What are liver enzymes and why are they important. How do doctors interpret liver function test results. What causes abnormal liver enzyme levels. How can you maintain healthy liver enzyme levels.

The Basics of Liver Enzymes and Liver Function Tests

Liver enzymes are proteins that play crucial roles in various metabolic processes within the liver. Monitoring these enzyme levels through liver function tests (LFTs) provides valuable insights into the health and functionality of this vital organ. But what exactly are these tests measuring, and how do healthcare professionals interpret the results?

Liver function tests typically analyze several key components in a blood sample:

• Albumin
• Total protein
• Alkaline phosphatase (ALP)
• Alanine transaminase (ALT)
• Aspartate aminotransferase (AST)
• Gamma-glutamyl transferase (GGT)
• Bilirubin
• Lactate dehydrogenase (LD)
• Prothrombin time (PT)

When one or more of these substances fall outside the normal range, it may indicate liver disease or damage. However, interpreting these results requires a nuanced understanding of each component’s role and potential influencing factors.

Decoding Aminotransferase Enzymes: ALT and AST

Among the most commonly scrutinized liver enzymes are the aminotransferases: alanine aminotransferase (ALT) and aspartate aminotransferase (AST). These enzymes facilitate the transfer of amino groups between molecules, playing a vital role in amino acid metabolism.

ALT, also known as serum glutamic pyruvic transaminase (SGPT), is primarily found in liver cells. Its elevated presence in the bloodstream often signals liver cell damage or disease, even before symptoms manifest. This makes ALT a particularly valuable marker for early detection of liver issues.

AST, formerly called serum glutamic oxaloacetic transaminase (SGOT), is present in various tissues including the liver, heart, muscles, kidneys, and brain. While elevated AST levels can indicate liver problems, they’re less specific than ALT due to their wider distribution throughout the body.

Normal Ranges for ALT and AST

Understanding what constitutes “normal” levels is crucial for interpreting liver enzyme test results:

• ALT: The normal range is typically between 7 to 56 units per liter (U/L) of blood for men and 7 to 45 U/L for women.
• AST: Normal levels usually fall between 10 to 40 U/L for adults.

However, it’s important to note that these ranges can vary slightly between laboratories and may be adjusted based on factors such as age, gender, and overall health status.

Elevated Liver Enzymes: Causes and Implications

When liver enzyme levels exceed the normal range, it often indicates some form of liver cell injury or increased liver cell turnover. But what are the potential causes of these elevations?

• Viral hepatitis (A, B, C)
• Alcoholic liver disease
• Nonalcoholic fatty liver disease (NAFLD)
• Certain medications
• Autoimmune hepatitis
• Hemochromatosis
• Wilson’s disease
• Liver cancer

In some cases, elevated enzymes may be temporary and resolve on their own. However, persistent elevations warrant further investigation to identify and address the underlying cause.

The AST/ALT Ratio

The ratio of AST to ALT can provide additional diagnostic clues. In most types of liver disease, ALT levels are higher than AST. However, in alcoholic liver disease, AST levels often exceed ALT levels, typically in a ratio of 2:1 or higher.

Low Liver Enzyme Levels: Should You Be Concerned?

While much attention is given to elevated liver enzymes, low levels can also be indicative of certain health issues. Low ALT or AST levels are less common and generally less concerning than high levels, but they may signal:

• Vitamin B6 deficiency
• Chronic kidney disease
• Frailty in older adults

In most cases, slightly low liver enzyme levels don’t require treatment unless accompanied by other symptoms or abnormalities.

