Liver function tests – Mayo Clinic

Overview

Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood.

Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Other liver function tests measure enzymes that liver cells release in response to damage or disease.

Abnormal liver function test results don’t always indicate liver disease. Your doctor will explain your results and what they mean.

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Why it’s done

Liver function tests can be used to:

• Screen for liver infections, such as hepatitis
• Monitor the progression of a disease, such as viral or alcoholic hepatitis, and determine how well a treatment is working
• Measure the severity of a disease, particularly scarring of the liver (cirrhosis)
• Monitor possible side effects of medications

Liver function tests check the levels of certain enzymes and proteins in your blood. Levels that are higher or lower than normal can indicate liver problems. Some common liver function tests include:

• Alanine transaminase (ALT). ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase.
• Aspartate transaminase (AST). AST is an enzyme that helps metabolize amino acids. Like ALT, AST is normally present in blood at low levels. An increase in AST levels may indicate liver damage, disease or muscle damage.
• Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-normal levels of ALP may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases.
• Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and to perform other functions. Lower-than-normal levels of albumin and total protein may indicate liver damage or disease.
• Bilirubin. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia.
• Gamma-glutamyltransferase (GGT). GGT is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage.
• L-lactate dehydrogenase (LD). LD is an enzyme found in the liver. Elevated levels may indicate liver damage but can be elevated in many other disorders.
• Prothrombin time (PT). PT is the time it takes your blood to clot. Increased PT may indicate liver damage but can also be elevated if you’re taking certain blood-thinning drugs, such as warfarin.

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Risks

The blood sample for liver function tests is usually taken from a vein in your arm. The main risk associated with blood tests is soreness or bruising at the site of the blood draw. Most people don’t have serious reactions to having blood drawn.

How you prepare

Certain foods and medications can affect the results of your liver function tests. Your doctor will probably ask you to avoid eating food and taking some medications before your blood is drawn.

What you can expect

During the test

The blood sample for liver function tests is usually drawn through a small needle inserted into a vein in the bend of your arm. The needle is attached to a small tube, to collect your blood. You may feel a quick pain as the needle is inserted into your arm and experience some short-term discomfort at the site after the needle is removed.

After the test

Your blood will be sent to a laboratory for analysis. If the lab analysis is done on-site, you could have your test results within hours. If your doctor sends your blood to an off-site laboratory, you may receive the results within several days.

Results

Normal blood test results for typical liver function tests include:

• ALT. 7 to 55 units per liter (U/L)
• AST. 8 to 48 U/L
• ALP. 40 to 129 U/L
• Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
• Total protein. 6.3 to 7.9 g/dL
• Bilirubin. 0.1 to 1.2 milligrams per deciliter (mg/dL)
• GGT. 8 to 61 U/L
• LD. 122 to 222 U/L
• PT. 9.4 to 12.5 seconds

These results are typical for adult men. Normal results vary from laboratory to laboratory and might be slightly different for women and children.

Your doctor will use these results to help diagnose your condition or determine treatment you might need. If you already have liver disease, liver function tests can help determine how your disease is progressing and if you’re responding to treatment.

Aspartate Aminotransferase (AST) | Lab Tests Online

Sources Used in Current Review

2020 Review completed by Faryal Ali, CLS/MLS, MBA, MSc, Senior Clinical Lab Scientist, USCF, ZSFG Clinical Laboratory.

© Mayo Foundation for Medical Education and Research. Liver Function Tests. Available online at https://www.mayoclinic.org/tests-procedures/liver-function-tests/about/pac-20394595. Accessed May 2020.

© UCSF Health. Aspartate aminotransferase (AST) blood test. Available online at https://www.ucsfhealth.org/medical-tests/003472 UCSF HEALTH. Accessed May 2020.

Diagnosing liver disease: Liver biopsy and liver function tests. American Liver Foundation. Available online at https://liverfoundation. org/for-patients/about-the-liver/the-progression-of-liver-disease/diagnosing-liver-disease. Accessed May 2020.

AST. Mayo Medical Laboratories. Available online at https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/8360. Accessed May 2020.

Sources Used in Previous Reviews

Pagana K, Pagana T. Mosby’s Manual of Diagnostic and Laboratory Tests. St. Louis: Mosby; 1998.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER and Bruns DE, eds. 4th ed. St. Louis, Missouri: Elsevier Saunders; 2006 Pp 604-606.

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds, (2005) Harrison’s Principles of Internal Medicine, 16th Edition, McGraw Hill, Pp 1811-1815.

Pagana K, Pagana T. Mosby’s Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006, Pp 126-129.

Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC Pp 270-271.

Carey, W (January 1, 2009) Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests, Cleveland Clinic. Available online at http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/guide-to-common-liver-tests/. Accessed February 2010.

Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson RA and Pincus MR, eds. Philadelphia: 2007, Pp 268-269.

(2000) Dufour, DR et al. National Academy of Clinical Biochemistry Standards of Laboratory Practice: Laboratory Guidelines for Screening, Diagnosis and Monitoring of Hepatic Injury. Available online at http://www.aacc.org/SiteCollectionDocuments/NACB/LMPG/hepatic/hepatic_combined.pdf#page=3. Accessed February 2010.

(March 15, 2005) Giboney, P. Mildly Elevated Liver Transaminases in the Asymptomatic Patient. Am Fam Physician 2005; 71:1105–10. Available online at http://www.aafp.org/afp/2005/0315/p1105.html. Accessed February 2010.

(Feb 23 2009) MedlinePlus Medical Encyclopedia: AST. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm. Accessed February 2010.

Nyblom, H. et. al. (July 2004.) High AST/ALT Ratio May Indicated Advanced Alcoholic Liver Disease Rather Than Heavy Drinking. National Center for Biotechnology Information PubMed. Available online at http://www.ncbi.nlm.nih.gov/pubmed/15208167. Accessed September 2013.

AST. (Updated Jan. 21, 2013.) MedlinePlus Medical Encyclopedia. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm. Accessed September 2013.

2016 review performed by Beth A. O’Donnell, MLS (ASCP) CM and the Editorial Review Board.

(Updated Feb. 8, 2015) MedlinePlus Medical Encyclopedia. AST. Available online at https://medlineplus.gov/ency/article/003472.htm. Accessed 8/15/2016.

(Updated Jul. 15, 2014.) Mayo Clinic. Liver disease. Available online at http://www.mayoclinic.org/diseases-conditions/liver-problems/basics/definition/con-20025300. Accessed 8/15/2016.

(January 2015) Karim, S. et. al. Correlation between Aminotransferase Ratio (AST/ALT) and Other Biochemical Parameters in Chronic Liver Disease of Viral Origin. Delta Medical College Journal. Available online at http://imsear.hellis.org/handle/123456789/172619. Accessed 8/15/2016.

Mildly Elevated Liver Transaminase Levels in the Asymptomatic Patient

PAUL T. GIBONEY, M.D., Keck School of Medicine, University of Southern California, Los Angeles, California

Am Fam Physician. 2005 Mar 15;71(6):1105-1110.

Mild elevations in liver chemistry tests such as alanine transaminase and aspartate transaminase can reveal serious underlying conditions or have transient and benign etiologies. Potential causes of liver transaminase elevations include viral hepatitis, alcohol use, medication use, steatosis or steatohepatitis, and cirrhosis. The history should be thorough, with special attention given to the use of medications, vitamins, herbs, drugs, and alcohol; family history; and any history of blood-product transfusions. Other common health conditions, such as diabetes, heart disease, and thyroid disease, can cause or augment liver transaminase elevations. The recent American Gastroenterological Association guideline regarding the evaluation and management of abnormal liver chemistry tests proposes a practical, algorithmic approach when the history and physical examination do not reveal the cause. In addition to liver chemistries, an initial serologic evaluation includes a prothrombin time; albumin; complete blood count with platelets; hepatitis A, B, and C serologies; and iron studies. Depending on the etiology, management strategies may include cessation of alcohol use, attention to medications, control of diabetes, and modification of lifestyle factors such as obesity. If elevations persist after an appropriate period of observation, further testing may include ultra-sonography and other serum studies. In some cases, biopsy may be indicated.

Hepatic transaminase tests such as alanine transaminase (ALT) and aspartate transaminase (AST) often are part of standard laboratory panels in asymptomatic outpatients, similar to screening tests for blood donors and for life insurance applicants. The evaluation of an abnormal ALT or AST level in an asymptomatic patient therefore is a common challenge encountered by primary care physicians.

According to the American Gastroenterological Association (AGA), 1 to 4 percent of the asymptomatic population may have elevated serum liver chemistries.1 This is consistent with the usual definition of an elevated transaminase level of the top 2.5 percent of the population range. Although one study2 of 19,877 asymptomatic young Air Force trainees found that only 0.5 percent had elevated ALT levels, physicians who have more patients with obesity, diabetes, and hyperlipidemia will have to address this issue more often.

Given the frequency of this problem, physicians should develop an informed approach to the investigation of transaminase elevations. An audit of primary care practices found that these abnormalities are not always investigated appropriately and that opportunities to intervene in treatable cases sometimes are missed.3 No controlled clinical trials have compared approaches to the management of abnormal transaminase levels. However, the AGA recently published a technical review1 and a position statement4 on the evaluation of liver chemistry tests. This article reviews the interpretation of ALT and AST levels and summarizes the AGA recommendations on addressing reported elevations.

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Strength of Recommendations

Strength of Recommendations

Markers of Hepatic Injury and Necrosis

ALT and AST are two of the most reliable markers of hepatocellular injury or necrosis. Their levels can be elevated in a variety of hepatic disorders. Of the two, ALT is thought to be more specific for hepatic injury because it is present mainly in the cytosol of the liver and in low concentrations elsewhere. AST has cytosolic and mitochondrial forms and is present in tissues of the liver, heart, skeletal muscle, kidneys, brain, pancreas, and lungs, and in white and red blood cells. AST is less commonly referred to as serum glutamic oxaloacetic transaminase and ALT as serum glutamic pyruvic transaminase.

Although levels of ALT and AST can be extremely elevated (exceeding 2,000 U per L in cases of hepatocyte injury and necrosis related to drugs, toxins, ischemia, and hepatitis), elevations less than five times the upper limit of normal (i. e., about 250 U per L and below) are much more common in primary care medicine. The range of possible etiologies at this level of transaminase elevation is broader (Table 15,6) and the tests less specific. It also is important to recall that patients with normal ALT and AST levels can have significant liver disease in the setting of chronic hepatocyte injury (e.g., cirrhosis, hepatitis C).

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TABLE 1

Etiology of ALT or AST Elevations When Less Than Five Times Normal

TABLE 1

Etiology of ALT or AST Elevations When Less Than Five Times Normal

The ratio of AST to ALT has some clinical utility, but has important limitations. In many forms of acute and chronic liver injury or steatosis (fatty infiltration of the liver), the ratio is less than or equal to 1. This is particularly true in patients with hepatitis C. However, an AST/ALT ratio greater than 2 characteristically is present in alcoholic hepatitis. A recent study7 of 140 patients with nonalcoholic steatohepatitis (NASH; confirmed by liver biopsy) or alcoholic liver disease found a mean AST/ALT ratio of 0.9 in patients with NASH and 2.6 in patients with alcoholic liver disease. Within the population studied, 87 percent of patients with an AST/ALT ratio of 1.3 or less had NASH (87 percent sensitivity, 84 percent specificity). The severity of NASH as measured by the degree of fibrosis increased, as did the AST/ALT ratio. A mean ratio of 1.4 was found in patients with cirrhosis related to NASH. Wilson’s disease, a rare problem, can cause the AST/ALT ratio to exceed 4.5 While these ratios are suggestive of certain conditions, there is too much overlap between groups to rely on them exclusively when making a diagnosis.

Lactate dehydrogenase (LDH) is a less specific marker of hepatocellular necrosis and usually does not add diagnostic information to that obtained with ALT and AST testing. An exception to this is the transient but massive rise of LDH in cases of ischemic hepatitis and its sustained elevation that, along with elevated alkaline phosphatase levels, suggests malignant infiltration of the liver.5

Elevations of ALT and AST are not exclusive to liver pathology. Hyperthyroidism has been found in several studies to increase serum levels of liver enzymes including ALT and AST.8 Genetic influences on the level of ALT also are possible. A study9 of Danish twins showed that genetic factors accounted for 33 to 66 percent of the variation in ALT, gamma glutamyl transpeptidase, LDH, and bilirubin in patients 73 to 94 years of age. The AGA technical review states that serum ALT has diurnal variation, may vary day to day, and may be affected by exercise. It also notes that serum AST may be 15 percent higher in black men than white men. 1

Another cause of elevated liver transaminase levels is muscle injury. Strenuous exercise or myopathy can cause elevations (especially of AST) without causing any other symptoms. A creatine kinase or other muscle marker can be obtained to confirm or exclude such a process.

Annual screening of healthy, asymptomatic patients for liver disease using ALT and AST levels is not useful. A Japanese study10 assessed the accuracy of ALT and AST for detecting hepatitis C, excess alcohol use, and fatty liver disease in male bank employees and found the positive predictive value of the test to be low. Only 3.9 percent of the men with an abnormal ALT level had hepatitis C; 8 percent were excessive users of alcohol; and 35.7 percent had fatty liver.

Management

A thorough medical history and physical examination are the cornerstone of the evaluation of patients with mildly elevated liver transaminase levels.1  The history should attempt to identify risk factors for disease, with special attention directed toward family history, medications, vitamins, herbal supplements, drug use, alcohol use, abnormal liver testing, blood-product transfusions, and symptoms of liver disease. Table 26 lists selected medications and herbal supplements that may cause elevated transaminase levels. Physicians should ask patients directly about their use of illicit drugs, herbal supplements, and other alternative “supplements” because these sometimes are omitted from the patient’s initial response to questions.

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TABLE 2

Common Agents That Can Cause Liver Transaminase Elevations

TABLE 2

Common Agents That Can Cause Liver Transaminase Elevations

The presence of other significant health conditions that can cause or augment liver transaminase elevations also should be noted; examples are diabetes, heart disease (including congestive heart failure), thyroid disease, muscle disease, and cancer. Physical findings and sequelae of liver dysfunction are given in Table 3.

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TABLE 3

Clues in the Evaluation of Mildly Elevated Liver Transaminase Levels

TABLE 3

Clues in the Evaluation of Mildly Elevated Liver Transaminase Levels

Once the history and physical examination are completed, additional testing can help discern the etiology of the transaminase elevation (Figure 1). 4

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Management of Mild ALT and AST Abnormalities

Figure 1.

Algorithm to manage mild ALT and AST abnormalities. (ALT = alanine transaminase; AST = aspartate transaminase.)

Adapted with permission from American Gastroenterological Association. Medical position statement: evaluation of liver chemistry tests. Gastroenterology 2002; 123:1365.

Management of Mild ALT and AST Abnormalities

Figure 1.

Algorithm to manage mild ALT and AST abnormalities. (ALT = alanine transaminase; AST = aspartate transaminase.)

Adapted with permission from American Gastroenterological Association. Medical position statement: evaluation of liver chemistry tests. Gastroenterology 2002; 123:1365.

INITIAL LABORATORY EVALUATION

Additional laboratory tests should be obtained when the history and physical examination show no obvious etiology for ALT and AST elevations. Ferritin, total iron-binding capacity, and serum iron can be used to look for hemochromatosis, while hepatitis A, B, and C serologies are used to rule out acute or chronic hepatitis.

Despite the emergence of widespread vaccination, hepatitis B remains a common cause of chronic liver disease in adults. Testing for hepatitis C is essential because its incidence has increased in the past decade, and new treatment strategies have been developed that can address this frequently missed problem.11

A prothrombin time (PT) and serum albumin should be ordered to identify patients with abnormalities of protein synthesis and liver function. Evaluation should be accelerated for patients with impaired hepatic synthetic function. A complete blood count with platelets also should be ordered. In addition to ruling out infection, neutropenia or thrombocytopenia can, along with an elevated PT, suggest advanced liver disease. An elevated mean red cell volume suggests heavy alcohol intake. Alkaline phosphatase and bilirubin are markers for hepatic cholestasis and should be ordered as part of the initial laboratory evaluation. While sometimes useful, they often are normal in the presence of hepatic injury.

