toxic effects of drugs. An increase in liver enzymes of alkaline phosphatase should not be disturbed in case of pregnancy and in children under 14 years of age. In other situations, violations are associated with improper outflow of bile caused by hepatotoxic factors, cholestasis, extrahepatic obstruction of the bile ducts.

Additional analyzes:

A blood test for bilirubin. Normal bilirubin levels are between 3.4 and 20.5 μmol / L. Bilirubin is a breakdown product of hemoglobin, which accumulates in the gallbladder, then together with fatty acids goes to duodenum... Bilirubin in bile helps to process fats that are taken with food, emulsifies them - breaks them down into small particles and makes them available for digestive enzymes. An increased level of bilirubin is observed with damage to the external and internal hepatic pathways, when the outflow of bile is disturbed, bilirubin is directed into the blood and leads to a yellow color of the eye proteins, urine, while the feces lose their yellow color and become gray. A blood test for albumin, the norm of which is 35-50 g / l and reflects the ability of the liver to synthesize proteins, necessary for the body... Albumin maintains fluid levels in the blood and regulates blood pressure, tolerates useful material... Its decline speaks of poor nutrition, renal or hepatic diseases.

Bilirubin blood test

Increase in liver enzymes or deviations from the norm indicate disorders in the body, require further diagnosis with the help of ultrasound and seek the advice of a specialist.

The level of liver enzymes is increased with the destruction of cells and the presence of the following diseases:

myocardial infarction; hepatitis A; cholangitis; cancer and cirrhosis; cholestasis; obstruction of the bile ducts; diabetes mellitus.

These factors lead to the destruction of liver cells:

exposure to the hepatitis virus; fatty hepatosis; poisoning with alcohol, decay products of bacteria and viruses, poor-quality food, fatty, fried, smoked, medicines; unfavorable environmental conditions, work in hazardous production; genetic predisposition; helminthiasis.

A blood test will help determine the cause of organ dysfunction, and the doctor will be able to prescribe a course of treatment and cell restoration.

An irreplaceable organ must be carefully protected. Consider what factors are worst affecting his condition:

Alcohol has a strong toxic effect, while it is not alcohol itself that is more harmful, but its decay products. An increase in liver enzymes may be associated with the presence of hepatitis A, B, C viruses, which destroy this organ and lead to intoxication of the whole organism. Fatty, fried, smoked foods have a detrimental effect on human health. Studies have shown that the liver perceives fat as a toxic agent and tries to break it down and remove it from the cells as quickly as possible. Unhealthy eating habits overload this organ. Margarine and products containing it are dangerous: baked goods, mayonnaise. The consumption of trans fats leads to fatty degeneration and damage to the liver cells, as a result of which the liver tissue is replaced by fatty tissue. Fructose and fructose syrups, which are sweeter than sugar, do not contain glucose, so the body is not saturated, but excess fat postponed. Eating these foods stimulates the release of insulin, which affects excess fat production. This leads to inflammation and destruction of liver tissue - steatohepatitis, and then to cirrhosis and even cancer. The direct toxic agent for the liver is the preservative monosodium glutamate, which is found in instant noodles, ready-made sauces, sausages, and chips. It is toxic to the liver, causes oxidative stress, which leads to destruction of the liver walls and scarring. As a result, the self-healing process is disrupted, serious illnesses... Sweet carbonated water with the sweetener aspartame also leads to hepatosis through the formation of fatty liver layers.

Alcohol

Any of these causes destroys liver cells, as a result of which the level of liver enzymes in the blood increases.

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