Beyond ALT and AST: Other Important Liver Function Markers

While ALT and AST are crucial indicators of liver health, other components of liver function tests provide valuable complementary information:

Alkaline Phosphatase (ALP)

ALP is an enzyme found in several tissues, with the highest concentrations in the liver and bones. Elevated ALP levels may indicate:

• Bile duct obstruction
• Certain bone disorders
• Pregnancy
• Certain cancers

Gamma-Glutamyl Transferase (GGT)

GGT is sensitive to alcohol consumption and certain medications. Elevated levels often indicate:

• Alcohol abuse
• Pancreatic disease
• Certain medications
• Liver or bile duct problems

Bilirubin

Bilirubin is a waste product from the breakdown of red blood cells. Elevated levels can cause jaundice and may indicate:

• Liver disease
• Bile duct obstruction
• Certain blood disorders

Symptoms Associated with Abnormal Liver Enzyme Levels

Abnormal liver enzyme levels often don’t cause noticeable symptoms, especially in the early stages. However, as liver damage progresses, individuals may experience:

• Fatigue
• Nausea
• Loss of appetite
• Abdominal pain or swelling
• Jaundice (yellowing of skin and eyes)
• Dark urine
• Pale stools
• Itchy skin

It’s crucial to note that these symptoms can be associated with various health conditions, not just liver problems. If you experience persistent symptoms, consult a healthcare professional for proper evaluation.

Maintaining Healthy Liver Enzyme Levels: Lifestyle and Prevention

While some causes of abnormal liver enzyme levels are beyond our control, many lifestyle factors can significantly impact liver health. Here are some strategies to maintain healthy liver enzyme levels:

1. Limit alcohol consumption
2. Maintain a healthy weight
3. Exercise regularly
4. Eat a balanced diet rich in fruits, vegetables, and whole grains
5. Avoid unnecessary medications and follow dosage instructions carefully
6. Get vaccinated against hepatitis A and B
7. Practice safe sex and avoid sharing needles to prevent hepatitis C
8. Manage underlying health conditions like diabetes and high cholesterol

By adopting these healthy habits, you can significantly reduce your risk of liver damage and maintain optimal liver function.

When to Seek Medical Attention for Liver Enzyme Abnormalities

Routine blood tests often detect abnormal liver enzyme levels before symptoms appear. However, certain situations warrant immediate medical attention:

• Sudden onset of severe abdominal pain
• Jaundice
• Persistent fatigue, nausea, or loss of appetite
• Dark urine or pale stools
• Unexplained weight loss
• Swelling in the legs or abdomen

If you experience these symptoms or have concerns about your liver health, don’t hesitate to consult a healthcare provider. Early detection and intervention can significantly improve outcomes for many liver conditions.

Diagnostic Procedures for Liver Enzyme Abnormalities

When abnormal liver enzyme levels are detected, healthcare providers may recommend additional tests to determine the underlying cause:

• Ultrasound, CT scan, or MRI of the liver
• Viral hepatitis tests
• Autoimmune antibody tests
• Liver biopsy
• Genetic testing for inherited liver diseases

These diagnostic procedures help healthcare providers develop an appropriate treatment plan tailored to the specific cause of liver dysfunction.

The Future of Liver Health Monitoring

As medical science advances, new technologies and approaches are emerging to enhance liver health monitoring and disease detection:

Non-Invasive Liver Fibrosis Assessment

Techniques like transient elastography (FibroScan) and magnetic resonance elastography (MRE) allow for non-invasive assessment of liver fibrosis, reducing the need for liver biopsies in some cases.

Biomarker Discovery

Researchers are identifying new biomarkers that may provide more specific and sensitive indicators of liver health and disease progression.

Artificial Intelligence in Liver Disease Diagnosis

Machine learning algorithms are being developed to analyze complex patterns in liver function test results, potentially improving early detection and diagnosis of liver diseases.

Personalized Medicine Approaches

Advances in genetic testing and understanding of liver disease mechanisms are paving the way for more personalized treatment strategies based on individual patient characteristics.

These emerging technologies and approaches hold promise for improving liver health assessment and management in the future, potentially leading to earlier interventions and better outcomes for patients with liver disease.

Liver Function Tests-Ranges-High & Low

Liver Function Tests (LFT)

Liver function tests (LFT) are blood tests, which are commonly performed to assess liver functions or liver injury. LFT is also known by other names such as, liver panel, liver function panel, liver profile hepatic function panel, LFT.