LIFESTYLE MODIFICATION

If the patient is asymptomatic and the initial serum testing is negative, a period of lifestyle modification can be attempted. Effective lifestyle modification includes complete abstinence from alcohol, control of diabetes and hyperlipidemia, weight loss in overweight patients, and stopping or changing potentially hepatotoxic medications and supplements. Such lifestyle changes directly impact several of the causes of mild transaminase elevation (Table 1).5,6 These seemingly small modifications may be all that is needed to correct the abnormalities.

FOLLOW-UP AND IMAGING STUDIES

A repeat set of liver chemistries should be obtained after six months. If the patient’s presentation changes or the physician has concern for an evolving process, shorter intervals can be used. If abnormalities persist at the six-month follow-up visit, ultra-sonography of the liver is recommended. Computed tomography of the abdomen also is used in this setting, although clinical trials have not demonstrated an advantage of this more expensive modality.

Steatohepatitis (or nonalcoholic fatty liver disease) often is discovered by imaging. This condition may be the most frequent cause of mild liver chemistry elevations and is especially common in patients who are obese, and those who have diabetes or hyperlipidemia. One study12 of patients referred to a hospital-based gastroenterology practice found that in 83 percent of patients with elevated transaminase levels whose serum evaluation was otherwise negative, liver biopsy revealed steatosis or steatohepatitis. In 10 percent of the patients, however, liver biopsy was normal—a reminder that, at times, mildly elevated transaminase levels do not represent any underlying pathology. Excellent reviews of the management of nonalcoholic fatty liver disease have been published.13,14

If the diagnosis is not apparent from the ultrasound examination, further testing is suggested for alpha₁-antitrypsin deficiency (alpha₁-antitrypsin levels), Wilson’s disease (serum ceruloplasmin), celiac disease (antigliadin and anti-endomysial antibody), and autoimmune hepatitis (antinuclear antibody, anti–smooth-muscle antibody), as well as for nonhepatic causes of transaminase elevation. According to the AGA, the decision to perform a liver biopsy needs to be made on an individual basis, taking into consideration the patient’s age, lifestyle, liver chemistry abnormalities, desire for prognostic information, and associated comorbid conditions.1 Only with chronic mild transaminase elevations would an asymptomatic patient be considered a possible candidate for biopsy.

Special Considerations in Interpreting Liver Function Tests

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7. Haber MM,
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9. Sherman KE.
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AST/ALT Blood Test: What Is It For and Normal Levels

AST and ALT, also known as transaminases, are two hepatic enzymes that are usually measured, through blood tests, with the purpose of assessing liver health.

AST, also known as aspartate aminotransferase is stored in the hepatic cells of the liver, but is produced in other various tissues, such as the heart and muscles. Thus, when there is only an increase in the AST levels, this is usually related to other conditions not linked to the liver.

On the other hand, ALT, known as alanine aminotransferase, is produced exclusively in the liver and therefore when there is an increase in ALT levels, it normally indicates that there may be an alteration in the liver.

Normal AST and ALT levels

AST and ALT can vary according to the laboratory, however, the levels that are considered normal are:

• AST: 5 to 40 U/L;
• ALT: 7 to 56 U/L.

Even though AST and ALT are considered liver markers, these enzymes can also be produced by other organs, especially the heart in the case of AST. Therefore, it’s important that the doctor who requested the test, checks the test results to establish a possible cause.

Possible causes for different blood levels

Alterations to both AST and ALT levels are normally indicative of liver lesion, which can happen due to hepatitis, cirrhosis, or fatty liver.

On the other hand, when only AST levels are altered, it is possibly a sign of heart disease, since AST is also a cardiac marker. In these cases, the doctor may prescribe other tests to check cardiac health, such as troponin, myoglobin and creatine phosphokinase (CPK) blood tests.

In general, alterations to both AST and ALT levels may be related to the following situations:

• Fulminant hepatitis;
• Alcoholic hepatitis;
• Cirrhosis due to excessive consumption of alcoholic drinks;
• Abusive use of illegal drugs;
• Fatty liver;
• Presence of a liver abscess;
• Acute pancreatitis;
• Bile duct obstruction;
• Heart attack;
• Heart failure;
• Cardiac ischemia;
• Muscle lesion;
• Use of medication for a long period and/or without medical supervision.

AST and ALT blood tests are normally prescribed by doctors when one of the conditions listed above is suspected or when the patient has suggestive symptoms, such as yellow skin and eyes, dark urine, frequent fatigue or yellowish to white stool.

Aspartate Aminotransferase (AST) Test | Michigan Medicine

Test Overview

An aspartate aminotransferase (AST) test measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. AST formerly was called serum glutamic oxaloacetic transaminase (SGOT).

Low levels of AST are normally found in the blood. When body tissue or an organ such as the heart or liver is diseased or damaged, additional AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage. After severe damage, AST levels rise in 6 to 10 hours and remain high for about 4 days.

The AST test may be done at the same time as a test for alanine aminotransferase, or ALT. The ratio of AST to ALT sometimes can help determine whether the liver or another organ has been damaged. Both ALT and AST levels can test for liver damage.

Why It Is Done

This test is done to:

• Check for liver damage.
• Help look for liver disease, such as hepatitis. Liver disease may cause symptoms. These may include pain in the upper belly, nausea, vomiting, and sometimes jaundice.
• Check to see how well treatment for liver disease is working.
• Find out if jaundice was caused by a blood disorder or liver disease.
• Keep track of the effects of medicines that can damage the liver.

How To Prepare

In general, there’s nothing you have to do before this test, unless your doctor tells you to.

How It Is Done

A health professional uses a needle to take a blood sample, usually from the arm.

How long the test takes

The test will take a few minutes.

Watch

How It Feels

When a blood sample is taken, you may feel nothing at all from the needle. Or you might feel a quick sting or pinch.

Risks

There is very little chance of having a problem from this test. When a blood sample is taken, a small bruise may form at the site.

Results

An aspartate aminotransferase (AST) test measures the amount of this enzyme in the blood. Results are usually available within 12 hours.

Normal

The normal values listed here—called a reference range—are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what’s normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

High values

High levels of AST may be caused by:

References

Citations

1. Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine
Kathleen Romito MD – Family Medicine
Jerome B. Simon MD, FRCPC, FACP – Gastroenterology

Current as of: September 23, 2020

Author:
Healthwise Staff

Medical Review:E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Martin J. Gabica MD – Family Medicine & Kathleen Romito MD – Family Medicine & Jerome B. Simon MD, FRCPC, FACP – Gastroenterology

Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Evaluation of abnormal liver function tests

Commonly available tests include alanine transaminase (ALT) and aspartate transaminase (AST), alkaline phosphatase (ALP), gammaglutamyl transferase, serum bilirubin, prothrombin time, or international normalised ratio and serum albumin (box 1). They reflect different functions of the liver—that is, to excrete anions (bilirubin), hepatocellular integrity (transaminases), formation and the subsequent free flow of bile (bilirubin and ALP), and protein synthesis (albumin).

Box 1:

Normal values

• Alanine transaminase: 0–45 IU/l.

• Aspartate transaminase: 0–35 IU/l.

• Alkaline phosphatase: 30–120 IU/l.

• Gammaglutamyl transferase: 0–30 IU/l.

• Bilirubin: 2–17 μmol/l.

• Prothrombin time: 10.9–12.5 sec.

• Albumin: 40–60 g/l.

Other tests are often performed by a specialist and include hepatitis serology, iron and copper studies, α₁-antitrypsin levels, and autoantibodies. These relate to the possible aetiology of the abnormality.

The enzymes tested are most commonly raised in liver disease but some enzymes are also present in other tissues and consequently may be raised in other conditions.

When faced with an abnormality in an asymptomatic patient it is imperative to establish that there is an abnormality in the first place, that is statistically significant (the normal value is the mean value in a group of healthy individuals ±2SD). The tests should be repeated and when confirmed appropriate steps be taken.

CLINICAL ASSESSMENT

A detailed history should be taken and full physical examination performed with a particular emphasis on alcohol consumption, risk factors for viral hepatitis (intravenous drug use, sexual promiscuity, homosexual relations, tattoos, non-sterile ear or body piercing, blood or blood product transfusions), medications used currently or previously, herbal or alternative remedies, and occupational exposure to toxins (box 2).

Box 2:

Clinical assessment

1. Alcohol consumption.

2. Risk factors for viral hepatitis:

   • Intravenous drug use.

   • Sexual promiscuity.

   • Homosexual relations.

   • Tattoos.

   • Non-sterile ear or body piercing.

   • Blood or blood product transfusions.

   • Residence in developing nations.

3. Medications.

4. Occupational exposure to toxins.

Other factors such as diabetes, obesity and hyperlipidaemia in non-alcoholic fatty liver disease, and family history (for Wilson’s disease, haemochromatosis, autoimmune disease) may be significant.

BILIRUBIN

Bilirubin is formed from the lysis of red cells (the haem component) within the reticuloendothelial system. Unconjugated bilirubin is transported to the liver loosely bound to albumin. It is water insoluble and therefore cannot be excreted in urine. Conjugated bilirubin is water soluble and appears in urine.

Within the liver it is conjugated to bilirubin glucoronide and subsequently secreted into bile and the gut respectively. Intestinal flora breaks it down into urobilinogen, some of which is reabsorbed and either excreted via the kidney into urine or excreted by the liver into the gastrointestinal tract. The remainder is excreted in the stool as stercobilinogen giving stool its brown colour.

Serum bilirubin is normally mainly in an unconjugated form reflecting a balance between production and hepatobiliary excretion. Bilirubin production increases in haemolysis, ineffective erythropoiesis, resorption of a haematoma, and rarely in muscle injury. In all these cases the bilirubin is mainly in an unconjugated form. Conjugated hyperbilirubinaemia characteristically occurs in parenchymal liver disease and biliary obstruction.

UNCONJUGATED HYPERBILIRUBINAEMIA

Unconjugated hyperbilirubinaemia (indirect bilirubin fraction >85% of total bilirubin) occurs with increased bilirubin production or in defects in hepatic uptake or conjugation, which in turn may be inherited or acquired (box 3).

Box 3:

Causes of isolated hyperbilirubinaemia

Gilbert’s syndrome deserves particular mention. This is a common, benign disorder characterised by unconjugated hyperbilirubinaemia, which is exacerbated by fasting. It does not require any specific treatment and the patient should be reassured.

Disproportionate isolated unconjugated hyperbilirubinaemia may also be seen in fulminant Wilson’s disease. It is interesting that the ALP is low in such situations. Haemolysis is believed to result from copper release in the blood stream with resulting red cell lysis.

It is worth mentioning here that bilirubin levels of more than 85 μmol/l in the presence of normal hepatic function cannot be explained by chronic haemolysis alone.^1,2

CONJUGATED HYPERBILIRUBINAEMIA (DIRECT BILIRUBIN >50% OF TOTAL BILIRUBIN)

This occurs in inherited or acquired defects in hepatic excretion. Bilirubin levels have prognostic significance in alcoholic hepatitis, primary biliary cirrhosis, and in acute liver failure. However a disproportionate rise in conjugated bilirubin has limited diagnostic value. As conjugated bilirubin is excreted in urine, bilirubin levels rarely exceed 510 μmol/l in the absence of renal failure or haemolysis.³

AMINOTRANSFERASES

These include AST and ALT. They are an excellent marker of hepatocellular injury. They participate in gluconeogenesis by catalysing the transfer of amino groups from aspartic acid or alanine to ketoglutaric acid to produce oxaloacetic acid and pyruvic acid respectively.

AST is present in cytosolic and mitochondrial isoenzymes and is found in the liver, cardiac muscle skeletal muscle, kidneys, brain, pancreas, lungs, leucocytes, and red cells.⁴ It is less sensitive and specific for the liver.

ALT, a cytosolic enzyme is found in its highest concentrations in the liver and is more specific to the liver.⁴

Hepatocellular injury and not necessarily cell death is the trigger for release of these enzymes into the circulation.

When faced with an abnormality, the first step should be to assess the degree of abnormality. The tests should probably be repeated if the abnormality is mild. Further investigation is warranted if repeated tests confirm abnormality. Very high levels should prompt further evaluation without delay.

Common causes are non-alcoholic fatty liver disease, alcoholic liver disease, chronic hepatitis B and C, autoimmune liver disease, haemochromatosis, Wilson’s disease, α₁– antitrypsin deficiency, and coeliac disease.

CAUSES OF RAISED AMINOTRANSFERASES

Alcohol

A reliable history is helpful; in reality this can be difficult. A biochemical clue is the ratio of AST to ALT (2:1 at least), reflecting the low level of activity of ALT in people with alcoholic liver disease.

A gammaglutamyl transferase level of twice the normal with an AST/ALT ratio of 2:1 or more is highly suggestive of alcohol abuse.⁵ Gammaglutamyl transferase is not specific to alcohol and hence cannot be used as an isolated test.⁴

Notably, AST levels of more than eight times normal and ALT levels more than fives times normal are exceptionally rare in alcoholic liver disease.⁵ Conversely ALT may be normal even in the face of severe alcoholic liver disease. Typically aminotransferase levels are less than 300 U/l in alcohol induced liver injury unless of course other insults such as viral or Paracetamol induced liver injury are superimposed on alcoholic liver disease, when serum aminotransferase levels may exceed 1000 U/l. Very high aminotransferase levels are characteristically seen in ischaemic liver injury, acute viral hepatitis, and drug or toxin induced liver injury and occasionally in acute obstructing choledocholithiasis.

Medication

Several drugs may cause raised liver enzymes, commonly non-steroidal anti-inflammatory drugs, antibiotics, statins, antiepileptics, and antituberculosis drugs (box 4). A specific inquiry should be made about herbal remedies, alternative medications, and substance abuse. The commonest drug induced cause of a massive aminotransferase rise is paracetamol overdose, typically at doses of 10 g or more but also at lower doses particularly in the context of other insults such as alcohol.

Box 4:

Common causes of raised transaminases

• Alcohol.

• Medications: non-steroidal anti-inflammatory drugs, antibiotics, HMG Co-A-reductase inhibitors, antiepileptic drugs, antituberculous drugs, herbal medications, illicit drug use.

• Non-alcoholic steatohepatosis.

• Chronic hepatitis B and C.

• Autoimmune diseases.

• Haemochromatosis.

• Wilson’s disease.

• Congestive cardiac failure and ischaemic hepatitis.

• α₁-Antitrypsin deficiency.

• Coeliac disease.

• Endocrine disease: hypothyroidism, Addison’s disease.

• Diseases of striate muscle.

• Glycogen storage diseases.

Drug induced liver enzyme rise may present as an enzyme rise soon after starting a drug. A logical step is to stop the drug and see if the results normalise. If the drug is essential for the patient a risk benefit assessment will be required. A liver biopsy may be necessary to assess the severity of the injury or confirm a drug induced reaction.

Viral hepatitis

Hepatitis B and/or C are common causes and hepatitis serology should thus be requested. We will consider the diagnostic laboratory features in turn.

If hepatitis B surface antigen (HbsAg) is positive then HBeAg and HBe antibody results are normally available automatically. A positive HbsAg may represent an acute or chronic infection. HbsAg becomes positive 2–8 weeks before biochemical evidence of jaundice or liver damage. Once HbsAg has appeared other markers of viral replication—namely, hepatitis B virus DNA and HbeAg—will also appear. IgM anti-HBc, the best serological test for acute hepatitis B, is detectable within 2–4 weeks of the appearance of the surface antigen. If positive, it suggests acute hepatitis B infection and HbsAg and anti-HBs should be obtained in six months.

