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High glutamic pyruvic transaminase

Disease name

Transaminases are generally divided into: Glutamic pyruvic transaminase and Glutamic oxaloacetic transaminase Etc. Glutamic pyruvic transaminase mainly exists in liver tissue, while glutamic oxaloacetic transaminase exists in heart and other tissues and organs. Since the content of transaminase in the whole liver is about 100 times that in the blood, if all released enzymes remain active, only 1% Hepatocyte necrosis Is enough to make enzymatic activity Double. And because of the transaminase The concentration is 1000~5000 times higher than that of serum, and transaminase in liver cells can also leak into blood due to this concentration difference.

TCM disease name: High glutamic pyruvic transaminase
Foreign name: Cereal third transaminase high
Alias: High alanine aminotransferase^[1]

Common location: liver^[1]
Common causes: Liver disease^[1]
normal level: 0-40U/L^[1]
High risk value: 800U/L and above^[1]

catalog

Normal value

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The normal value of alanine aminotransferase is usually 0-40u/L. (The hospital generally adopts Lai's method for detection.)^[1]

The normal value of alanine aminotransferase may be different due to different detection methods and drugs in hospitals.

Reasons for high

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Non disease factors

Long term stay up late, fatigue, long-term eating barbecue, hot pot, fried and fried food, especially people who often eat midnight snack, are prone to abnormal high of this indicator. Generally, they can recover to normal by taking a rest and paying attention to diet after rechecking.

Due to endocrine and uterine oppression, women in the third trimester of pregnancy may slightly increase this index, which has no effect on pregnant women and fetuses, and no special treatment is required. Just pay attention to diet and rest.^[1]

Physiological factors

There are many disease factors with elevated alanine aminotransferase index, among which viral hepatitis, liver cancer, cirrhosis, cholestasis, drug hepatitis and other diseases are the most common.

Viral hepatitis: it can cause damage to liver cells, and alanine aminotransferase is widely distributed in liver cells. When liver cells are damaged, alanine aminotransferase is released into the blood, which will cause the increase of serum alanine aminotransferase. It should be noted that if alanine aminotransferase is significantly increased in a short time, it indicates that there is serious damage and necrosis in the liver tissue, which requires immediate medical attention.

Liver cancer: liver cancer tissue will damage liver cells, causing the release of alanine aminotransferase in liver cells into the blood, causing the increase of alanine aminotransferase, but early liver cancer may not show the increase of alanine aminotransferase.

Liver cirrhosis: liver cell damage will be caused during the development of liver cirrhosis, leading to the elevation of serum alanine transferase. As cirrhosis is a slow process, the increase of alanine aminotransferase is generally 1-2 times, and there will be no significant increase.

Cholestasis: It can cause excessive accumulation of bile components in the liver, damage liver cells and the body, and even form fibrosis or cirrhosis for a long time. This process is accompanied by liver cell damage, leading to the elevation of alanine aminotransferase.

Drug induced hepatitis: Chlorpromazine, isoniazid, and some antibacterial drugs can cause drug induced hepatitis, causing liver cell damage, thus leading to an increase in alanine aminotransferase indicators.^[1]

symptom

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Symptoms of high alanine aminotransferase are Insomnia and dreaminess , fatigue Tolerance 、 Low fever , greasy jaundice , nausea, vomiting, abdominal pain, diarrhea, liver discomfort, etc. Mild symptoms are easy to sweat Lethargy , thirsty, reading eyes easily tired, etc. Chinese hepatitis B There are many patients, most of whom have varying degrees of liver injury. Therefore, many patients with hepatitis B will have symptoms of high alanine aminotransferase.

It should be reminded that many people think that the symptom of high alanine aminotransferase is hepatitis. In fact, there are many reasons for high alanine aminotransferase, such as drinking Fatty liver 、 Alcoholic liver 、 myocarditis 、 influenza Will cause the elevation of alanine aminotransferase. To determine whether it is the symptom of high alanine aminotransferase caused by hepatitis, other examinations need to be done, and a comprehensive analysis should be made in combination with the medical history, symptoms and signs.

High hazard

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The increase of alanine aminotransferase activity is a typical manifestation of all types of liver diseases. All types include various Acute and chronic hepatitis , liver cirrhosis Infectious mononucleosis , Urgent Chronic heart failure , various infections Metastatic cancer as well as granuloma Sex and Alcoholic liver disease 。 An increase of more than 8 times is nonspecific and can be seen in any of the above disease states.