An initial step in detecting liver damage is a simple blood test to determine the level of certain liver enzymes (proteins) in the blood. Under normal circumstances, these enzymes mostly reside within the cells of the liver.

But when the liver is injured for any reason, these enzymes are spilled into the blood stream. Enzymes are proteins that are present throughout the body, each with a unique function.

Enzymes help to speed up (catalyze) routine and vital chemical reactions in the body.

Liver function tests (also known as a liver panel) are blood tests that measure different enzymes, proteins, and other substances made by the liver. These tests check the overall health of the liver.

Following are the different substances often tested at the same time on a single blood sample for LFT:

• Albumin a protein made in the liver
• Total protein. This test measures the total amount of protein in the blood.
• ALP ALP(alkaline phosphatase), ALT (alanine transaminase), AST (aspartate aminotransferase), and gamma-glutamyl transferase (GGT). These are different enzymes made by the liver.
• Bilirubin, a waste product made by the liver.
• Lactate dehydrogenase (LD), an enzyme found in most of the body’s cells. LD is released into the blood when cells have been damaged by disease or injury.
• Prothrombin time (PT), a protein involved in blood clotting.

If levels of one or more of these substances are outside of the normal range, it may be a sign of liver disease.

Aminotransferase Enzymes (ALT, AST)

The aminotransferase enzymes catalyze chemical reactions in which an amino group from one amino acid (amino acids are building blocks of proteins) is transferred from a donor molecule to a recipient molecule, hence, the names “aminotransferases.”

Medical terms can sometimes be confusing, as is the case with these enzymes because they have interchangeable names that commonly appear in both medical and non-medical articles. For example:

• Another name for aminotransferase is transaminase.
• The enzyme aspartate aminotransferase (AST) is also known as serum glutamic oxaloacetic transaminase (SGOT).
• Alanine aminotransferase (ALT) is also known as serum glutamic pyruvic transaminase (SGPT).

Briefly, AST = SGOT and ALT = SGPT; they are enzymes produced by the liver and other types of cells.

Alanine aminotransferase (ALT)

Alanine aminotransferase (ALT) is present primarily in liver cells. In viral hepatitis and other forms of liver disease associated with hepatic necrosis, serum ALT is elevated even before the clinical signs and symptoms of the disease appear.

Although serum levels of both aspartate aminotransferase (AST) and ALT become elevated whenever disease processes affect liver cell integrity, ALT is a more liver-specific enzyme.

Serum elevations of ALT are rarely observed in conditions other than parenchymal liver disease. Moreover, the elevation of ALT activity persists longer than does AST activity.

Aspartate Aminotransferase (AST)

Aspartate aminotransferase (AST) is a transaminase enzyme that catalyzes the conversion of aspartate and alpha-ketoglutarate to oxaloacetate and glutamate.

The AST enzyme was formerly known as serum glutamate oxalate transaminase (SGOT) and is present in all tissues except bone, with highest levels in liver and skeletal muscle. Concentration of AST is elevated after bruising, trauma, necrosis, infection, or neoplasia of liver or muscle.

The AST enzyme is found in cerebrospinal fluid, exudates, and transudates in proportion to the amount of cellular damage.

Where AST (aspartate aminotransferase) and ALT (aminotransferase enzymes) are Found

AST (SGOT) is normally found in a variety of tissues including the liver, heart, muscle, kidney, and brain. It is released into the serum when any one of these tissues is damaged.

For example, the AST level in serum is elevated in heart attacks or with a muscle injury. It is, therefore, not a highly specific indicator of liver injury as its elevation can occur as a result of other injured tissues.

ALT (SGPT) is, by contrast, normally found largely in the liver. This is not to say that it is exclusively located in the liver, but that is where it is most concentrated.

It is released into the bloodstream as the result of liver injury. Thus, it serves as a fairly specific indicator of liver status.