The infection may have resolved (HbsAg negative, anti-HBs positive) or may have become chronic (HbsAg positive, anti-HBs negative). If IgM anti-HBc is negative suggesting a chronic hepatitis B virus infection, the HbeAg and anti-HBe will help determine whether the infection in the carrier is actively replicating or is quiescent.⁶ Patients with a positive HBe Ag and hepatitis B virus DNA may be considered for a liver biopsy.⁴ Family members and intimate contacts of HbsAg positive individuals should be screened for exposure to hepatitis B by checking HbsAg and anti-HBc. If anti-HBc negative, family members/intimate contacts would be candidates for immunoprophylaxis if not previously vaccinated.⁶

A positive hepatitis C antibody in a patient with risk factors would reflect previous contact with the virus. Antibodies to hepatitis C virus are not protective. The presence of antihepatitis C in a patient with an abnormal ALT, and risk factors for hepatitis C infection would strongly suggest current hepatitis C infection. The initial test for antihepatitis C is the enzyne linked immunosorbent assay (ELISA) test. The test is very sensitive but false positive tests are not infrequent even with third generation ELISAs as seen in hypergammaglobulinaemia of autoimmune hepatitis. If antihepatitis C is negative it is unlikely that the patient has hepatitis C. The specificity of ELISA testing may be improved by addition of the recombinant immunoblot assay for antihepatitis C.³ No methods of culturing the virus are available. Consequently detection of the virus in serum is used as a marker of the virus itself. Hepatitis C RNA detected by polymerase chain reaction is the current gold standard.⁷ A positive test would suggest active viral infection and replication. Polymerase chain reaction testing may be done by quantitative or qualitative methods. The sensitivity of quantitative testing varies between 2000–200 000 viral copies/ml whereas qualitative tests will detect as few as 100 viral copies/ml usually within one week of exposure.³ Quantitative tests should therefore not be used for diagnosis as these can miss patients with a low level viraemia. Due consideration would be given for antiviral therapy by a specialist. If the polymerase chain reaction is negative despite a positive antibody test, it should be retested in three months to ensure that it was not a false negative.

AUTOIMMUNE HEPATITIS

Autoimmune hepatitis is an unresolving inflammation of the liver of unknown cause that is associated with interface hepatitis on histological examination, hypergammaglobulinaemia, and autoantibodies. The typical clinical case is that of a young to middle aged woman (a ratio of female to male of 4:1) with raised transaminases in the absence of any other apparent cause. On serum protein electrophoresis around 80% or more patients demonstrate hypergammaglobulinaemia.⁸ Polyclonal immunoglobulins more than twice normal are highly suggestive.⁴

Appropriate tests would include immunoglobulins, antinuclear antibodies, antibodies to smooth muscle, antiliver-kidney microsomal antibodies and antibodies to the soluble liver antigen, which typify type 1, 2, and 3 autoimmune liver disease. Routine use of all three tests is not required. Liver biopsy is useful.

Type 1 autoimmune hepatitis is characterised by the presence of antinuclear antibody and/or smooth muscle (actin) antibodies. It is the most common form of the disease worldwide. Seventy percent are women less than 40 years old and over 30% have concurrent immune diseases, especially autoimmune thyroiditis, synovitis, or ulcerative colitis.

Type 2 autoimmune hepatitis is characterised by the presence of anti-LKM1 and is predominantly a disease of children aged 2–14 years. Patients with this form of hepatitis commonly have other concurrent autoimmune disorders such as type 1 diabetes, vitiligo, and autoimmune thyroiditis. Other organ specific autoimmune antibodies such as antibodies to parietal cells, islets of Langerhans, and thyroid may be found. These patients may have low serum levels of immunoglobulin A. Both type 1 and 2 autoimmune hepatitis generally respond well to steroids.

Type 3 autoimmune hepatitis is the least established form of the disease and is characterised by the presence of antibodies to soluble liver antigen/liver pancreas. Patients with these antibodies are indistinguishable from patients with classical type 1 autoimmune hepatitis by age, gender distribution, frequency and nature of other autoantibodies, and responsiveness to steroids.

HEPATIC STEATOSIS AND NON-ALCOHOLIC STEATOHEPATITIS

Non-alcoholic steatohepatitis (NASH) has emerged in recent years as a chronic hepatic disease of clinical importance. NASH in fact represents a stage within a spectrum of histological disease known as non-alcoholic fatty liver disease. The diagnosis of NASH is usually suspected among individuals with asymptomatic increases in serum liver biochemistries; the presence of a raised body mass index, type 2 diabetes mellitus, or hyperlipidaemia; and no evidence of clinically relevant alcohol use. Mild increases in transaminases (less than four times normal) may be the only clinical clue and in fact it is fair to say that non-alcoholic fatty liver disease is probably the commonest cause of mild aminotransferase increases.^9,10 The AST to ALT ratio is usually less than 1:1.^10,11 Total bilirubin and albumin are usually normal. Leucopenia and thrombocytopenia should raise concerns for the existence of cirrhosis and occult portal hypertension. Ultrasonography, which should form part of the assessment of chronically raised transaminases, may show fatty infiltration. NASH can be proved by liver biopsy⁴ if felt appropriate in the clinical context.

Steatosis tends to follow a benign course whereas NASH may progress to cirrhosis,¹² though liver failure is uncommon. Programmed weight loss and addressing underlying factors form the basis of treatment.¹³

HAEMOCHROMATOSIS

This is a common autosomal recessive condition among white people associated with increased intestinal absorption of iron and deposition of excessive amounts of iron in the liver, pancreas, and other organs. Many patients are asymptomatic at diagnosis but clinical manifestations include cutaneous hyperpigmentation, diabetes mellitus, and chronic liver disease which may manifest as fatigue, abdominal pain, hepatomegaly, abnormal liver tests, cirrhosis, and hepatocellular carcinoma. Other clinical features include cardiomyopathy, cardiac conduction disorders, hypothyroidism, hypogonadism, impotence, and arthropathy.

A diagnosis of haemochromatosis is based upon a combination of clinical, laboratory, and pathological criteria. A raised serum ferritin raises suspicion of underlying haemochromatosis but a more reliable test is transferrin saturation. Measuring serum iron and total iron binding capacity gives a transferrin saturation index. A value more than 45% is suggestive.¹⁴ Serum ferritin being an acute phase reactant may also be raised in a number of other inflammatory states and as such is not a useful screening test.

Iron overload may be confirmed by liver biopsy to assess hepatic iron index (hepatic iron level in μmol/g of dry weight divided by the patient’s age). A ratio of more than 1.9 is consistent with homozygous hereditary haemochromatosis.¹⁴

The discovery of the haemochromatosis gene (HFE) in 1996 has revolutionised the diagnosis of haemochromatosis. The mutation in HFE, located on the short arm of chromosome 6 responsible for the majority of cases is now available by genetic testing. Two point mutations have been designated C282Y and H63D. The greatest risk of iron overload exists in those who are homozygous for the C282Y mutation. Iron overload also occurs in a minority of those with other HFE mutations, especially compound heterozygotes who have one copy of C282Y and one copy of H63D and occasionally H63D homozygotes. It must be remembered that clinically significant iron overload can occur in the absence of HFE mutations. A negative gene test therefore does not exclude haemochromatosis. The HFE test is a polymerase chain reaction that is usually performed on a whole blood sample. The gene test is most useful in screening adult family members of an identified proband. It is often also useful in helping resolve ambiguous cases, such as iron overload associated with hepatitis C, alcoholic liver disease, or other causes of end stage liver disease. Before obtaining the HFE test an individual should be counselled about the risks, benefits, and alternatives of genetic testing by a qualified professional. There is concern about the possibility of insurance or employment based on the results of these tests. For this reason gene testing usually is not recommended for anyone younger than 18 years of age.

The need for liver biopsy has decreased with genetic testing becoming available. Liver biopsy still remains the gold standard for assessing the degree of fibrosis. It is important to exclude cirrhosis because of the increased risk of developing hepatocellular carcinoma. In such patients screening with an ultrasound and α-fetoprotein every six months may be appropriate. A recent study¹⁵ confirmed that certain non-invasive predictors were accurate in excluding cirrhosis in C282Y homozygotes. In this study, there were no cases of cirrhosis in 96 C282Y homozygotes who had serum ferritin levels lower than 1000 μg/l, normal AST values, and no evidence of hepatomegaly. These results have been confirmed in other studies. A serum ferritin of <1000 μg/l therefore seems to be the best predictor of the absence of cirrhosis in C282Y homozygotes. The positive predictive value of a serum ferritin >1000 μg/l is poor, however, as only about 50% of those with values of >1000 μg/l have cirrhosis. A liver biopsy is advisable in this group of patients to definitely assess for the presence of cirrhosis. Similar information is not available for non-C282Y homozygotes.

Liver biopsy is not essential in patients with hereditary haemochromatosis less than 40 years with normal liver function.⁴

WILSON’S DISEASE

This is a genetic disorder of biliary copper excretion. Usually detected between the ages of 5 and 25, it should also be considered in patients up to 40 years of age.

Serum caeruloplasmin, the usual screening test is reduced in approximately 85% of cases.⁴ Kayser-Fleischer rings may be a useful clinical clue. Caeruloplasmin may be normal and Kayser-Fleischer rings absent, in which case a 24 hour urinary copper excretion should be checked. Excretion of more than 100 μg suggests Wilson’s disease.

Liver biopsy will confirm the diagnosis if hepatic copper concentrations are more than 250 μg/g dry liver weight. The genetic defect has been identified but due to the large number of mutations involved molecular diagnosis is not yet possible.

ALPHA

₁-ANTITRYPSIN DEFICIENCY

This is an uncommon cause of chronic liver disease in adults. Low levels of α₁-antitrypsin may be detected by direct measurement of serum levels or by the lack of a rise in α-globulin bands on serum protein electrophoresis.⁴

NON-HEPATIC CAUSES OF ABNORMALITY

Hepatic infiltration such as metastatic or even primary hepatocellular carcinoma, tuberculosis, sarcoidosis, and amyloidosis may cause a modest (up to threefold) rises in aminotransferases, and an up to 20-fold rise in ALP depending upon the extent of involvement. Bilirubin levels are usually normal but up to fivefold increases are recognised.³

Occult coeliac sprue is recognised as a cause of raised transaminases.¹⁶ Antiendomyseal antibodies and antigliadin antibodies are useful confirmatory tests. Box 4 lists common and rare but recognised non-hepatic causes of transaminase abnormalities.

If despite comprehensive testing the cause is not apparent a liver biopsy may be required. Figure 1 suggests an algorithm for the investigation of abnormal transaminases.

Figure 1

Suggested algorithm for evaluating raised transaminases (ALT, alanine transaminase; HAV, hepatitis A virus; HCV, hepatitis C virus; PT, prothrombin time).

CAUSES OF RAISED ALKALINE PHOSPHATASE

ALP originates mainly from two sources: liver and bone.² The enzymes may be present in a variety of other tissues namely intestine, kidney placenta, and leucocytes. The elevation may be physiological or pathological. The physiological role of these enzymes is not entirely clear but production increases in tissues undergoing metabolic stimulation. Elevations are seen in the third trimester of pregnancy, a result of an influx of placental ALP. Adolescents may show increases that are twice normal for adults as a result of bone ALP into the blood, corresponding with growth.

Clearly the first step in determining the cause is to identify the source of the raised ALP. The most sensitive and indeed specific method is electrophoretic separation but it is not freely available. A good discriminator is testing for 5′ nucleotidase or gammaglutamyl transferase, which rise in liver but not bone disease. If ALP is of liver origin, imaging by ultrasound should be arranged.

Box 5 lists common causes of raised ALP. Extrahepatic biliary obstruction, infiltrative diseases, and metastasis may cause mild to striking elevations in ALP

Box 5:

Common causes of raised ALP

Hepatic ALP is present on the canalicular and luminal domain of the bile duct epithelium and levels rise as a result of increased synthesis and consequent release into the circulation. As a result levels may not rise until one or two days after biliary obstruction. Further the enzyme has a half life of a week and so even after resolution of biliary obstruction, it may take several days for levels to normalise.

It is also worth noting that ALP may be raised in malignancies without liver or bone involvement. This isoenzyme is called the “Regan isoenzyme” and occurs in various neoplasms for example lung cancers.³

Figure 2 suggests an algorithm for evaluating patients with a raised ALP.

Figure 2

Suggested algorithm for evaluating a raised ALP (ALP, alkaline phosphatase; ERCP, endoscopic retrograde cholangiopancreatography; GGT, gammaglutamyl transferase; PT, prothrombin time; MRCP, magnetic resonance cholangiopancreatography).

GAMMAGLUTAMYL TRANSFERASE

This enzyme is found in hepatocytes and biliary epithelial cells. Though a sensitive test of hepatobiliary disease its usefulness is limited by lack of specificity. Raised levels may be seen in pancreatic disease, myocardial infarction, renal failure, chronic obstructive pulmonary disease, diabetes, and alcoholism.¹⁷

Medications like phenytoin, carbamazepine, and barbiturates may also cause a mild rise in gammaglutamyl transferase (box 6).¹⁸

Box 6:

Causes of raised gammaglutamyl transferase

• Hepatobiliary disease (often with other liver enzyme abnormalities).

• Pancreatic disease.

• Alcoholism.

• Chronic obstructive pulmonary disease.

• Renal failure.

• Diabetes.

• Myocardial infarction.

• Drugs—for example, carbamazepine, phenytoin, and barbiturates.

With other enzyme abnormalities, a raised gammaglutamyl transferase would support a hepatobiliary source. For example it would confirm hepatic source for a raised ALP. A raised gammaglutamyl transferase with raised transaminases and a ratio of AST to ALT of 2:1 or more would suggest alcohol related liver disease.

A sensible approach is to follow patients with isolated gammaglutamyl transferase elevations at few monthly intervals. If other enzymes become abnormal or gammaglutamyl transferase increases further an abdominal ultrasound, computed tomography, or both should be requested to exclude a space occupying lesion and a liver biopsy examination considered.¹⁹

ALBUMIN

Albumin synthesis is an important function of the liver. Approximately 10 g is synthesised and secreted daily. With progressive liver disease serum albumin levels fall, reflecting decreased synthesis. Albumin levels are dependant on a number of other factors such as the nutritional status, catabolism, hormonal factors, and urinary and gastrointestinal losses. These should be taken into account when interpreting low albumin levels. Having said that, albumin concentration does correlate with the prognosis in chronic liver disease.

PROTHROMBIN TIME

The synthesis of coagulation factors (except factor VIII) is an important function of the liver. The prothrombin time measures the rate of conversion of prothrombin to thrombin (requiring factors II, V, VII, and X) and thus reflects a vital synthetic function of the liver. Vitamin K is required for the gamma carboxylation of the above named factors.

Prothrombin time may therefore be prolonged in vitamin K deficiency, warfarin therapy, liver disease, and consumptive coagulopathy.

It is important to distinguish a prolonged prothrombin time due to hepatocellular disease from that due to chronic cholestasis with fat malabsorption. In practice a useful way of differentiating the two is the administration of vitamin K, which will reduce a prolonged prothrombin time due to fat malabsorption but not due to intrinsic liver disease.

INTERNATIONAL NORMALISED RATIO

This is more often tested now instead of or along with prothrombin time, in order to standardise the reporting of prothrombin time (PT) results. It is calculated according to a formula as follows:

International normalised ratio = [patient PT/mean control PT] ^ISI

(ISI = international sensitivity index).

This is helpful because it avoids the interlaboratory variability in prothrombin time. Its interpretation is otherwise similar to prothrombin time.

QUANTITATIVE TESTS OF LIVER FUNCTION

Limitations of the various biochemical tests have prompted the search for more sensitive and quantitative tests of liver function. Though these tests are currently limited to research centres they deserve mention and include³:

• Indocyanine green clearance.

• ¹⁴C-aminopyrine breath test.

• Antipyrine clearance.

• Galactose elimination capacity.

• ¹³C-caffeine breath test.

The tests are expensive and more labour intensive. Well designed clinical trials are needed comparing them to biochemical tests before they gain wider acceptance.

WHEN TO REFER FOR A SPECIALIST OPINION?

This would normally include⁶ patients with:

(1) Unexplained liver abnormalities more than 1.5 times normal on two occasions, a minimum of six months apart.

(2) Unexplained liver disease with evidence of hepatic dysfunction (hypoalbuminaemia, hyperbilirubinaemia, prolonged prothrombin time, or international normalised ratio)

(3) Known liver disease where treatment beyond the withdrawal of the implicating agent is required.

WHAT TESTS TO DO BEFORE REFERRAL

⁶

Consider the following:

(1) Screen for viral hepatitis: IgM antihepatitis A virus, HbsAg, antihepatitis C virus.

(2) Antinuclear antibodies.

(3) Caeruloplasmin in patients younger than 40 years.

(4) Iron studies (iron, total iron binding capacity, and ferritin).

