Glutamic alanine transaminase, also called alanine aminotransferase, is the most commonly used and sensitive indicator of liver function.Under normal circumstances, the concentration of alanine aminotransferase in human blood is very low. Only when liver cells are damaged or the permeability of liver cell membrane is increased, will the concentration of alanine aminotransferase in serum increase.The normal range of alanine aminotransferase is 0-40U/L.
The main reasons for the high alanine aminotransferase include liver diseases, such as various typeshepatitis、liver cancer、cirrhosisEtc.In addition, people who stay up late for a long time, are tired, and eat high fat food for a long time, especially those who often eat midnight snack, are prone to increase of alanine aminotransferase.
The treatment and prognosis of alanine aminotransferase mainly depend on the diseases that lead to its elevation, and doctors should be consulted for interpretation.If liver cancer causes the elevation of alanine aminotransferase, surgery may be required.For aViral hepatitisPatients with elevated alanine aminotransferase usually need to useAntiviral drugs。CholestasisandDrug-induced hepatitisThe elevation of glutamic pyruvic transaminase caused by it should be treated for the primary disease.Most patients with elevated alanine aminotransferase can recover to the normal value range (0~40U/L) through treatment or lifestyle adjustment.However, for advanced liver cancer, severe cirrhosis and other incurable diseases, alanine aminotransferase often increases continuously or repeatedly.
Patients with high alanine aminotransferase should pay attention to ensure adequate sleep, avoid fatigue, quit smoking and alcohol;Keep an optimistic attitude and good mood, manage the infection prevention awareness of patients with viral liver disease, and avoid cross use of personal belongings by others;If you have chronic diseases, you should strictly follow the doctor's treatment and medication guidance, and you should not arbitrarily reduce or increase drugs;Keep moderate exercise and exercise. It is recommended to choose aerobic exercise, such as jogging, fast walking, cycling, etc.
Chinese name
Glutamic pyruvic transaminase
Foreign name
Alanine aminotransferase
Full name
Alanine aminotransferase
abbreviation
ALT
Inspection purpose
To determine whether there is damage to liver function, one of the most commonly used indicators of liver function examination
normal range
0-40U/L
High indicators
If it is higher than 40U/L, it is higher. The common reason is liver disease
Indicators are low
If it is less than 0U/L, it is low, but it does not exist in clinical practice, which is of no practical significance
atlas
Science popularization in China
Committed to authoritative science communication
The certification expert of this term is
Yang Tiesheng|Chief physician
Laboratory Department of Peking University People's Hospitalto examine
ALT mainly exists inliver、heartIn tissue cells, when these tissues are diseased, the enzyme activity increases.
GenerallyALTIt is 2.5 times higher than the upper limit of the normal reference value and lasts for more than half a month as the standard for diagnosis of hepatitis.Most people with chronic HBV infection have different degrees of immune tolerance. Even if the ALT test result does not reach this value, if it persists for a long time, it can also be diagnosed as hepatitis, which often indicates a serious condition.The determination of serum ALT has the characteristics of high sensitivity and poor specificity in the diagnosis of hepatitis.Many extrahepatic factors can cause the increase of serum ALT activity, such as malnutrition, alcoholismCardiomyopathy、Cerebral vascular disease, skeletal muscle diseases, infectious mononucleosis andpancreatitisEtc.In addition, some drugs and poisons that are toxic to the liver, such aschlorpromazine、isoniazid、quinineSalicylic acid preparationampicillin、carbon tetrachloride、OrganophosphorusIt can also lead to increased serum ALT activity.
Normal reference value
Announce
edit
0~40U/L (the normal value varies with different kits and laboratories).
The common reasons for the elevation of alanine aminotransferase include non disease factors and disease factors, which should also be explained by consulting the doctor:
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 abnormally high indicators. Generally, they can recover to normal by taking a rest and paying attention to food recheck.
Due to endocrine and uterine oppression, women in the third trimester of pregnancy may have a slight increase in this index, which has no effect on pregnant women and fetuses, and no special treatment is required. Just pay attention to diet and rest.
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 be damagedHepatocyte, causing the release of alanine aminotransferase from hepatocytes into the blood, causing the elevation of alanine aminotransferase, but the elevation of alanine aminotransferase may not occur in early liver cancer.
Liver cirrhosis: liver cells will be damaged during the development of liver cirrhosis, resulting in the elevation of serum alanine aminotransferase.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、isoniazidSome antibacterial drugs can cause drug-induced hepatitis, and cause liver cell damage, thus leading to the increase of alanine aminotransferase index.
Indication for medical treatment with high indicators
Alanine aminotransferase will rise in many cases. Generally, it has clinical significance when the value exceeds 2 times of the reference value.
If it is found that the index value exceeds 80U/L, it is necessary to seek medical advice in time.
If the value reaches above 200U/L, seek medical advice as soon as possible to determine whether there is acute hepatitis.