High (Elevated) Levels of AST and ALT

Following are the normal ranges of AST and ALT:

• The normal range of values for AST (SGOT) is about 5 to 40 units per liter of serum (the liquid part of the blood).
• The normal range of values for ALT (SGPT) is about 7 to 56 units per liter of serum.

The ranges of AST and ALT numbers may differ slightly depending on the technique and protocols used by different laboratories worldwide. However, normal reference ranges are routinely provided by each laboratory and printed with each patient’s individual report.

AST (SGOT) and ALT (SGPT) are reasonably sensitive indicators of liver damage or injury from different types of diseases or conditions, and collectively they are termed liver tests or liver blood tests.

However, it must be emphasized that higher-than-normal levels of these liver enzymes should not be automatically equated with liver disease. They may mean liver problems or they may not.

For example, elevations of these enzymes can occur with muscle damage. The interpretation of elevated AST and ALT results depends upon the entire clinical evaluation of an individual, and so it is best done by physicians experienced in evaluating liver disease and muscle disease.

Moreover, the precise levels of these liver enzyme tests do not correlate well with the extent of liver problems or the prognosis (outlook). Thus, the exact levels of AST (SGOT) and ALT (SGPT) cannot be used to determine the degree of liver disease or predict the future prognosis for liver function.

For example, patients with acute viral hepatitis-A may develop very high AST and ALT levels (sometimes in the thousands of units/liter range), but most patients with acute viral hepatitis-A recover fully without residual liver disease.

Again, patients with chronic hepatitis-C infection typically have only a little elevation in their AST and ALT levels while having substantial liver injury and even advanced scarring of the liver (cirrhosis) from ongoing minor inflammation of the liver.

Types of Liver Function Tests (LFT)

A liver function test is one of a group of tests that check levels of certain enzymes and other proteins in the blood. Some of the tests look for enzymes that are found in liver disease  and when the liver is damaged. Others check that the liver is working properly, the way it should.

Following are some of the blood tests reflect liver function:

• Coagulation panel (prothrombin time or PT, and international normalized ratio or INR): These tests measure blood’s ability for normal clotting and prevention of bleeding and bruising. This is the function of certain proteins called clotting factors that normally are produced in the liver. Normal values are about 9.5 to 13.8 seconds.
• Albumin level (hypoalbuminemia): Albumin is a very common protein found in the blood with a variety of functions. It also is produced only in the liver, and if its levels are lower than normal it can be suggestive of chronic liver disease or liver cirrhosis. Of note, many conditions other than liver disease also may cause low albumin levels. Normal values are about 3.5 to 5 g/dL.
• Bilirubin: This molecule is a byproduct of the routine destruction of red blood cells occurring in the liver. It is normally released as bile in the feces. Elevation of the bilirubin can suggest liver dysfunction. However, other conditions with increased destruction of red blood cells also can cause elevated bilirubin levels despite normal liver function. Normal values are about 0.1 to 1.0 mg/dL.
• Platelet count: Low platelet count (thrombocytopenia) has many causes, one of which can be advanced liver disease. Normal platelet counts are about 150,000 to 400,000 per (µL).
• Glucose: Glucose level is maintained in the body by a variety of mechanisms. The liver can release glucose in the blood for nourishment of other cells in case of starvation with insufficient oral intake of glucose. This process, called gluconeogenesis, is another major function of the liver. In advanced liver disease, this function of the liver can be compromised leading to unusually low glucose levels in the absence of adequate oral intake. Again, a large number of patients with liver cirrhosis become glucose intolerant and develop diabetes.
• GGT (Gamma-glutamyl transpeptidase): This enzyme is thought to indicate possible liver damage; the higher the abnormal level, the more likely there is liver damage. Normal levels of GGT are about 9 to 48 U/L.
• ALP (alkaline phosphatase): The liver synthesizes the highest amounts of this enzyme so high levels in the blood may suggest liver injury among other causes. Normal levels of ALP are about 45 to 115 U/L.
• LD or LDH (Lactate dehydrogenase): This enzyme may be elevated in many types of diseases, including liver disease. Normal levels are about 122 to 222U/L.