(5) Ultrasound of the liver especially where fatty infiltration is suspected (obese individuals, diabetics and/or hyperlipidaemic patients).

Key points

• Abnormal liver tests may present in an asymptomatic patient.

• A good clinical history and physical examination are often rewarding.

• Liver tests often become abnormal in non-hepatic diseases.

• If a systematic approach is adopted the cause is often apparent.

• A specialist opinion should be sought when appropriate.

An ultrasound should also be performed in symptomatic patients with liver enzyme abnormalities or those with evidence of hepatic dysfunction (increased bilirubin or prothrombin time, or decreased albumin) and in those with biochemical evidence of cholestasis.

REFERENCES

1. ↵

   Friedman LS, Martin P, Munroz SJ. Liver function tests and the objective evaluation of the patient with liver disease. In: Zakim D, Boyer TD, ed. Hepatology: a textbook of liver disease. Vol 1. Philadelphia, WB Saunders, 1996: 791–833.

2. ↵

   Pratt DS, Kaplan MM. Laboratory tests. In: Schiff ER, Sorrell MF, Maddrey WC, eds. Schiff’s diseases of the liver. 8th Ed. Vol 1. Philadelphia: Lippencott-Raven, 1999: 205–44.

3. ↵

   Feldman M, Friedman LS, Sleisenger MH. Sleisenger & Fordtran’s gastrointestinal and liver disease. 7th Ed. 2002: 1227–39, 1310–11.

4. ↵

   Pratt DS, Kaplan MM. Evaluation of abnormal liver enzyme results in asymptomatic patients. N Engl J Med2000;342:1266–71.

5. ↵

   Cohen JA, Kaplan MM. The SGOT/SGPT ratio-an indicator of alcoholic liver disease. Dig Dis Sci1979;24:835–8.

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   Minuk G. Canadian Association of Gastroenterology Practice Guidelines: evaluation of abnormal liver enzyme tests. Can J Gastroenterol1998;12(6):417–21.

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   Schiff ER, de Medina M, Kahn RS. New perspectives in the diagnosis of hepatitis C. Semin Liver Dis1999;suppl 1:3–15.

8. ↵

   Czaja AJ. Natural history, clinical features, and treatment of autoimmune hepatitis. Semin Liver Dis1984;4:1–12.

9. ↵

   Diehl AM, Goodman Z, Ishak KG. Alcohol like liver disease in nonalcoholics: a clinical and histologic comparison with alcohol-induced liver injury. Gastroenterology1988;95:1056–62.

10. ↵

    Bacon BR, Farahvash MJ, Janney CG, et al. Non-alcoholic steatohepatitis: an expanded clinical entity. Gastroenterology1994;107:1103–9.

11. ↵

    Sorbi D, Boynton J, Lindor KD. The ratio of aspartate aminotransferase to alanine transferase: potential value in differentiating non-alcoholic steatohepatitis from alcoholic liver disease. Am J Gastroenterol1999;94:1018–22.

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    Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology1999;116:1413–9.

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    Eriksson S, Eriksson KF, Bondesson L. Nonalcoholic steatohepatitis in obesity: a reversible condition. Acta Med Scand1986;220:83–8.

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    Powell LW, George DK, McDonnell SM, et al. Diagnosis of haemochromatosis. Ann Intern Med1998;129:925–31.

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    Guyader D, Jacquelinet C, Moirand R, et al. Non invasive prediction of fibrosis in C282Y homozygous haemochromatosis. Gastroenterology1998;115:929–36.

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    Bardella MT, Vecchi M, Conte D, et al. Chronic unexplained hypertransaminasemia may be caused by occult coeliac disease. Hepatology1999;29:654–7.

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    Goldberg DM, Martin JV. Role of gamma-glutamyl transpeptidase activity in the diagnosis of hepatobiliary disease. Digestion1975;12:232–46.

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    Rosalki SB, Tarlow D, Rau D. Plasma gamma-glutamyl transpeptidase elevation in patients receiving enzyme-inducing drugs. Lancet1971;ii:376–7.

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    Bloom S, ed. Abnormal liver function test in an asymptomatic patient. Practical gastroenterology. 1st Ed. UK: Martin Dunitz, 2002: 503–6.

What is the normal value of alt and ast should be in women

For the diagnosis of a number of diseases, an ALT blood test is prescribed, what is it? Alanine aminotransferase (ALT, ALT) is an enzyme involved in the transport of the amino acid alatin. ALT is found everywhere in all cells of the body, it can be found in large quantities:

• in the muscles, including the heart;
• in the cells of the pancreas, liver and kidneys.

For an adult, normal blood ALT:

• for men – 39-40 U / l;
• for women – 29-30 U / l.

In inflammatory processes, necrosis and other destruction of internal organs, the ALT index rises. Therefore, if the blood contains more ALT than it should be according to the standard, this allows you to determine the stage to which the organ damage has reached.

Analysis for AlAt is often prescribed in conjunction with another biochemical study, for AST. Simultaneous testing of blood for AST and ALT allows you to make a diagnosis more accurately. AST is an enzyme that transports the amino acid aspartate.

Most AST detected:

• in the liver;
• in skeletal muscle and heart;
• in the kidneys.

Analyzes for AST and ALT are prescribed as additional diagnostic measures in combination with other studies.

The ALT enzyme is found in greater amounts in liver cells; when these cells are damaged, it is released into the circulatory system, which makes it possible to diagnose cirrhosis, hepatitis and other diseases in which the liver mainly suffers.The AST enzyme is present in a greater volume in the muscle tissue of the myocardium, therefore, in ischemia, myocardial infarction, myocarditis and other heart diseases, an increased content of AST in the blood can detect pathology.

Analyzes for AST and ALT are prescribed as additional diagnostic measures in combination with other studies.

1Which doctor will prescribe an analysis

Most often, a biochemical blood test for AST and ALT is prescribed by a cardiologist or gastroenterologist.What other doctors can refer to this study?

• gynecologist;
• endocrinologist;
• orthopedist;
• nephrologist.

A blood test for AST and ALT can be taken in any clinic. It is better to order a survey together with a transcript.

A blood test for AST and ALT can be taken in any state clinic and in almost every private laboratory. It is better to order an examination together with a transcript, since laboratory test data may be presented in different ways in the report, depending on the standards of a particular institution.

2How to take the analysis of ALT and AST

The level of enzymes is influenced by stress, alcohol and drug intoxication. Therefore, in order for the test data to reflect the real situation, the patient needs special training:

• stop using alcoholic beverages and drugs in 7 days;
• refrain from intense excitement and stress;
• 10 hours before the tests, refrain from food, do not drink anything other than plain water.

If the patient is taking any medications, it is necessary to inform the attending physician about it.Many medications (especially steroids and enzymes) can interfere with the test results.

In men, the enzyme composition of the blood quickly reacts to intense physical activity (lifting weights, running, sports training), therefore, before the tests, you should refrain from going to the gym and other strenuous muscle work. In men and women, the enzyme composition of the blood is sensitive to nervous tension and stress.

To get results that are consistent with the real situation, you should get a good night’s sleep before donating blood and limit conflict situations.

3What diseases require AST and ALT tests

ALT and AST analyzes are used to diagnose the following diseases:

1. Viral hepatitis, liver cirrhosis, liver tumors, including cancer, mononucleosis.
2. Pancreatic diseases, pancreatitis.
3. Heart failure, ischemic heart disease, myocardial infarction, inflammation of the heart muscle (myocarditis, pericarditis).
4. Diseases of skeletal muscles, inflammatory processes in muscles, myositis, myopathy.
5. Lung infarction.
6. Hypothyroidism.
7. Hemolytic anemia.
8. Injuries, shock, burns, hypoxia.

An increase in ALT and AST shows necrotic changes, therefore it is widely used to quickly determine the severity of the disease. The interpretation of the analysis results is carried out by the attending physician. The AST and ALT scores are influenced by many factors that the doctor takes into account when interpreting the results:

• pregnancy;
• obesity;
• sex, age;
• chronic diseases;
• taking medications, for example, hormonal contraceptives, non-steroidal anti-inflammatory drugs.

Due to the destruction of muscle tissue and liver cells, ALT is increased due to severe mental shocks, extensive burns, pain shock and trauma.

In conditions that threaten the patient’s life, a biochemical blood test for ALT and AST is not used, but is universally carried out to diagnose diseases of the heart muscle and liver.

4 Transcript of results

AST and ALT indicators are measured in conventional units per liter (U / L). Some laboratories use different units of measurement, so when analyzing data, you need to clarify how to translate results from one system to another.How does the amount of these enzymes change with age?

• the optimal indicator for a newborn child up to 5 days of life is 49 U / l;
• norm for children under 6 months – 56 U / l;
• from 6 months to 1 year – 54 U / l;
• from 1 to 3 years – 33 U / l;
• from 3 to 6 years – 29 U / l;
• from 6 to 12 years old – 39 U / l.

Fluctuations in AST and ALT are associated with a person’s height. For each age, a person is characterized by a certain hormonal background and biochemical composition of the blood.

A slight increase in enzymes in children does not necessarily indicate any serious illness.

In adolescents from 12 to 14 years old, AST and ALT indicators gradually reach the values ​​characteristic of adults. The norm of ALT and AST in the blood for adults:

• for men, the optimal performance is up to 40 U / l;
• for women – up to 30 U / l.

For diagnostics, it is not the ALT (ALT in Latin abbreviation) and AST (AST) indices themselves that matter, but their ratio.This ratio is named after Dr. de Ritis (DRr). To calculate it, the AST indicator must be divided by ALT. You will get a number by which you can make a conclusion about the presence or absence of pathology. For men and women, the de Ritis coefficient is estimated in the same way.

Fluctuations in AST and ALT are associated with a person’s height. For each age, a person is characterized by a certain hormonal background and biochemical composition of the blood.

In hepatitis, the DRr coefficient is less than one, in dystrophic processes in the liver, it is greater than or equal to one.For a more accurate clinical picture, an albumin test is used.

If the DRr coefficient is greater than 2, and the albumin indicator is less than 35 g / l, this indicates liver necrosis. AST and ALT blood tests can detect viral hepatitis A 2 weeks before the onset of jaundice, and viral hepatitis B – 2-10 weeks before obvious changes.

The diagnosis is never made only on the basis of the DRr coefficient, the attending physician prescribes other tests.

5 Changes in indicators for various diseases

As an additional diagnostic measure, a biochemical blood test for AST and ALT is used to monitor the state of the liver and heart, less often the pancreas.How do the indices of enzymes change relative to the norm in pathological processes in the heart and liver?

1. Gestosis. If in the first trimester of pregnancy the levels of AST and ALT are normal, what does this mean? Most often, the reason is not any serious illness, but a lack of vitamin B6. For the normal development of the fetus, a large amount of vitamin B6 is required, which is involved in the synthesis of the enzymes AST and ALT. When vitamin B6 deficiency is compensated, liver and muscle tissue homeostasis is restored.In the 2-3 trimesters, the level stabilizes, which indicates that the woman’s liver and kidneys are coping with the increased load. If the indicators are significantly higher than the norm, this indicates gestosis.
2. Hepatitis. Acute viral hepatitis leads to an increase in ALT up to 500-3000 U / L. The indicator reaches its peak values ​​2-3 weeks after infection, then a decrease begins. A repeated increase in ALT levels indicates liver cirrhosis. With alcoholic hepatitis, ALT and AST indicators are 500-600 U / l.A biochemical blood test can detect diseases that do not have symptoms in the early stages, for example, viral hepatitis B.
3. Hyperfermentation. Moderate hyperfermentation of the liver gives an increase in ALT and AST by 1.5-5 times, moderate hyperfermentation – by 6-10 times, severe – an increase of more than 10 times compared with the norm. A change in the volume of enzymes circulating in the circulatory system allows us to conclude that there is a serious disturbance in the liver. If these enzymes enter the bloodstream in large volumes, what does this mean? Liver cells are damaged and destroyed by a pathological process.Other studies specify which pathology is being discussed. If the increase in AST is greater than ALT, hyperfermentation may indicate cirrhosis, metastases of a malignant tumor in the liver, intrahepatic cholestasis, and infectious mononucleosis.
4. Heart disease. In myocardial infarction, the increase in enzyme values ​​does not occur synchronously. AST increases 8-10 times, and ALT – 1.5-2 times. After an attack, an increase in AST and ALT occurs within 6-8 hours, the maximum value is reached after 16-48, the indicators return to normal values ​​after 3-6 days.

In myocardial infarction, the increase in enzyme indices does not occur synchronously. AST increases 8-10 times, and ALT – 1.5-2 times.

In order for the test data to be reliable, the doctor evaluates not only AST and ALT, but also other liver enzymes:

• bilirubin;
• creatine kinase;
• alkaline phosphatase;
• gamma glutamyl transferase;
• lactate dehydrogenase.

An increase in liver enzymes by 5-10% in the first trimester of pregnancy is the norm in women.The examination is usually carried out 1 time per pregnancy, most often in 2-3 trimesters, if there is no indication for urgent analysis. If heart disease is suspected, in addition to AST and ALT, the biochemical blood test includes:

• myoglobin;
• C-reactive protein;
• troponins;
• Creatine kinase MB fraction.

A biochemical blood test is used not only for diagnosis, but also for disease control.

The half-life of AST and ALT is from 12 to 24 hours, therefore, when monitoring the patient’s condition, studies are carried out no more often than once every 2 days.

In adult men and women, the indicators can fluctuate during the day within 10-30% of the norm.

AST in women rises naturally during gestation; within 2-3 months after conception, the level of enzymes normalizes.

AST in women rises naturally during gestation; within 2-3 months after conception, the level of enzymes normalizes.

6 Indicator below normal

Reduced AST and ALT indices are determined in analyzes due to two violations:

• lack of vitamin B6, which is involved in the synthesis of these enzymes;
• severe cirrhosis of the liver, in which the organ can no longer produce enough enzymes.

Vitamin B6 does not accumulate in cells, therefore, for the effective synthesis of AST and ALT, its constant intake with food is necessary. What are the signs of vitamin B6 deficiency?

• from the immune system: decreased immunity, vulnerability to infectious diseases;
• from the heart: surges in blood pressure, dizziness, fainting, insufficient blood supply;
• diseases of the nervous system and psyche: depression, anxiety, insomnia, decreased concentration;
• from the side of the muscles: convulsions, myalgia;
• from the side of the skin: a decrease in the rate of tissue regeneration;
• from the liver: lack of liver enzymes, which leads to indigestion.

B6 deficiency negatively affects the work of all organs and systems of the body without exception. B6 – pyridoxine is a substance that is indispensable in a variety of chemical reactions. Therefore, if you suspect vitamin B6 deficiency, it is useful to take a biochemical blood test.

Find out the norms of ALT and AST in the blood

All cells of living organisms contain aminotransferases, each of which has its own function of transferring amino acids . AST is responsible for the transfer of aspartic acid, ALT is responsible for the transfer of alanine molecules.

Both components are proteins and are involved in the transport of amino acids. Their entry into the blood occurs only when organs are damaged. An increase or decrease in the level of these components is used to study the biochemical composition of the blood.

These indicators help to identify the absence or presence of trauma, hepatitis, heart attack and other diseases in a patient.

What can negatively affect the results of the study of these proteins? The analysis is negatively affected taking certain types of drugs .It can be hormonal contraceptives, drugs with nicotinic acid, immunosuppressants.

The analyzes are also distorted by excess weight, the presence of pregnancy in the patient.

And also, before the analysis, you must not load the body with physical activity, otherwise, a laboratory study may give an unreliable result.

Analysis transcript

To do this, stop taking medications 7 days before taking blood .Blood is donated only on an empty stomach. Sports and intense physical activity should not be performed 24 hours before the analysis. Before the study, you must not smoke tobacco and take alcohol, eat fatty fried foods.

When diagnosing diseases, the doctor should take into account that AST is responsible for the functioning of the liver, muscle tissue, kidneys, heart, while ALT reflects the work of the liver and kidneys.

De Ritis decoding

It is generally accepted in medical practice to diagnose diseases using the de Ritis coefficient.

This ratio is the ratio of ALT protein to AST protein. Normally, it should vary from 0.91 to 1.75 units.