If the value reaches above 500U/L, the situation is already serious, and you should immediately seek medical advice for examination and treatment.
If the value reaches 1000U/L or above, it is a critical value. Most of them have suffered serious damage, and must be treated immediately.
Other inspections with high indicators
When alanine aminotransferase is on the high side, it is generally considered as liver disease clinically, such as viral hepatitis, liver cancer, cirrhosis, cholestasis, drug-induced hepatitis, etc., and it is necessary to cooperate with doctors to carry out laboratory, imaging and other examinations for troubleshooting:
Viral hepatitis
In order to determine whether high alanine aminotransferase is caused by viral hepatitis, it is generally necessary to carry out liver function serum enzyme and viral tests, such as screening of hepatitis A, hepatitis B, hepatitis E and other viral antibodies and antigens.
liver cancer
In order to determine whether the high alanine aminotransferase is a liver cancer, it is generally necessary to carry out liver function serum enzymes, tumor serum markers, abdominal CT, ultrasound and other examinations to make a clear diagnosis.
cirrhosis
Liver cirrhosis will lead to a high level of alanine aminotransferase. In order to diagnose the disease, liver function serum enzyme, ultrasound, CT and other examinations are generally required.
Cholestasis
In order to determine whether the high alanine aminotransferase is caused by cholestasis, other liver function serum enzymes, ultrasound, CT and other examinations are needed to make a clear diagnosis.
Drug-induced hepatitis
In order to determine whether the high alanine aminotransferase is caused by drug-induced hepatitis, it is necessary to carry out pathogenic examination related to viral hepatitis, excluding viral hepatitis, detecting autoantibodies and other autoimmune hepatitis, as well as excluding the influence of alcohol and other factors. The diagnosis can be made only after combining the medication history of patients before liver damage.
Treatment mode with high indicators
Elevated alanine aminotransferase is most commonly seen in viral hepatitis, liver cancer, cirrhosis, cholestasis, drug-induced hepatitis and other diseases. Relevant treatment measures are as follows:
Viral hepatitis
First, use liver protective drugs, such as reduced glutathione, compound glycyrrhizic acid preparations, etc.Secondly, use antiviral drugs according to different virological indicators, such asinterferon、EntecawayIt can resist hepatitis B virus.Critical patients need to be treated with artificial liver and liver transplantation.
liver cancer
Surgical treatment is the first choice. If the surgical indications are not met, hepatic artery interventional embolization, microwave ablation, radio frequency ablation can be selected. At the same time, targeted drugs can be taken to inhibit tumor cells.If there is cirrhosis, the most effective treatment is liver transplantation.
cirrhosis
First, remove the cause, improve liver function, protect normal hepatocytes, and prevent and treat gastrointestinal bleeding, hepatic encephalopathy and other complications.
Cholestasis
For patients with cholestasis, the first step is to actively treat the primary disease, such as removing it through surgeryBiliary obstruction。Second, cholagogic drugs and lipid-lowering drugs, such asUrsodeoxycholic acidandSimvastatin。
Drug-induced hepatitis
First of all, drugs that may cause liver damage should be stopped, and drugs such as reduced glutathione, ursodeoxycholic acid, compound glycyrrhizic acid preparations, N-acetylcysteine, etc. should be used for treatment.Severe patients may need hemofiltration treatment to remove toxins from the body.
Dietary guidance for high indicators
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;proteinHigh 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.
High indicators Daily attention
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 avoid 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, the treatment and medication should be strictly in accordance with the doctor's guidance, and drugs should not be arbitrarily reduced or increased.
Keep an optimistic attitude and good mood, and avoid anxiety 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.
High index Curability
Most patients with high alanine aminotransferase can recover to the normal value range (0~40U/L) through treatment or lifestyle adjustment.However, it should be noted that advanced liver cancer, severe cirrhosis and other incurable diseases are prone to sustained or repeated elevation of alanine aminotransferase.The reexamination suggestion is once a month for the first three months, and then once every three months. If there is no abnormality after one year, the reexamination can be conducted regularly every year.
Indicators are low
Announce
edit
The normal value of alanine aminotransferase is 0-40U/L. If it is less than 0U/L, it is said that the index is low, but it does not exist clinically, so it is meaningless.
matters needing attention
Announce
edit
1. DeterminationserumWhen glutamic pyruvic transaminase is usedsubstrateThe serum is kept warm in a 37 ℃ water bath, and then the substrate is added to the serum for accurate timing.
2. The serum sample should be separated from the blood clot quickly and measured in time. If it cannot be measured immediately, it should be placed in the refrigerator, but not more than 3 days.Hemolytic samples should not be measured, because the activity of intracellular enzymes is high, which will affect the measurement results.
3. During operation, the operating time, temperature, pH value, reagent concentration and reagent dosage should be accurately mastered to avoid affecting the measurement results.