Reasons for Abnormal Liver Tests

Abnormal liver tests may be detected a variety of liver conditions in the blood. Some of those are the following:

• Mild to moderate elevations of the liver enzymes are common. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT readings in such cases are usually between twice the upper limits of normal and several hundred units/liter. One of the most common causes of mild to moderate elevations of these liver tests is a condition referred to as fatty liver disease (steatohepatitis or hepatic steatosis). In the United States, the most frequent cause of fatty liver disease is alcohol abuse.  

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time.

The risk is higher for heavy drinkers who are women, have obesity, or have certain genetic mutations.

Other causes of fatty liver include diabetes mellitus, and obesity. Fatty liver disease tests are composed of several tests including blood tests, CT and/or MRI scan tests, and in some patients, a liver biopsy.

• Hepatitis-B and Hepatitis-C are other causes of chronic mild to moderate liver enzyme elevation. In these conditions, ALT and AST may be only slightly high and the degree of abnormality in liver function tests can indicate the degree of injury.
• Chronic and acute alcohol use also can commonly cause abnormal liver blood tests. In alcoholic hepatitis, the range of liver tests can vary greatly. In chronic alcohol liver disease or alcoholic cirrhosis, slight elevation of ALT and AST may be observed, whereas, in acute alcoholic hepatitis, high liver enzyme numbers are often seen.
  
• Some medications can be responsible for a mild to moderate increase in the liver enzyme tests.

Medications that can cause increased liver enzyme tests (AST and ALT) levels

Following are examples of some of the common medications with potential liver toxicity:

Pain Relief Medications

• Aspirin
• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Naproxen (Naprosyn, Naprelan, Anaprox, Aleve)
• Diclofenac (Voltaren, Cataflam, Voltaren-XR)
• Phenylbutazone (Butazolidine)

Anti-seizure Medications

• Phenytoin (Dilantin)
• Valproic acid ( Depakote)
• Carbamazepine (Tegretol)
• Phenobarbital

Antibiotics

• Tetracyclines (Achromycin)
• Sulfonamides
• Isoniazid (Nydrazid, Laniazid)
• Sulfamethoxazole (Gantanol)
• Trimethoprim(Trimpex; Proloprim, Primsol)
• Nitrofurantoin (Macrodantin, Furadantin, Macrobid)
• Fluconazole (Dilflucan) and other anti-fungals

Cholesterol Lowering Drugs (Statins)

• Lovastatin (Mevacor, Altocor)
• Pravastatin (Pravachol)
• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Simvastatin (Zocor)
• Rosuvastatin (Crestor)
• Niacin

Cardiovascular Drugs

• Amiodarone (Cordaone)
• Hydralazine (Apresoline)
• Quinidine (Quinaglute, Quinidex)

Other Drugs

• Antidepressant drugs of the tricyclic type

With drug-induced liver enzyme abnormalities, the enzymes usually normalize weeks to months after stopping the medications. Typically, the physician will want to monitor the patient’s liver enzymes over time to confirm that the values are normalizing.

Diseases that can cause very high AST or ALT levels

AST and ALT serum levels in some liver conditions can range anywhere from ten times the upper limits of normal to thousands of units/liter.

The highest levels of AST and ALT are found with disorders that cause rapid death of numerous liver cells (extensive hepatic necrosis). Although this degree of liver enzymes elevation is not common, it can occur in such conditions as:

• Acute viral hepatitis A or B
• Profound liver damage inflicted by toxins as from an overdose of acetaminophen (brand-name Tylenol) or mushroom poisoning
• Prolonged collapse of the circulatory system (shock) when the liver is deprived of fresh blood providing oxygen and nutrients

Also, very high AST and ALT levels can be a result of severe muscle diseases.