It is necessary to calculate the ratio if, when taking blood for biochemistry and subsequent studies, the laboratory assistant reveals deviations in indicators 10 times higher than the norm. For example, in a patient with hepatitis, ALT may increase up to 10 times the normal value.

If AST is sharply increased, then this indicates a necrotic process in liver cells.

• If AST is much higher than ALT, then this often means the presence of chronic hepatitis and irreversible changes.
• Doctors observe similar indicators in persons suffering from chronic alcoholism .
• In cases where the patient’s de Ritis coefficient is less than one, this indicates the presence of viral hepatitis.
• If the coefficient varies from 1 to 2, then this is a sign of chronic liver pathologies.

A ratio above 2 units usually reflects whether a patient has a myocardial infarction or alcohol-related cirrhosis.

What values ​​are considered the norm?

For women, the boundaries of indicators from 20 to 40 are characteristic, and in male patients this indicator is lower and is from 15 to 31 units.

In a newly born child, the indicator varies from 25 to 75 and gradually decreases.

From one year to 18 years, the protein norm is from 15 to 60 .

In pregnant patients, this indicator varies slightly.During the first three months of pregnancy, it can deviate by 5-10% and can be either increased or decreased.

In this case, this does not mean any serious illness.

ALT level

In patients aged 18 years and older, it should be about 32 units, and in male patients of this age it reaches 41 .

In a newborn child, the ALT level is increased and is 48 units, by the age of six months it rises to 55 , and then gradually decreases again.

By the age of 11, it reaches 38 units.

A slight increase is a 2–3 fold change, a moderate increase in a component is an increase of 6 to 10 times. A very high level of increase – 10 times or more.

Read also: Causes and treatment of increased ALT and AST in the blood

In people with recorded obesity and a large number of extra pounds, these indicators can be increased by up to 50%.

Reasons for increasing

Alanine aminotransferase may increase due to medication , for example, cytostatics, narcotics, oral contraceptives.

And also its changes are observed with prolonged stress, if the patient constantly eats fatty or fried foods, drinks alcoholic beverages. Such changes are also recorded with active growth or heavy physical exertion, injuries.

Often, its increase indicates a problem with the liver, usually after that bilirubin in the blood begins to rise.

Doctors note that an excess of the level by 5-10 times is observed in the acute phases of the disease.

In addition, if it does not decrease, then this may indicate necrotic processes in the liver.The reasons for the increase in ALT can be hepatitis, cancer in the liver, cirrhosis, jaundice, trauma with a large number of damaged muscle fibers, myocardial infarction.

Clinical picture ALT

The clinical manifestations of elevated ALT depend on the underlying cause of the disease. But there are a number of general symptoms, for example, feces and urine become much lighter, painful sensations appear in the right side of the abdomen, limbs and chest ache. A person quickly gets tired, he does not want to eat, he is often sick and may even vomit.

Yellow spots appear on the skin.

Reasons for increasing AST

1. This indicator deviates from the normal level upwards, if patient had injuries , a dystrophic or inflammatory process is going on in the body.
2. And it can also cause severe intoxication, stress, significant physical activity and cancer.
3. Most often, heart disease is the cause of its increase, for example, with myocardial infarction, the indicator increases up to 20 times.
4. And its increase is also observed in angina pectoris, coronary insufficiency, hepatitis of various etiologies, stagnation of bile, an inflammatory process in the gallbladder.

In addition, an increase in AST causes pancreatitis in the chronic stage, the presence of purulent inflammation in the abdomen.

Treatment of elevated AST and ALT

Power

In order to reduce the level of these indicators, it is necessary to eat properly , eat meat products, fish, seasonal vegetables and fruits.Meals should be fractional at least 5 times a day.

It is recommended to eat only freshly prepared food with reduced fat and carbohydrate content. Food is thoroughly worried, it is not recommended to eat dry food. Dinner should be no later than 2 hours before bedtime.

The use of foods fortified with vitamin B6 is also important.

It can be meat, bananas, spinach.

For the treatment of the disease, doctors prescribe hepatoprotectors. It can be Galstena, Gepabene, Carsil, Essentiale forte N and other drugs.

Read also: Causes and treatment of increased ALT and AST in the blood

Decreased values ​​

ALT can decrease with cancer , pathologies of the genitourinary system, vitamin B6 deficiency, necrotic processes in the liver.

The AST index may fall due to damage to liver cells or a lack of vitamin B6.

This condition is more rare than elevated component levels. But you can’t self-medicate.Treatment of concomitant diseases can only be carried out by a doctor.

In these cases, the therapist refers the patient to a surgeon, gastroenterologist, endocrinologist or other doctor.

The specialist prescribes an individual medication treatment for the patient, which depends on the underlying cause.

Prevention

To maintain these indicators in the norm, you should include more vitamin D in your menu, remove an abundance of fatty and salty foods from the diet. This will help relieve the patient’s liver.

Doctors strongly recommend to stop drinking alcoholic beverages and smoking.

The patient should be careful about his health and not expose the body to toxic agents that destroy liver cells.

In addition, patients are not recommended to self-medicate and take antibiotics on their own.

Long-term use of this group of drugs contributes to the destruction of the liver.

Watch the video on this topic

Output

Abnormal ALT and AST levels per se is not a disease , but indicates a serious malfunction in the body, for example, in muscle tissue, heart, urinary tract or liver.

Detection of high or low values ​​by means of a blood test indicates the presence of a serious illness.

The patient is recommended to undergo additional examination in order to find the root cause of the disease.

The doctor, on the basis of the tests carried out, based on the course of the disease and its stage, he prescribes an effective therapy for a person. The patient’s nutrition also plays an important role in this process.

When changing indicators, it is recommended to minimize the use of fatty, salty, fried foods.

Separately deserve attention and preventive measures, which consist in maintaining a healthy lifestyle, maximizing the toxic effects on the body of alcohol and tobacco, and other measures.

Norm of ALT and AST in blood, analyzes and decoding

Before prescribing a treatment for any disease, you must first conduct a complete examination of the body in order to make the correct diagnosis. A general and biochemical blood test, which includes tests for ALT and AST, will help to do this.

Currently, medicine has such an indicator as the rate of ALT and AST in the blood. If it is increased, it means that the person is sick with a certain disease.

But before looking for the reasons why the level of ALT and AST is elevated, or one indicator out of two, as well as looking for ways of treatment, you need to find out in more detail what it is.

What are AST and ALT?

Many cells of living organisms contain aminotransferases, which used to be called transaminases.They can be found both in the simplest unicellular organisms and in multicellular organisms.

Each such aminotransferase has its own inherent functions that cells are able to carry (this also applies to amino acids, which each has its own).

The following groups of aminotransferases exist:

• Aspartate aminotransferase (AST, ASAT) is a specific enzyme capable of transferring aspartate amino acids from biomolecules.
• Alanine aminotransferase (ALT, ALT) is an enzyme that carries the amino acid alanine of biomolecules.

The maximum activity of ALT and AST is observed in the human body in the kidneys, muscle tissue, heart and liver. The greatest activity of ALT can be noted in the pancreas. Important: since each group of aminotransferases is located in a specific organ, if it is damaged, it easily enters the blood stream.

Thanks to this property of the enzyme ALAT and AST, it is possible to determine the presence of diseases that are latent in the body. If after taking blood in the biochemical analysis the ALT and AST values ​​are increased, this means that the patient suffers from hepatitis, pancreatitis, myocardial infarction, or any injuries have occurred in the body.

What does an increase in performance mean?

Since the level of AST and ALT in each internal organ is different, increased indicators indicate its disease.

The main part of the ALAT enzyme is found in the liver, heart muscle, kidneys and pancreas. With pathologies of these organs, ALT enters the bloodstream, which causes a strong increase in this enzyme during the analysis.

Most of the AST enzyme is found in the myocardium, nerve and muscle tissues, and the liver.Damage to any of the above organs leads to an increase in the level of AST in the blood.

The norm of ALT and AST in the blood directly depends on the functioning of the liver, which is responsible for the following functions:

• Protein synthesis in the body;
• Removal of toxic substances and poison in case of poisoning;
• Creation of biochemical substances;
• Storage of glycogen, which is responsible for vital activity and normal functioning of the body;
• Regulation of biochemical reactions.

What indicators are considered the norm of AST and ALT?

A biochemical blood test helps to identify dangerous diseases latent in the body at an early stage.

Often, an increase in ALT means and indicates a dysfunction of the liver, while an increased rate of AST reflects a malfunction in the heart.

But which indicators are considered normal and which are abnormalities, so that it can be argued that high or low levels of ALT and AST are a sign of a dangerous progressive disease.

Normal and acceptable levels of ALT and AST depend on gender, so it will differ significantly in men, women and children.

• In adult women, the level of ALT and AST should be less than 31 U / L.
• In adult men, the AST rate in the blood should be less than 47 U / L, and the ALT rate should not be higher than 45 U / L.
• Since children are constantly growing, their ALT and AST readings change. At the same time, the ALT level in children should be below 50 U / L, while the AST indicator in children in the first 5 days of life reaches 140 U / L.After 5 days and up to the age of nine, the AST level in children should be below 55 U / L.

For the convenience of determining the level of ALT and AST, a table was developed, which reflects all indicators depending on the gender of the patient:

ALT and ASAT levels in children, men and women

Since the level of AST and ALT can be different depending on the modernity of the equipment used for the biochemical analysis, a table was developed, which reflects the normal values ​​and degrees of deviation of enzymes present in the blood:

If the parameters of AST and ALT during biochemical analysis are strongly increased, the patient can be diagnosed with liver pathologies.Often this phenomenon is observed with latent hepatitis and other dangerous diseases.

If the biochemical analysis showed that the AST level is increased several times, this means the presence of myocardial infarction in the body. If the AST was first increased, and after 4 days it decreased, then there was no heart attack.

Reasons for changing the level of indicators

After deciphering the analysis of biochemistry, it was noticed that certain diseases affect the decrease in ALT, but this has nothing to do with the functionality of the liver.A decrease in ALT can be caused by infectious genitourinary systems, alcoholic hepatitis, tumor neoplasms, frequent alcohol consumption, and a lack of vitamin B6 due to an improper diet.

The main reasons that the analysis rates in men, children and women are increased are:

• Myocardial infarction;
• Hepatitis;
• Forms of pancreatitis;
• Liver pathologies caused by drugs, alcohol or a viral infection;
• Taking steroids;
• Reaction of the body to drugs;
• Liver metastases;
• Fatty hepatosis;
• Burns and injuries where muscle and muscle tissue damage has occurred.

It is worth knowing that the decrease in the level of these enzymes occurs on their own after the underlying disease is cured.

The first symptoms showing an increase in AST and ALT:

• Nervousness and depression;
• Itching;
• Bad sleep;
• Decreased appetite that causes weight loss;
• General weakness of the body.

Late symptoms of elevated enzyme levels include:

• Changed color of urine, which becomes darker;
• Discolored stool;
• Whites of eyes and skin become yellowish;
• Nausea and feeling unwell;
• Swelling of the extremities.

Additional diagnostic measures to determine the presence of latent diseases:

• Blood test for hepatitis B and C;
• ultrasound of the abdominal organs;
• Clinical blood test;
• Liver biopsy;
• Blood donation for thyroid hormones.

Treatment

If the level of AST and ALT in children, men and women is increased, it means that there is some disease in the body. To lower the indicators of these enzymes, you first need to get rid of the focus of the disease, which caused their increase.

First of all, you need to properly organize your food, which must be of high quality and healthy:

• You need to eat a lot of fresh fruits and vegetables, because these foods contain fiber. This also includes brown rice, which has the same properties.
• Green and medicinal teas containing burdock, dandelion or milk thistle will help cleanse the liver and restore the body’s water balance.
• It is important to eat foods that contain large amounts of vitamin C.For example, revit vitamins contain a whole range of useful substances.
• Drinking regime should be observed.
• It is necessary to take a cool shower.
• Respiratory gymnastics, as well as morning exercises or sports activities – all this helps to defeat the disease, and therefore to reduce the level of AsAT and ALAT in the blood.

Since ALT levels are often elevated in liver pathologies, it means that the doctor must also prescribe drugs that will help protect hepatocytes from the effects of other harmful factors.These drugs are collectively called hematoprotectors.

Also, the doctor will note that the liver during illness in children, men and women is severely weakened, which means that it should not be exposed to unnecessary risk, as the organ will be damaged even more.

Ast and alt increased: what does it mean and how to treat it?

Why, at the first visit to the hospital, to any doctor, from a general practitioner to a narrow-profile specialist, the patient is immediately sent for a blood test? Because it is through the biochemical blood test that you can find out about the presence of pathologies in the body.

Even if there are no other obvious signs of the disease, arising and developing in the patient, even if the disease has not yet had a serious impact on the organs and systems, certain indicators will already be changed in the “biochemistry”. And this will lead the doctor to suspect the presence of pathology.

And if necessary, the doctor will send the patient for further examination in order to prescribe the required treatment.

One of the main indicators of a biochemical blood test is ALT (or ALAT) and AST (or ASAT).Any increase or decrease in these indices indicates that something is going wrong in the human body. What exactly can be evidenced by the fact that ALT and AST are elevated, and what treatment is prescribed for such indications?

One of the main indicators of the biochemical blood test – ALT and AST

What is ALT and AST

First, you need to answer the main question: what are alt and ast? The full medical name for these indicators is aspartate aminotransferase (ASAT) and ALAT, called alanine aminotransferase.

As doctors say, the enzymes AST and ALT (also sometimes referred to as transaminase) are active participants in the metabolism of the human body.

In simple terms, what is it? ALT “lives” in hepatocytes (liver cells) and, together with other participants in the process, breaks down the amino acid alanine. Liver enzymes – this is the name of this substance.

AST is responsible for what? This enzyme also “works” on the breakdown of amino acids, but only aspartic.And it is mainly found in the tissues of the heart muscle.

What does the deviation of the level of these enzymes from normal values ​​indicate during the measurement?

The ALT index rises if there are any malfunctions in the liver or some pathology of this gland occurs. Also in medicine, there are cases when an increase in the level of this enzyme in the blood indicated developing diseases of the kidneys, skeletal muscles and tissues of the nervous system.

AST is considered a marker of myocardial destruction.If this indicator in the blood test deviated in the positive direction, then it is urgently necessary to monitor the work of the heart.

Preparation for analyzes

ALT and AST blood tests are taken, like the rest of “biochemistry”, on an empty stomach

As doctors say, special preparation for donating blood for these indicators is not required. ALT and AST blood tests are taken, like the rest of “biochemistry”, on an empty stomach. It is imperative that the patient does not eat for at least 12 hours prior to blood donation.

Also, at least two days before the analysis, you must not drink alcohol, smoke for 10-12 hours. In addition, doctors recommend that on the eve of donating blood for research, protect yourself from emotional and physical overload. And you shouldn’t go for an analysis immediately after any even the most minimal surgical interventions or after dental treatment.

It should be noted that ALT in hepatitis C is always increased by . And, if the patient is aware that he has been diagnosed with this disease, it is worth warning the doctor and the laboratory assistant who takes the blood.You also need to know that the ALT rate in women is slightly lower than that of the stronger sex.

Norm of ALT and AST in blood

Of course, there is an established ALT and AST norm – indicators in numbers that are characteristic of an average healthy person. There is a special table in which the norms for age and sex are entered.

The level of this enzyme is measured in different ways: there are units of measurement of indicators in mol, but many laboratories issue research results, where the data are indicated in units / l.

We give the norm indicators that can be seen in adults in the table in these units.

In men, the normal levels of these enzymes in the blood test throughout life, if the person is healthy, do not change. In representatives of the stronger sex, biochemistry, in the case of order in the body, gives ALT a maximum of 18 U / L, and AST – a maximum of 22 18 U / L.

But women have different norms at different stages of life. So a biochemical blood test in a healthy woman shows ALT not higher than 15, and AST – not higher than 17 U / L.Blood from a vein in women who are expecting a baby will give the level of these enzymes slightly lower (by 5-10%) than usual.

The numbers in the transcript of the study in nursing mothers and young ladies who have menstrual bleeding at the time of the test are gradually returning to normal values. Although, there may be minor deviations, for example, in nursing mothers, the level of substances may increase slightly.

But the norm in the blood after 50 years in both men and women remains at the same level as at a young age.