The highest activity of glutamic pyruvic transaminase often occurs in the universality Hepatocyte injury When, such as drugs or Viral hepatitis 、 Acute heart failure At this time, the level of alanine aminotransferase is often as high as thousands or thousands of units. However, 10000~15000U/L can be seen in a few patients with viral hepatitis with unstable recovery.

The level of glutamic pyruvic transaminase is at Obstructive jaundice , with viral hepatitis Acquirability immunodeficiency Syndrome（ AIDS ）Patients and cirrhosis will generally reach 500U/L, while Alcoholic liver disease Usually lower than 300U/L. Choledocholithiasis Acute caused bile duct During obstruction, the value of alanine aminotransferase can reach several thousand units within 24~48 hours after acute biliary obstruction. In most liver and gallbladder diseases, alanine aminotransferase and Glutamic oxaloacetic transaminase The level will rise at the same time, and glutamic pyruvic transaminase is generally slightly higher than glutamic oxalic transaminase.

diet

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Glutamic pyruvic transaminase reflects Hepatocyte The most sensitive indicator of the degree of damage. When hepatocytes are damaged due to degeneration, necrosis, poisoning, etc., alanine aminotransferase is released into the blood, it will cause Serum alanine aminotransferase On the high side. High glutamic pyruvic transaminase In addition to the treatment for the cause of disease, the diet should also be paid attention to. For patients with elevated alanine aminotransferase, proper diet adjustment can accelerate the recovery of patients and avoid the aggravation of liver function damage. Specific suggestions are as follows:

For patients with elevated alanine aminotransferase, light, low salt and low fat diet is recommended. Eat more fresh fruits and vegetables, supplement adequate vitamins, avoid spicy, stimulating, greasy and other foods, and avoid overeating to increase the burden on the liver.

The choice of staple food should be based on refined flour and rice; Vegetables are mainly green leafy plants; Protein should be mainly high-quality protein, such as milk, lean meat, bean products, fish, etc.

Prohibited food: animal viscera, animal fat, fried and roasted food, pepper, strong tea, coffee, etc.^[1]

therapeutic method

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Glutamic pyruvic transaminase mainly exists in liver, heart and skeletal muscle Medium, hepatocytes or some tissue damage Or necrosis will increase the glutamic pyruvic transaminase in the blood. Therefore High glutamic pyruvic transaminase There are many reasons, so the treatment of alanine aminotransferase needs to be treated differently:

1. Normal level of alanine aminotransferase and persistent liver damage.

Chronic hepatitis B virus carriers, these people hepatitis B virus The index has always been positive, but it has never been raised, but if such patients are treated with liver biopsy But we can find the liver inflammatory reaction It is very serious. Some have already had fibrosis, even cirrhosis and liver cancer Therefore, these patients need to take anti fibrosis drugs and pay attention to anti fibrosis treatment.

2. Glutamic pyruvic transaminase has been abnormal for a long time, but the level is not high.

This is often seen in chronic hepatitis Patients, including chronic B and Hepatitis C 、 Autoimmune hepatitis 、 After long-term heavy drinking Alcoholic hepatitis Etc. The level of transaminase like this is not very high, most of which are between 100 and 200 units, or less than 100 units of chronic hepatitis patients need the most attention, because the number of such patients is the largest sustained development ， prognosis It is also the worst, and is easy to develop into cirrhosis Or liver cancer. Appropriate treatment should be taken as soon as possible, especially for patients with viral hepatitis Antiviral therapy 。

3. Temporary liver damage, resulting in high alanine aminotransferase.

For example, taking a drug that is highly toxic to the liver will cause a temporary increase of alanine aminotransferase, which will return to normal two days after stopping the drug. However, if you take drugs that are toxic to the liver for a long time, it will aggravate the disease and cause viral hepatitis, so you must pay attention. If it is a temporary elevation of alanine aminotransferase, no drug treatment is needed.

Low to moderate increase

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Serum of many chronic hepatobiliary diseases transaminase Continuous increase. Some liver and gallbladder diseases characterized by extremely high serum transaminase often only have a low level of serum transaminase increase in the initial or mild cases.