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What To Do About Fluctuating Liver Enzyme Levels

Liver enzymes are proteins the liver produces. The amount of these proteins in your blood is a good indication of your liver’s overall health. But elevated liver enzyme levels do not always mean serious liver damage or disease.

Sometimes, factors such as hormonal changes or reactions to medications can cause temporarily elevated liver enzyme levels. Elevated levels caused by these factors will generally return to normal in about 2 to 4 weeks without treatment.

Your liver makes proteins called liver enzymes that help your body perform necessary functions. For instance, liver enzymes help your body:

• fight infections
• make coagulation proteins that are necessary for blood clotting
• break down the food you eat
• break down toxins

Your liver makes several liver enzymes, including:

• Aspartate transaminase (AST)
• Alkaline phosphatase (ALP)
• Alanine transaminase (ALT)
• Gamma-glutamyl transferase (GGT)

These liver enzyme levels are a good indicator of how well your liver is functioning. A liver panel test checks liver enzyme levels in your blood.

A healthcare professional might order this test as part of routine blood work, as a way to monitor you if you’re at risk for liver disease, or as a diagnostic test if you have symptoms of liver disease or liver damage.

There are many reasons liver enzyme levels can change. Some causes are temporary and will resolve on their own. Other causes are more serious and will require medical treatment.

Temporary causes of changes in liver enzyme levels include:

• Hormones: Fluctuations in your liver levels can occur during your menstrual cycle and pregnancy.
• Certain medications: Some medications, including acetaminophen, antibiotics, and some cholesterol-lowering medications, can elevate your liver enzyme levels.
• Herbal supplements: Supplements such as iron, vitamin A, comfrey, and chaparral can elevate liver enzyme levels.
• Alcohol: Heavy drinking can raise your liver enzyme levels.

Causes of elevated liver enzyme levels that are more likely to be chronic include:

• Fatty liver disease: Heavy alcohol use, obesity, and a range of other factors can cause fatty liver disease. No matter the cause, fatty liver disease raises your liver enzyme levels.
• Hemochromatosis: Hemochromatosis is a rare condition that occurs when your body builds up too much iron. Elevated liver enzyme levels can be a symptom of the condition.
• All types of hepatitis: Any type of hepatitis, including hepatitis A, hepatitis B, hepatitis C, autoimmune hepatitis, and alcoholic hepatitis, causes liver inflammation and elevated liver enzymes.
• Cirrhosis: Cirrhosis is chronic liver damage. This damage causes elevated levels of liver enzymes.
• Liver cancer: Cancer that impacts your liver will also affect your liver enzyme levels.
• Hemolysis: Hemolysis is a type of anemia that occurs when your red blood cells are destroyed. It’s sometimes seen with alcohol-related liver diseases, and it can cause changes to liver enzyme levels.
• Thyroid disease: Hyperthyroidism can sometimes cause high levels of liver enzymes.
• Metabolic syndrome: Metabolic syndrome is a term that refers to a group of conditions that raise your risk of diabetes, heart disease, and stroke. These conditions include high blood pressure, high cholesterol, high blood sugar, and carrying excess weight around your midsection. People with metabolic syndrome may also have elevated liver levels.

The exact threshold for what is considered an elevated level or a typical level depends on your age, gender, health goals, and the values used by the specific lab. You can see some standard thresholds below.

• AST: under 36 U/L
• ALP: between 20 and 140 U/L
• ALT: under 25 U/L for women or under 33 U/L for men
• GGT: between 5 and 40 U/L

A liver function test might also measure:

• Albumin: between 35 and 50 U/L
• Bilirubin: between 0. 1 and 1.2 mg/dl

These values are not enzymes, but they’re also important chemicals made by your liver.

A liver function test is a standard blood draw. It can be done during a regular office visit. You don’t generally need any special preparation before a liver function test, although a doctor might ask you to fast for 12 to 24 hours before the blood draw. You can read more about liver function tests here.