As for children, the highest levels of AST and ALT are recorded in infants. In newborns under one month of age, ALT at 38 U / L is common, and AST up to 32. In children under one year of age, the maximum AST and ALT thresholds are fixed at 36 and 27 units (respectively), in children up to 16 years old – 31 and 22 (respectively).

What does the deviation of the level of these enzymes in the body from the norm indicate? As already mentioned, this says one thing: something went wrong with some of the internal organs and their functions.To understand what kind of failure occurred and to pinpoint the problem, doctors look at other indicators of a biochemical blood test, and also prescribe additional examinations.

Reasons for the increase

So, what exactly can the increase in ALT and AST in the blood be evidence of? It has already been noted that if ALT and AST are elevated, then this clearly indicates pathologies of the heart and liver and indirectly indicates problems with the kidneys, muscles, blood vessels, and the nervous system.

Reasons why ALT enzyme levels are elevated:

High rates for this substance are given by a blood test for cirrhosis of the liver of various etiologies

• High values ​​for this substance are given by a blood test for liver cirrhosis of various etiologies (alcoholic, toxic, arising as a result of other hepatic pathologies), with prolonged and regular use of alcohol, as well as with alcoholic liver damage.
• A high level of ALT indicates the development of acute pancreatitis in the patient.
• Increased figures relative to the norm will be in the conclusion of the analysis in acute hepatitis or chronic development of this disease.
• Elevated ALT in the analysis may indicate that cancer is progressing in the liver and / or biliary tract. And also that metastases of a tumor “living” in another organ began to spread to these organs.
• An increase in the concentration of a substance is observed with fatty hepatosis.
• The level of this enzyme also increases if the patient develops cholestasis or cholestatic jaundice.
• Such a development of events is also possible: ALT rises with normal bilirubin. This, as a rule, indicates that the patient is taking various drugs – oral contraceptives, drugs that prevent the development of tumors, chemotherapy and psychotropic drugs.
• Also, the level of ALT is increased in severe burns.

In this case, the doctor will also pay attention to such a line in the conclusion about the study of the patient’s blood as gamma-glutamyltransferase (GGT). Information about the level of this substance can confirm or deny the presence of one or another hepatic pathology.

Why can there be a high content of ast-enzyme in the blood:

• The patient has acute myocarditis or myocardial infarction.
• Increased AST indicators can be in case of serious muscle injuries – sprains, ruptures.
• There may be increased asthma with hepatitis C and other hepatic pathologies.
• The indicator for the enzyme changes to “plus” if the patient is diagnosed with myopathy, myositis, myodystrophy.
• Unstable angina pectoris, as well as pulmonary embolism, can also give an increase in the substance.

An increase in the level of both enzymes at once can be caused by severe physical fatigue or a prolonged state of stress in which the patient is.

It is especially dangerous when these indicators were about to be normal, and suddenly increased sharply at two times 2 times. This suggests that some kind of negative scenario is developing with dysfunctions of internal organs, and at the same time there is a lack of substances vital for a person.

Reasons for decline

Low values ​​for these enzymes in the test results should also alert the patient and the doctor. ALT and AST indicators may be below normal in hepatitis, and when the disease is started, when it has not been diagnosed and treated for a long time, and the organ tissues have already undergone necrosis.

Also a decrease in ALT and AST means in a biochemical blood test that a person does not have enough vitamin B6-peroxin. This condition is usually triggered by long-term antibiotic use.

Indicators in pregnant women and children

As already mentioned, the analysis of ALT, AST, bilirubin in pregnant women may differ from the conclusion of a blood test of a woman who is not expecting a baby.

The level of these enzymes in the first trimester of pregnancy, due to changes in hormonal levels, usually slightly increases, and later, in the second and third trimester, is slightly below normal.

As a rule, this does not lead to anything bad, but is simply caused by the current state of the expectant mother.

But if suddenly the situation gets out of control, and the enzyme numbers decrease significantly or, conversely, dramatically increase, the gynecologist leading the pregnancy prescribes additional tests and examinations.

This is necessary to exclude the presence of a serious pathology in a mother or an unborn baby.

For example, an increase in ALT and AST may indicate the development of gestosis, which negatively affects the condition of the mother and the fetus.

Interpretation of results by De Ritis coefficient

There is another very important indicator in the biochemical study of a patient’s blood – the De Ritis coefficient. This is the ratio of AST to ALT, the quantitative ratio of enzymes to each other.

The ALT and AST reference values ​​are 1.33 units. If the patient’s indicators are less than these values, then he probably develops some kind of serious hepatic pathology.

In the case when the De Ritis coefficient is higher than normal, then the patient has problems with the myocardium.

What to do if ALT and AST are above the norm

Of course, in a situation where the level of enzymes is above or below normal, it is necessary to take action.

As a rule, with such test results, doctors, if they do not immediately diagnose, then send the patient for an additional examination, after which adequate treatment is prescribed.

Usually, when eliminating pathologies, as a result of which an increase in the level of substances is caused, it is possible to automatically lower the indicators.How quickly this happens depends on the correctness of the prescribed therapy and on the response of the patient’s body to it.

What to do, if you cannot reduce the numbers in the lines with the words “ALT” and “AST” in the conclusion of the blood test? This may be due to a misdiagnosis and / or incorrect treatment. Most likely, in this case, an adjustment of the appointments and / or a new examination will be required.

Medicines

Hepatoprotectors will help restore liver cells

How to reduce the level of enzymes with drugs if they are still high, and the patient has been treated as required, and the patient has absolutely no pathologies at this stage.

There are a number of medications for lowering ALT and AST levels.

How to effectively lower the level of these enzymes? In this case, hepatoprotectors will help, “working” to restore liver tissue and cells, normalizing its functions; enzymes that “put in order” the stomach and pancreas; heart medications; and pain relievers to relieve spasms.

Of course, self-medication is not worth doing in this case either. And all drugs must be taken exclusively as directed by the attending physician.

A child under the age of 16 has physiologically increased indicators for these substances. A decrease, if everything is in order in the body, occurs as the little patient grows up.

Folk remedies

It is believed that the level of these enzymes can be normalized with folk remedies. To do this, it is recommended to take various hepatic fees, milk thistle decoction, dandelion flower tincture, as well as corn silk infusion. To maintain the heart, you can drink the adonis infusion.

Of course, folk remedies are good. But with serious pathologies and serious deviations from the norm with their help, the result cannot be achieved. They can be used, but only in conjunction with drugs. And only then can you achieve a good result from the therapy.

Diet and Prevention

What is the prevention of such abnormalities in blood test results? Of course, first of all, it is necessary to prevent the occurrence of pathologies and diseases that provoke an increase or decrease in the level of enzymes in the human body.

Of course, there must be a rejection of bad habits, the use of alcoholic beverages, some potent and / or illegal drugs, smoking.

It is also necessary to lead a correct and healthy lifestyle, which consists in rational and timely nutrition and the organization of moderate and adequate physical activity.

When it is necessary to reduce the level of enzymes in the blood, along with the intake of medications prescribed by the doctor and ancillary folk remedies, a reasonable diet should also be applied.

In case of pathologies associated with the liver, a complete rejection of alcohol, fried in oil and fatty, smoked and too salty, sweet, is recommended. The patient’s diet should consist of the correct combination of proteins, fats and carbohydrates, poultry and lean meat, as well as fish, vegetables and cereals, can be eaten. And everything must be steamed or stewed without adding oil.

Videos

About blood tests AST and ALT.

Alt and ast the norm in women

AST and ALT research is used in the diagnosis of liver diseases.The rate of AST and ALT in women may increase during pregnancy, steatosis and cirrhosis of the liver, damage to it, after taking medications or exercising.

Table of contents:

Decreased rates are observed, for example, with urinary tract infections.

Alanine aminotransferase (ALT) is an enzyme that acts mainly in the cytoplasm of the parenchymal cells of the liver, epithelial cells of the renal glomeruli, and in smaller amounts in the heart and skeletal muscles.

ALT is involved in protein metabolism. Vitamin B6 is needed for its synthesis. It occurs in the body in some organs, but the overwhelming amount is found in liver cells. When the cells of the above organs are destroyed, the ALT level increases in the blood. A small amount of enzyme activity is present in the blood of healthy people, and in the case of illness, growth depends on the severity of organ damage.

Determination of ALT level in biochemical blood test is carried out most often:

• when performing diagnostics, differentiation and control of inflammatory processes in the liver, mainly associated with the hepatitis B and C virus;
• for alcoholism;
• for toxic effects of drugs;
• for inflammation of the biliary tract.

An increase in the level of alanine aminotransferase in the blood serum is the most important indicator of liver cell necrosis. Often, an increase in ALT is observed for no apparent reason.

An increase in ALT activity outstrips the onset of jaundice by 7-14 days in the case of viral hepatitis. Alanine aminotransferase values ​​may vary depending on the time of day.

Its high concentrations in the blood serum are observed during the day, and lower – early in the morning.

Aspartate aminotransferase (AST) is an enzyme that is present in the form of the cytoplasmic membrane and mitochondrial inclusions in many tissues of the body.AST is mainly present in the liver, heart and skeletal muscles, in smaller amounts in the kidneys, pancreas and erythrocytes.

AST was the first enzyme whose designation was used to determine necrotic changes in the myocardium during a heart attack.

Currently, the determination of AST activity is used in the diagnosis of acute and chronic inflammation of the liver. It is one of the most important indicators of liver cell necrosis.

An increase in the activity of ALT and AST in the blood always indicates damage to liver cells.AST is less sensitive to ALT in liver disease.

• The indication for determination is the recognition, differentiation and control of the course of diseases of the liver and biliary tract and (to a lesser extent) diseases of skeletal muscles and pancreas.
• The material for the study is blood serum and plasma, a blood test is performed.
• Blood sampling for analysis should be performed in the morning on an empty stomach.

The study does not require special training.However, strenuous physical effort should be avoided before taking the test. Due to the fact that the results of the study can be influenced by the medications taken and the current diseases, it is necessary to inform the doctor in advance about them.

It is important to inform the doctor and personnel responsible for blood collection about existing blood clotting disorders and the presence of pathogens transmitted through the blood (for example, HIV, hepatitis B, C) in order to take the necessary safety measures.

To obtain material for research, an injection is made into a vein (usually in the area of ​​the lower part of the elbow) using a disposable sterile needle and blood is collected into a test tube.The blood sample is examined in a special device. After removing the needle, you need to press on the injection site for a few minutes to prevent bleeding.

Standard values ​​of the norm of ALT and AST in adults and children:

• ALT in women –

90,000 ASAT – what is it? Properties and indications

Analysis number in the “Science” database: 123.

Aspartate aminotransferase (AST, AST) is an endogenous enzyme belonging to the class of transferases, a subclass of aminotransferases (transaminases).Aspartate aminotransferase is synthesized intracellularly, and normally only a small part of this enzyme enters the bloodstream. Determination of AST activity in blood serum is a diagnostic indicator of damage, primarily, of myocardial and liver tissue.

Synonyms

AST, AST, glutamate oxaloacetate transaminase, aspartate aminotransferase, EC 2.6.1.1.

Research method

UV kinetic test.

In what units is the activity of AST expressed

U / L (unit per liter).

Biomaterial for analysis

Blood serum.

Preparation for research:

Blood sampling should be done in the morning on an empty stomach. After the last meal, at least 12 hours should pass. Physical and emotional stress should be avoided 30 minutes before blood sampling. Do not smoke for 30 minutes before donating blood.

Description

AST catalyzes the transamination reaction, which results in the conversion of oxaloacetate (oxaloacetic acid, PAA) to aspartic acid (aspartate) by transferring the amino group to the PAA molecule.The second product of the reaction is α-ketoglutaric acid (α-ketoglutarate), one of the intermediate products of the tricarboxylic acid cycle. The reaction plays an important role in the release of ammonia from amino acids. Then ammonia is processed in the urea cycle, since the aspartate obtained during the reaction is needed for the formation of argininosuccinate. In addition, the reverse reaction converts aspartate to oxaloacetate. Thus, this reaction is of great importance in the processes of gluconeogenesis.
For diagnostic purposes, the determination of AST activity is usually carried out in conjunction with the determination of the activity of another aminotransferase – alanine aminotransferase (ALT, ALT). Both enzymes are present in cells of various tissues, but ALT is present in significant amounts only in liver tissue. In myocardial tissue and skeletal muscles, the amount of AST is 20 times higher than the level of ALT. Sometimes there is a very high activity of AST, which can exceed the normal limit by 100 times. This occurs in diseases associated with severe tissue damage – acute hepatitis, compression syndrome, tissue hypoxia.In hepatitis, AST readings exceed the norm by 10–20 times and this happens during the prodromal stage (at the time of the onset of jaundice or shortly before that). With myocardial infarction, AST activity increases after 12 hours. The peak of activity falls on 24-36 hours after a heart attack with an excess of 10 times the norm. Then the indicators decrease within two to three days, which is evidence of the absence of damage to the heart muscle.

In most diseases associated with an increase in the concentration of AST, there is a simultaneous, albeit less high, rise in the concentration of ALT.However, in hepatitis, the plasma ALT activity may exceed the AST activity. AST concentration is often measured as an element of the “biochemical profile”. AST concentrations exceeding the upper limit of the norm by more than 20 times are most often observed in the prodromal stage of viral hepatitis. Double increases in concentration are sometimes observed in the absence of clinical symptoms of tissue damage. The reason in this case is most often alcohol abuse. This enzyme lacks tissue-specific isoforms, and if no other biochemical abnormalities and no obvious reasons for such an increase are found, then the analysis should be repeated after 2-3 weeks.

What the analysis is used for

For determination of AST activity in blood serum.

When assigned

Suspected of:

• myocardial infarction,
• hepatitis,
• cholangitis,
• liver cancer.

Reference values ​​(norm)

The normal level of AST activity in the serum of an adult is:

• for men 0-50 U / l,
• for women 0–45 U / l.

Result values ​​

Exceeding the upper limit of the norm by more than 10 times:

• acute hepatitis and liver necrosis,
• severe constriction syndrome,
• severe tissue hypoxia (the value of AST activity can sometimes exceed the upper limit of the norm by more than 100 times).

Exceeding the upper limit of the norm by 5-10 times:

• myocardial infarction,
• after surgery or trauma,
• skeletal muscle disease,
• cholestasis,
• chronic hepatitis.

Exceeding the upper limit of the norm by less than 10 times:

• physiological (in newborns),
• other liver diseases,
• pancreatitis,
• hemolysis (in vivo and in vitro).

Decrease in AST activity has no clinical significance.

90,000 marker of the rate of aging of the liver and the risk of mortality

Alanine aminotransferase (ALT) is an intracellular enzyme that is involved in the conversion of the amino acid alanine.Normally, the level of ALT in the blood is low, but with liver disease and cell destruction, it increases sharply.
ALT is often compared to the level of aspartate aminotransferase (AST), an enzyme that converts the amino acid aspartate (also called aspartic acid), also intracellular and produced mainly in the liver, heart and other muscles. When the cells of these organs are destroyed, the amount of AST in the blood also increases.

Fig. ALT / AST ratio in case of damage to the heart muscle and liver

If the elevated ALT level exceeds the elevated AST level, the liver is considered damaged (Fig.). If AST rises more than ALT, problems with the cells of the myocardium (heart muscle) or inflammation in other muscles are suggested. It should be noted that an increase in ALT levels may not always be associated with liver disease, it is observed, for example, with problems with the bile ducts. In order not to start sounding the alarm about the liver ahead of time, the level of alkaline phosphatase should be measured. Anticonvulsant, anti-inflammatory, and many other drugs, including paracetamol, antibiotics, statins, can increase ALT levels [274].

Fig. Change in the level of ALT in the blood with age [275, 276]

A decrease in the content of ALT in the blood plasma is possible with renal failure, deficiency of pyridoxine (vitamin B6), after hemodialysis and during pregnancy.