In chronic HBV infection, alanine aminotransferase usually exceeds 2.5 × ULN (upper limit of normal) and lasts for more than half a month hepatitis B Standards. This diagnosis is appropriate and rigorous for most cases critical value , but it may cause many chronic diseases hepatitis Missed diagnosis. If glutamic pyruvic transaminase does not reach this value, it may also be hepatitis, or even more serious hepatitis if it persists for a long time. The serum transaminase continued to rise>0.5 × ULN, and about half of the cases were proved to be Chronic active hepatitis 。

Extremely high

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Due to glutamic pyruvic transaminase Hepatocyte The liver specificity of alanine aminotransferase can be improved with its level. Therefore, when serum Elevated transaminase>15 × ULN is usually an acute hepatobiliary disease. Very high serum transaminase levels (>75 × ULN) are seen in 90% of acute ischemia Sexual or toxic liver injury, rare in Acute viral hepatitis 。 In acute ischemic or toxic liver injury, Glutamic oxaloacetic transaminase The peak usually precedes the peak of alanine aminotransferase, because the former is consistent with the pathological changes in the liver.

A variety of catalytic enzymes are required to participate in a series of biochemical reactions of human protein, one of which is glutamic pyruvic transaminase (GPT). GPT is the most abundant in liver tissue, with 44000 units of GPT per gram of tissue. The content of GPT in blood is very low. There are only 16 units per milliliter of blood. In addition, GPT was found in kidney, myocardium, spleen, lung and other tissues. The GPT assay we conducted essentially refers to the GPT content in the blood, and the normal value should be below 30 IU. Therefore, once there is a GPT increase, it should be considered in many ways. Some people have observed 36 cases and 51 cases of single GPT elevation for 1-3 years, and found that 60% and 72.6% of these people are related to viral hepatitis, respectively, although they have no obvious symptoms of hepatitis. But others such as myocardial infarction 、 Muscular atrophy , cholecystitis, cholelithiasis and other diseases can make GPT release into the blood and cause increase. In addition, the content of GPT in blood is also affected by physiological conditions, other drugs, laboratory conditions and other factors. In general, school-age children GPT is higher than that of adults; For adults, strenuous exercise, severe insomnia, excessive emotional tension, excitement and excitement, as well as colds High fever GPT can be increased in varying degrees; Heavy drinking and taking excessive drugs can also temporarily damage the liver and increase GPT; Test conditions such as reagent quality, temperature PH 、 reaction time The level of instruments and laboratory personnel is closely related to GPT. Therefore, the simple increase of GPT can only indicate that there is a greater possibility of hepatitis, but it is not entirely caused by hepatitis.

contagion

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Viral hepatitis Always check the diagnosis of Glutamic pyruvic transaminase Moreover, the elevation of alanine aminotransferase is very important in the diagnosis of viral hepatitis, and viral hepatitis has different infectivity Therefore, people naturally associate the elevation of alanine aminotransferase with infectivity.

In fact, the elevation of alanine aminotransferase only reflects the presence of liver inflammatory reaction The real infectious period is hepatitis virus Early stage of infection (clinically referred to as incubation period ）At this time, there is no symptom, and the liver has no inflammatory reaction. Glutamic pyruvic transaminase is normal. Once the liver has inflammatory reaction, and Glutamic pyruvic transaminase increases Virus titer It tends to decline quickly, and the infectivity is obviously weakened. The change of virus in all types of viral hepatitis has this rule. Therefore, it is totally a misunderstanding that the elevation of alanine aminotransferase means that the patient is infectious.

In addition, Biliary diseases , alcoholic liver damage, drug-induced liver damage Fatty liver Glutamic pyruvic transaminase can also increase when many diseases such as cardiogenic liver damage involve the liver, but there is no infectious problem at all.

matters needing attention

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In addition to diet, the high alanine aminotransferase should also pay attention to the following matters in daily life:

Ensure adequate sleep, avoid fatigue, quit smoking and alcohol

After the condition is stable, easy work can be carried out to avoid heavy physical and mental labor· Patients with viral liver disease should have awareness of infection prevention and avoid cross use of personal belongings by others.

For the increase of this index caused by the primary disease, treatment and medication should be strictly in accordance with the guidance of the doctor, and drugs should not be arbitrarily reduced or increased. Keep an optimistic attitude and good mood, and avoid worry and tension.

For moderate exercise and exercise, it is recommended to choose aerobic exercise, such as jogging, fast walking, cycling, etc. The amount of exercise should be based on your own situation, and it is appropriate to sweat slightly.^[1]

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