Dr. David Le Cooter from Australia with colleagues in 2010 found that over the age of 70, the ALT level decreases down to 16.8 U / L (Fig.). This increases the likelihood of sarcopenia (atrophic degeneration of skeletal muscle), wasting and low activity levels, and decreases survival.Traditionally, people with elevated ALT levels in the blood were thought to die earlier, but this study shows that people with very low ALT levels also have higher mortality, probably due to the fact that low ALT levels reflect the development of sarcopenia [275, 276]. Sarcopenia is an age-related change in skeletal muscle, leading to gradual loss of muscle mass and even death. In fig. 16 shows that ALT first increases by about 50 years of age, and then tends to decrease.Perhaps this is because by the age of 50, liver damage gradually accumulates, which is reflected in an increase in ALT. Later, the age-related involution of the liver occurs, the number of its cells decreases, and at the same time the level of ALT released into the blood decreases. At the same time, after the age of 50, the level of muscle mass decreases as a result of sarcopenia, which leads to a lower production of ALT by muscle cells [275, 276, 277].
As revealed by a study of Scottish scientists in 2011, the decrease in ALT with age below 14–17 U / L is inversely related to overall mortality [278].A population study of Danish twins has shown that in older twin pairs (73–94 years), higher ALT is not associated with mortality risk [279].
In 2014, a group of researchers from Israel also showed in 23 506 patients that ALT values ​​below 17 U / L may be a predictively unfavorable indicator of overall mortality in middle-aged people. The dependence of survival
on ALT levels (above or below 17 U / L) persisted even after adjusting for age, sex, GFR, low albumin levels, arterial hypertension, diabetes mellitus and coronary heart disease incidence [280].

Note: if the ALT level in a person’s entire life was, for example, 8 U / L, then this is probably the norm for a particular person. But if ALT was always higher than 14–17 U / L and suddenly became, for example, 8 U / L, this is a reason to consult a doctor.

The optimal ALT value is 17-30 U / L for men and 14-30 U / L for women.

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How to Optimize Your ALT Level

The reasons for the increase in ALT above the normal value are varied: hepatitis B, C or D, alcohol consumption, non-alcoholic fatty liver disease, and first of all, treatment should be directed to them [281].Before taking any action, it is necessary to re-take a blood test to make sure that the ALT level is indeed elevated. It is also necessary to exclude another possible reason for the increase in ALT, for example, the use of any drugs: anti-inflammatory, antibiotics or statins [274].
In Russia, the so-called hepatoprotectors are used to protect the liver, which are presented on the market with more than 700 drugs [282, 283]. However, in the international drug classification system, there is generally no association of drugs under the general name “hepatoprotectors”.The effectiveness of most hepatoprotectors has not been confirmed by clinical trials. And some of them are potentially harmful and can have toxic effects on the liver [284].
When treated with high doses of paracetamol (acetaminophen), the use of acetylcysteine ​​as a cover-up therapy is considered hepatoprotective [285].
Steatohepatitis – an inflammatory process in the liver against the background of its fatty degeneration. Most recently, Intercept Pharmaceuticals has successfully completed a Phase III clinical trial of obeticholic acid for the treatment of non-alcoholic steatohepatitis.It is likely that soon an effective drug for the treatment of the liver will appear in pharmacies for the first time, although at first it is very expensive [286].
Thus, it is advisable to treat the underlying disease leading to an increase in ALT, and not just a decrease in the level of the enzyme, especially since the effectiveness of almost all hepatoprotectors has not been proven.
While at a young age, too low ALT levels are not associated with an increased risk of mortality, in people over 65 years of age it is the opposite [275, 281]. But this does not mean at all that you need to increase ALT.A decrease in ALT in old age signals that sarcopenia is likely to develop – a decrease in muscle mass is one of the causes of death in older people [287]. And in this case, it is advisable to prevent or slow down the development of this process with the help of regular aerobic exercise and muscle training with bodyweight exercises. Otherwise, a person can lose at least 1 year of life [288].

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Bibliography:

274.Watkins P.B., Kaplowitz N., Slattery J.T. et al. Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial. JAMA. 2006 Jul 5; 296 (1): 87-93. doi: 10.1001 / jama.296.1.87. www.ncbi.nlm.nih.gov/pubmed/16820551 (date accessed: 01/29/2021).
275. Le Couteur D.G., Blyth F.M., Creasey H.M. et al. The association of alanine transaminase with aging, frailty, and mortality. J Gerontol A Biol Sci Med Sci. 2010 Jul; 65 (7): 712-7. doi: 10.1093 / gerona / glq082.www.ncbi.nlm.nih.gov/pubmed/20498223 (date accessed: 01/29/2021).
276. Elinav E., Ben-Dov I.Z., Ackerman E. et al. Correlation between serum alanine aminotransferase activity and age: an inverted U curve pattern. Am J Gastroenterol. 2005 Oct; 100 (10): 2201-4. doi: 10.1111 / j.1572-0241.2005.41822.x. www.ncbi.nlm.nih.gov/pubmed/16181369 (date accessed: 01/29/2021).
277. Ozer J., Ratner M., Shaw M. et al. The current state of serum biomarkers of hepatotoxicity. Toxicology. 2008 Mar 20; 245 (3): 194-205.doi: 10.1016 / j.tox.2007.11.021. www.ncbi.nlm.nih.gov/pubmed/182 (date accessed: 01/29/2021).
278. Ford I., Mooijaart S. P., Lloyd S. et al. The inverse relationship between alanine aminotransferase in the normal range and adverse cardiovascular and non-cardiovascular outcomes. Int J Epidemiol. 2011 Dec; 40 (6): 1530-8. doi: 10.1093 / ije / dyr172. www.ncbi.nlm.nih.gov/pubmed/22158663 (date accessed: 01/29/2021).
279. Fraser A., ​​Thinggaard M., Christensen K., Lawlor D.A. Alanine aminotransferase, gamma-glutamyltransferase (GGT) and all-cause mortality: results from a population-based Danish twins study alanine aminotransferase, GGT and mortality in elderly twins.Liver Int. 2009 Nov; 29 (10): 1494-9. doi: 10.1111 / j.1478-3231.2009.02090.x. www.ncbi.nlm.nih.gov/pubmed/19686309 (date accessed: 01/29/2021).
280. Ramaty E., Maor E., Peltz-Sinvani N. et al. Low ALT blood levels predict long-term all-cause mortality among adults. A historical prospective cohort study. Eur J Intern Med. 2014 Dec; 25 (10): 919-21. doi: 10.1016 / j.ejim.2014.10.019. www.ncbi.nlm.nih.gov/pubmed/25468741 (date accessed: 01/29/2021).
281. Vento S., Nobili V. Aminotransferases as predictors of mortality.Lancet. 2008 May 31; 371 (9627): 1822-3. doi: 10.1016 / S0140-6736 (08) 60778-3. www.ncbi.nlm.nih.gov/pubmed/18514716 (date accessed: 01/29/2021).
282. Register of medicines of Russia. (RLS) Pharmacological group – Hepatoprotectors. (Electronic resource) URL: www.rlsnet.ru/fg_index_id_222.htm (date of access: 01/29/2021).
283. Register of medicines of Russia. (RLS) Pharmacological group – Hepatoprotectors. (Electronic resource) URL: www.rlsnet.ru/fg_index_id_222_sort_mnn.htm (date accessed: 29.01.2021).
284. Specialization medical portal Health-ua.com. Efficiency and safety of hepatoprotectors from the point of view of evidence-based medicine. 03/27/2015. (Electronic resource) URL: http://health-ua.com/article/15676-effektivnost-i-bezopasnost-gepatoprotektorov-s-tochki-zreniya-dokazatelnoj- (date of access: 01/29/2021).
285. Barton S. Acetylcysteine ​​for Acetaminophen Overdose. Utox Apdate. 2005. Volume 7. Issue 1. (Electronic resource) URL: https://poisoncontrol.utah.edu/newsletters/pdfs/toxicology-today-archive/Vol7_No1.pdf (date accessed: 01/29/2021).
286. Von Reuss T. “Okaliva”: an important drug for the treatment of primary biliary cholangitis. Published on May 28, 2016. Updated 12.21. (Electronic resource) URL: https://mosmedpreparaty.ru/news/16226] [https://mosmedpreparaty.ru/news/7907 (date of access: 01/29/2021).
287. Vespasiani-Gentilucci U., De Vincentis A., Ferrucci L. et al. Low Alanine Aminotransferase Levels in the Elderly Population: Frailty, Disability, Sarcopenia, and Reduced Survival.J Gerontol A Biol Sci Med Sci. 2018 Jun 14; 73 (7): 925-930. doi: 10.1093 / gerona / glx126. www.ncbi.nlm.nih.gov/pubmed/28633440 (date accessed: 01/29/2021).
288. Peltz-Sinvani N., Klempfner R., Ramaty E. et al. Low ALT Levels Independently Associated with 22-Year All-Cause Mortality Among Coronary Heart Disease Patients. J Gen Intern Med. 2016 Feb; 31 (2): 209-214. doi: 10.1007 / s11606-015-3480-6. www.ncbi.nlm.nih.gov/pubmed/26245731 (date accessed: 01/29/2021).

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Analyzes

To confirm the diagnosis of hepatitis C it is necessary: ​​

1.Biochemical blood test:
Alanine aminotransferase (ALT, ALT, ALT)
Aspartate aminotransferase (AST, AsAT, AST)
Bilirubin
Glucose
Gamma-glutamyl transpeptidase (GGT, GGTP)
Protein total
Ferritin
Albumin
Protein fractions
Creatinine

2. PCR analysis of hepatitis C (qualitative / quantitative analysis)
3.Elastography (fibroscanning)

4. Carrying out genotyping of hepatitis C virus (HCV)

For a complete diagnosis of hepatitis C and making a clinical decision on treatment, it is necessary to pass the following tests:

1. Biochemical blood test : a study that allows for the analysis of various trace elements in the blood to assess the functional state of organs and systems of the human body.

Components of a biochemical blood test used in the diagnosis of viral hepatitis:

Alanine aminotransferase (ALT, ALT, ALT) is an enzyme contained in tissues in the liver and released into the blood when it is damaged. Elevated ALT levels can be caused by viral, toxic, or other liver damage. In chronic viral hepatitis, ALT levels can fluctuate over time from normal values ​​to several norms, so this enzyme must be monitored every 3-6 months.It is generally accepted that the ALT level reflects the degree of activity of hepatitis, however, in about 20% of patients with chronic viral hepatitis with a stable normal level of ALT, serious liver damage is found. It can be added that ALT is a sensitive and accurate test for the early diagnosis of acute hepatitis.
Aspartate aminotransferase (AST, AST, AST) is an enzyme found in the tissues of the heart, liver, skeletal muscles, nervous tissue and kidneys and other organs. An increase in AST in a blood test together with ALT in patients with viral hepatitis may indicate liver cell necrosis.When diagnosing hepatitis, special attention should be paid to the AST / ALT ratio, called the de Ritis coefficient. An excess of AST in the blood test over ALT in patients with hepatitis may indicate severe liver fibrosis or toxic (drug or alcoholic) liver damage. If AST in the analysis is significantly increased, then this indicates necrosis of hepatocytes, accompanied by the disintegration of cellular organelles.
Alkaline phosphatase (ALP, AR, Alkaline phosphatase, ALP, ALKP) is used to diagnose liver diseases accompanied by cholestasis.A joint increase in alkaline phosphatase and GGT may indicate a pathology of the biliary tract, cholelithiasis, a violation of the outflow of bile. This enzyme is located in the epithelium of the bile ducts, therefore, an increase in its activity indicates cholestasis of any genesis (intra- and extrahepatic). An isolated increase in the level of alkaline phosphatase is an unfavorable prognostic sign and may indicate the development of hepatocellular carcinoma.
Bilirubin is one of the main components of bile.It is formed as a result of the breakdown of hemoglobin, myoglobin and cytochromes in the cells of the reticuloendothelial system, spleen and liver. Total bilirubin includes direct (conjugated, bound) and indirect (unconjugated, free) bilirubin. It is believed that the increase in bilirubin in the blood (hyperbilirubinemia) due to the direct fraction (more than 80% of the total bilirubin is direct bilirubin) is of hepatic origin. This situation is typical for chronic viral hepatitis. It may also be associated with impaired excretion of direct bilirubin due to cytolysis of hepatocytes.An increase in concentration due to free bilirubin in the blood may indicate a volumetric lesion of the liver parenchyma. Another reason may be a congenital pathology – Gilbert’s syndrome. Also, the concentration of bilirubin (bilirubinemia) in the blood can increase if the outflow of bile is obstructed (blockage of the bile ducts). During antiviral therapy for hepatitis, an increase in bilirubin can be caused by an increase in the intensity of erythrocyte hemolysis. With hyperbilirubinemia above 30 μmol / l, jaundice appears, which is manifested by yellowing of the skin and sclera of the eyes, as well as darkening of urine (urine becomes dark beer color).
Glucose (Glucose) – used in the diagnosis of diabetes mellitus, endocrine diseases, and diseases of the pancreas.
Gamma-glutamyl transpeptidase (GGT, GGTP) is an enzyme whose activity increases in diseases of the hepatobiliary system (a marker of cholestasis). It is used in the diagnosis of obstructive jaundice, cholangitis and cholecystitis. Also, GGT is used as an indicator of toxic liver damage caused by the use of alcohol and hepatotoxic drugs.GGT is assessed in conjunction with ALT and alkaline phosphatase. This enzyme is found in the liver, pancreas, kidneys. It is more sensitive to abnormalities in the liver tissues than ALT, AST, alkaline phosphatase, etc. It is especially sensitive to prolonged alcohol abuse. At least five processes in the liver increase its activity: cytolysis, cholestasis, alcohol intoxication, tumor growth, and drug damage. In chronic viral hepatitis, a persistent increase in GGTP indicates either a severe process in the liver (cirrhosis) or toxic effects.
Total protein (Protein total) – the total concentration of proteins (albumin and globulins) in the blood serum. A strong decrease in total protein in the analysis may indicate a lack of liver function.
Ferritin (Ferritin) – the main indicator of iron stores in the body. An increase in ferritin in chronic viral hepatitis may indicate hepatic pathology. An increase in ferritin levels can be a factor that reduces the effectiveness of antiviral therapy.
Albumin (Albumin) – the main protein of blood plasma, synthesized in the liver A decrease in its level may indicate liver pathology caused by acute and chronic diseases. A decrease in the amount of albumin indicates severe liver damage with a decrease in its protein-synthetic function, which occurs already in the stage of liver cirrhosis.
Protein fractions – protein components contained in the blood. There are quite a large number of protein fractions, however, for people with chronic viral hepatitis, special attention should be paid to five main ones: albumin, alpha1-globulins, alpha2-globulins, beta-globulins and gamma-globulins.A decrease in albumin may indicate liver and kidney pathology. An increase in each of the globulins can indicate various disorders in the liver.
Creatinine is the result of the metabolism of proteins in the liver. Creatinine is excreted by the kidneys in the urine. An increase in the level of creatitine in the blood may indicate a violation of the normal functioning of the kidneys. The analysis is done before antiviral therapy to assess its safety.

2. PCR analysis of hepatitis C (hepatitis C RNA, HCV RNA) – qualitative and quantitative research.
A qualitative test indicates the presence of a virus in the blood. This test is necessary for all patients with antibodies to hepatitis C. Its result may be “detected” or “not detected”. Reference values ​​(value that should be normal) – “not found”. A “detected” result may indicate that the virus is multiplying and infecting all new liver cells. A qualitative PCR test has a certain sensitivity (10-500 IU / ml.). This means that if the virus is present in the blood at a very low concentration (below the detection threshold of the method), a “not detected” result can be obtained.Therefore, when conducting high-quality PCR in patients with low viremia (virus concentration), for example, undergoing antiviral therapy, it is important to know the sensitivity of the diagnostic system. To control the virological response during antiviral therapy, it is desirable to use a diagnostic system with a sensitivity of at least 50 IU / ml. Such criteria are met, for example, by analyzers COBAS AMPLICOR HCV-TEST (analytical sensitivity 50 IU / ml or 100 copies / ml), RealBest HCV RNA (analytical sensitivity 15 IU / ml or 38 copies / ml) and others.

Quantitative PCR (viral load) analysis is a test for the concentration of the virus in the blood. Viral load is the number of units of genetic material (viral RNA) that is present in a given volume of blood (usually 1 ml, which corresponds to 1 cubic centimeter). This amount is expressed in numbers, units of measure IU / ml (international units per milliliter). The amount of virus can be displayed in different ways. For example, 1.5 million IU / ml, which corresponds to 1.500.000 IU / ml or 1.5 * 106 IU / ml. Some laboratories use other units of measurement – copies / ml. The conversion factor from copies to international units is different for different test systems. The approximate value can be recalculated according to the formula 1 IU / ml = 4 copies / ml, for example, 5.5 * 105 IU / ml = 2.2 * 106 copies / ml.

It is important to remember that there is no direct relationship between the concentration of the virus in the blood and the severity of hepatitis C.

What does viral load affect?

The higher the concentration of the virus, the higher the risk of transmitting the virus, for example through sexual intercourse or through vertical transmission.And also the concentration of the virus affects the effectiveness of treatment (if the treatment is carried out on the basis of interferon). Thus, a low viral load is a favorable factor during therapy, and a very high viral load is an unfavorable factor. Also, quantitative PCR is of great importance when conducting interferon therapy to assess its success and plan the duration of the course. So, with a quick response to treatment and low viremia before therapy, treatment times can be shortened. Conversely, with a slow decrease in the concentration of the virus, AVT can be prolonged.

3.Elastography (fiber scanning)
It is necessary to exclude food intake 4 hours before the study. Excess weight affects the accuracy of the result, therefore, the medical specialist reserves the right to decide on the possibility of conducting a study.

Elastography is a study of liver tissue, which is performed using the FibroScan apparatus. It is used as an alternative method to biopsy. Allows to determine the degree of liver fibrosis in patients with chronic liver diseases, primarily with chronic viral hepatitis.The procedure is similar to an ultrasound scan, it takes no more than 10-15 minutes. This method is simple, painless and harmless.
The principle of elastography is based on the relationship between tissue elasticity and the degree of fibrosis: the lower the elasticity (that is, the denser the liver tissue), the more pronounced the fibrosis. The sensor is installed in the intercostal spaces on the right, where the liver is located. A jolt is felt with each measurement. To obtain an accurate result, at least 10 measurements are taken, on the basis of which the device calculates the average result.This figure reflects the density of the liver tissue, according to which the doctor-researcher judges the severity of fibrosis and makes a conclusion. Depending on the indicators, the degree of fibrosis is determined according to the Metavir scale.

Legend:

F 0-3 – stages of fibrosis on the METAVIR scale in chronic hepatitis.

F 4 – cirrhosis of the liver.

F 4 + EVVP – cirrhosis of the liver with the presence of varicose veins of the esophagus.

F 4 + EVVP * – liver cirrhosis, portal hypertension complicated by bleeding from varicose veins of the esophagus.

HCC – hepatocellular carcinoma.

* in some cases, a puncture biopsy of the liver may be indicated.

4. Carrying out genotyping of hepatitis C virus (HCV)

An important analysis that influences the choice of treatment regimen, as well as determining the duration. The presence of a virus of a particular genotype does not give any estimate of the severity of the course of the disease.Different genotypes have different drug resistance (resistance), therefore, a different treatment regimen is selected for each type. There is also evidence that patients with genotype 3 are more likely to have a concomitant liver disease – steatosis. Genotypes 1 and 3 of hepatitis C are the most common in Russia, Belarus and Ukraine.

There are 6 main genotypes of the hepatitis C virus and about 500 subtypes. Genotype 1 is the most widespread in the world (40-80%). Type 1a is often found in the United States; type 1b is typical for Western Europe and South Asia.Genotype 2 occurs with a frequency of 10-40%. Genotype 3 is common in Scotland, Australia, India and Pakistan. HCV type 4 is typical for Central Asia and North Africa, genotype 5 – for South Africa, 6 – for some Asian countries. In Russia, genotype 1b prevails, then with a decreasing frequency – 3, 1a, 2, in the USA – 1a / 1b, 2b, and 3a.

Having all the above results, a medical specialist will be able to make a complete diagnosis, determine the level of development of the viral process in the body, assess the state of the liver and the degree of its damage, and give recommendations on an effective treatment regimen.

It is also recommended to be tested for antibodies to hepatitis B virus and, in the case of hepatitis B, for antibodies to hepatitis D. Timely detection of these forms of viral hepatitis can help stop or slow down the process of liver destruction by these viruses.

90 040 90 041 90 000 C-reactive protein – diagnosis of coronavirus infection – – Articles

Public health in all countries of the world today faces a huge problem of diagnosing and stopping the epidemic of coronavirus infection COVID-19 caused by the SARS-CoV-2 virus.

It was determined that in adult patients in whom the COVID-19 coronavirus was detected (up to 95%), the concentration of C-reactive protein (CRP) was significantly increased, both in severe and mild forms of the disease. Studies of patients with COVID-19 have shown that CRP levels are directly correlated with disease, with critically ill patients experiencing significant increases in CRP levels. Quantification of CRP can serve as a reliable diagnostic marker of the severity, progression and outcome of the disease.So, for example, in one of the studies, which focused on the study of predictors (predictor markers) of death in COVID-19, it was shown that in surviving patients the average level of CRP was ~ 40 mg / L, while in the deceased – on average 125 mg / l.

The most important diagnostic advantage of C-reactive protein is that it is a very early marker of inflammation that occurs during infection with COVID-19: its concentration rises as early as 6-8 hours after infection.When the SARS-CoV-2 virus enters the body, an immune response is triggered to fight this pathogen, which leads to an increase in CRP levels. Other markers of inflammation, such as the number of leukocytes in the blood, have insufficient predictive ability to distinguish between bacterial and viral infections.

In accordance with the Methodological Recommendations of the Ministry of Health of the Russian Federation for the prevention, diagnosis and treatment of a new coronavirus infection, if COVID-19 is suspected, the diagnosis is established on the basis of a set of diagnostic tests, in which CRP is the main laboratory marker of the activity of the pathological process in the lungs.The increase in CRP correlates with the volume of lung tissue damage and is the basis for initiating anti-inflammatory therapy.

General biochemical blood test (urea, creatinine, electrolytes, glucose, alanine aminotransferase, aspartate aminotransferase, bilirubin, albumin, lactate, lactate dehydrogenase, troponin, ferritin) refers to additional laboratory diagnosis of COVID-19. Deviations of biochemical markers from the norm have a certain prognostic value, can indicate the development of complications and help in the choice of drugs, as well as in their dosage regimen.For example, another feature of the COVID-19 disease is a pronounced increase in the level of hepatic transaminases (ALT and AST), which may reflect viral liver damage. It has been shown that an increase in ALT and AST directly correlates with the severity of the course of COVID-19.

We offer a complete list of tests for biochemical analysis of COVID-19 markers in accordance with the Methodological Recommendations of the Ministry of Health of the Russian Federation for the prevention, diagnosis and treatment of new coronavirus infection (COVID-19), including kits for quantitative determination:

C- reactive protein high sensitivity, endpoint immunoturbidimetric method
Kit for quantitative determination of C-reactive protein in serum and plasma

To carry out the test, you will need a control (HT-C1122-CTL), a calibrator (HT-C1122-STD). More details in the catalog of biochemical reagents

ALT Enzymatic kinetic method

Kit for the quantitative determination of alanine aminotransferase (ALT) in blood serum.

AST Enzymatic kinetic method


Kit for the quantitative determination of aspartate aminotransferase (AST) in serum

Laboratory medical photometer Biochem SA is a compact benchtop semi-automatic biochemical analyzer.
Ideal for low sample volume labs. High performance and innovative design. BioChem series automatic biochemistry analyzers of various capacities for performing a wide range of tasks in laboratories with small and medium volumes of biochemical research.

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Evaluation of the effect of chronic alcohol intoxication on some indicators of the autonomic nervous system and cognitive functions | Akalaev

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Biochemical blood test / “9 months”

No. 3, March 2008 .

For 9 months of pregnancy, the expectant mother has to take a considerable number of tests. Why is this needed and what do their results mean?

Biochemical blood test allows you to evaluate the work of many internal organs – kidneys, liver, pancreas, etc. In addition, a biochemical blood test shows which trace elements are lacking in a woman’s body. Since various changes occur during pregnancy associated with metabolic processes, the assessment of blood biochemical parameters is important for the timely diagnosis of pathological conditions that may arise in the body of the expectant mother.

Let’s list the main indicators of the biochemical blood test.

Total protein – an indicator of protein metabolism, reflecting the total content of all proteins in the blood serum. The normal concentration of total protein in the blood is 63-83 g / l. Plasma proteins are divided into groups with different structures and functions, which are called protein fractions. Among the protein fractions, albumin and alpha, beta, gamma globulins are distinguished. Their definition and ratio allows you to more accurately assess the dysfunctions of internal organs.Physiological hypoproteinemia (decrease in protein levels) can be observed in pregnant women (especially in the third trimester) and during lactation due to a decrease in the number of red blood cells in plasma associated with an increase in total plasma volume. A slight decrease in total protein (55-65 g / l) during pregnancy is not a pathology. An increase in the concentration of protein in the blood serum is observed due to pathology – dehydration and thickening of the blood with fluid loss.

Lipids (fats) – there are 4 main groups of lipids in the blood: cholesterol (cholesterol), tri-glycerides, phospholipids, fatty acids.Cholesterol is the most important indicator of lipid metabolism, serves as a structural component of cell membranes, participates in the synthesis of sex hormones, bile acids, vitamin D. Fractions of low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL) and some others differing in composition and functions. The content of cholesterol in the blood is highly dependent on age. The normal level of cholesterol in the blood of a young woman is 3.15-5.8 mmol / L.During pregnancy, there is a physiological increase in the level of total cholesterol (up to 6.0-6.2), which is due to the increased formation of endogenous (produced in the liver) cholesterol, which is necessary for building the vascular bed of the placenta and the fetus. An increase in blood cholesterol levels is considered a factor predisposing to the development of atherosclerosis – the formation of specific plaques in blood vessels.

Carbohydrates are the main source of energy for the body.

Glucose is a source of energy and a vital component of any cell in the body.The normal concentration of glucose in the blood in adults is 3.9-5.8 mmol / l. In healthy pregnant women, the glucose level may be slightly lowered (up to 3.5-4.0 mmol / L), as the growing fetus consumes more and more glucose.

During pregnancy, the increased body’s need for insulin (a pancreatic hormone that regulates carbohydrate metabolism) exceeds the functional capacity of the cells of the pancreas that produce insulin. This can lead to insufficient secretion of it to maintain normal blood glucose levels.During this period, in some pregnant women, the relative lack of insulin can cause the development of gestational diabetes (diabetes during pregnancy), as evidenced by an increase in blood glucose. Therefore, all expectant mothers between the 24th and 28th weeks are advised to conduct a blood glucose test . This analysis is carried out additionally, without examining other indicators of biochemical analysis.

In the body, specific proteins , which are called enzymes , are involved in all biochemical reactions as catalysts.Each reaction involves its own specific enzyme, so there are hundreds of them. In this case, only a few dozen enzymes are of diagnostic value.

Alanine aminotransferase (ALT) – normally in women it contains up to 32 U / L. The highest ALT activity is found in the liver and kidneys. ALT levels rise when liver cells, kidney cells are damaged by viruses or chemicals.

Aspartate aminotransferase (ACT) – normally in women it contains up to 30 U / L.ACT is found in the tissues of the heart, liver, nervous tissue and kidneys; accordingly, it is determined in order to identify the pathology of these organs. In the normal course of pregnancy, ALT and ACT indicators do not change. A slight increase in transaminases is observed with preeclampsia of mild and moderate severity. A multiple increase in the activity of ALT (up to 100 IU / L) and ACT (up to 160 IU / L) is observed with severe preeclampsia. This result indicates that the liver cannot cope with the load.

Alkaline phosphatase is present in almost all tissues of the body.The highest activity of ALP is found in the cells of bone tissue, liver, kidneys, intestinal mucosa and placenta. An increase in blood alkaline phosphatase activity is mainly associated with bone diseases and liver pathology. In pregnant women, especially in the third trimester, there is also a physiological increase in the activity of this enzyme, an additional source of alkaline phosphatase in this case is the placenta. Normal values ​​of ALP in adults are up to 150 U / L. In pregnant women, this figure can rise to 240 U / L.

Pancreatic amylase is synthesized by cells of the pancreas. Normally, in adults, it contains up to 50 U / l. The level of pancreatic amylase in the blood increases with pancreatic pathology.

Pigments are colored organic substances. Bile pigments (bilirubin and urobilinogen) and porphyrins (red pigments) are of diagnostic value.

Bilirubin is a bile pigment that is formed as a result of the breakdown of hemoglobin, a pigment in red blood cells, to which oxygen is attached.During the breakdown of hemoglobin, free bilirubin is initially formed, which is transported from the spleen to the liver in combination with albumin. Then, in the liver, free bilirubin binds with a special acid (glucuronic), resulting in the formation of direct, less toxic bilirubin, which is actively secreted into the bile ducts and excreted in the bile. It is one of the main components of bile. Bilirubin is contained in blood serum in the form of two fractions : direct (bound) and indirect (free) bilirubin , together making up total blood bilirubin .The normal level of total bilirubin, including during pregnancy, is 3.4-17.2 μmol / l. With an increase in the concentration of bilirubin in the blood (with accelerated decay of erythrocytes, liver or biliary tract pathology) jaundice appears . This is due to the fact that with hyperbilirubinemia, bilirubin accumulates in the eyeball and skin.

Nitrous substances are the end products of the breakdown of proteins and nucleic acids – urea, creatinine, creatine, ammonia, uric acid.But in blood biochemistry, urea and creatinine are mainly determined.

Urea – determination of serum urea, along with creatinine, is used to assess renal excretory function. The normal concentration of urea in the blood is 2.5-6.3 mmol / l. An increase in the concentration of urea in the blood is observed in various kidney diseases.

Creatinine – normal creatinine values ​​in women are 53-97 μmol / l. An increase in serum creatinine indicates a decrease in the level of renal filtration (decreased kidney function).The concentration of blood creatinine in pregnant women is physiologically reduced (by 40%) due to an increase in blood volume, an increase in renal plasma flow and filtration, especially in the second and third trimesters of pregnancy. For pregnant women, the normal creatinine level is 35-70 μmol / l.

Trace elements are chemical substances, the content of which in the body ranges from a few micrograms to a few nanograms. But, despite such a small amount, they play an essential role in all biochemical processes of the body.

Iron is a vital trace element involved in oxygen transport. The normal iron level in women is 8.95-30.4 μmol / L. Iron is a part of erythrocyte hemoglobin, muscle myoglobin and some enzymes. With iron deficiency, iron deficiency anemia develops – the most common pathology of pregnancy, which is observed mainly in the second or third trimester due to insufficient satisfaction of the increased needs of the mother and fetus in substances necessary for hematopoiesis.However, with a normal hemoglobin level, a low iron content is possible, which is an indicator of latent iron deficiency anemia – which is why it is important to monitor iron levels in a biochemical blood test during pregnancy. The greatest loss of iron occurs with bleeding.

Sodium – the most important component of the extracellular space, which is associated with the regulation of water distribution in the body. Normal sodium concentration is 136-145 mmol / l. Sodium is involved in the excitation mechanisms of nerve and muscle cells.A decrease in its plasma level causes general weakness and can lead to the development of various neurological disorders. An increase in the concentration of sodium in the blood is observed with restriction of water intake, vomiting, for example, with toxicosis in the first half of pregnancy or diarrhea (loose stools) without replacement of fluid loss.

Potassium is the main intracellular trace element. The normal potassium level in adults is 3.5-5.5 mmol / L. Hyperkalemia is observed with renal failure, drug overdose.With a decrease in the level of potassium, which can be with diarrhea, vomiting, cardiac arrhythmias, muscle weakness, and decreased muscle tone develop.

Calcium is the main component of bone tissue. The normal concentration of calcium in young women is 2.20-2.55 mmol / l. Calcium in the body performs many functions: it participates in the processes of muscle contraction, hormone secretion, regulation of the activity of many enzymes, and the process of blood coagulation. Calcium deficiency is observed during pregnancy, which is explained by the child’s need for building material for bones.When calcium decreases in the analysis, it is necessary to replenish its content with the help of drugs.

Phosphorus – its main part is in bone tissue in the form of calcium salts, the rest is mainly in soft tissues. The normal concentration of phosphorus for the expectant mother is 1.