The treatment for elevated liver enzymes depends on the cause. In many cases, liver enzyme levels return to normal on their own within about a month. You might need to switch medications, stop taking a supplement, or cut back on drinking if you drink, but you will not need a treatment plan.

In other cases, your doctor might need to treat the condition that’s raising your liver enzyme levels. They might order more tests, such as imaging tests, to get a better look at your liver or blood tests. They might also order a liver biopsy. Depending on your results, you might be referred to a specialist. Treatment will depend on your final diagnosis.

If you’re concerned your liver enzyme levels might be elevated, you might consider making some lifestyle changes at home, such as:

• reducing or eliminating alcohol from your diet
• being cautious about the medications and supplements you take
• staying active, including exercising regularly
• trying to add liver-friendly foods to your diet
• maintaining a moderate weight

Liver enzyme levels are an important indication of your liver’s health. When your enzyme levels are too high, it can be a symptom of liver damage or disease.

Some causes of elevated liver levels, such as hormonal changes or certain medications, are temporary and might resolve without treatment. Other causes are more serious and can include conditions such as cirrhosis, hepatitis C, and liver cancer.

Treatment for high liver enzyme levels depends on the cause.

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The cost of analyzes is indicated without taking biomaterial

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When choosing where to perform Enzymes in Moscow and other cities of Russia, do not forget that the cost, methods and terms of performing studies in regional medical offices may differ

Tissues of various organs differ in the spectrum of enzymatic activity. With inflammation or other damaging effects, the components of the cellular content in an increased amount enter the surrounding space and blood. If hepatitis or pancreatitis is suspected, a biochemical blood test for liver or pancreatic enzymes (ALT/AST/GGT and amylase/lipase, respectively) provides laboratory evidence in favor of the proposed diagnosis. Most enzymes do not have strict specificity – the data obtained are always subject to a comprehensive analysis by the attending physician, taking into account the anamnesis, clinical symptoms, and the results of other studies.

Test for alpha-amylase (diastase)

Method of determination
Enzymatic colorimetric (IFCC recommended).

Test material
Blood serum

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Synonyms: Diastasis; Serum amylase; Serum amylase. α-Amylase; AMY; AML; diastase; 1;4-β-D-glucanohydralase; Serum amylase; blood amylase.

Brief description of the analyte Alpha-amylase

Alpha-amylase belongs to the group of enzymes that break down dietary carbohydrates such as starch, glycogen into dextrins, maltose and glucose. This enzyme is produced mainly in the salivary glands and pancreas, then it enters the oral cavity or the lumen of the duodenum, respectively, and participates in the breakdown of food carbohydrates. In the blood serum, pancreatic (P-type) and salivary (S-type) amylase isoenzymes are isolated (see also test No. 12 Alpha-Amylase pancreatic). Usually, persistently low serum alpha-amylase activity is significantly increased in acute pancreatitis or inflammation of the salivary glands. The ovaries, fallopian tubes, small and large intestines, liver, and mammary glands during lactation have a significantly lower amylase activity.

What is the purpose of determining the concentration of alpha-amylase in the blood serum

The study of the level of alpha-amylase is used mainly for the diagnosis and monitoring of the treatment of acute pancreatitis, differentiation of pancreatitis from other acute abdominal disorders, as well as in the diagnosis of other types of pancreatic pathology .

Under what conditions is the concentration of alpha-amylase increased

In acute pancreatitis, after 2-12 hours from the onset of an attack, a transient increase in the activity of blood alpha-amylase is observed. Usually in acute pancreatitis, alpha-amylase activity is 4-6 times higher than the reference values, while the maximum values ​​are reached after 12-72 hours. Alpha-amylase levels return to normal on the third or fourth day. The magnitude of the increase in alpha-amylase is not directly related to the severity of the process in the pancreas. However, the higher the increase, the higher the likelihood of acute pancreatitis.

Up to 20% of cases of acute pancreatitis can occur with a normal level of serum amylase, parallel determination of lipase (test No. 23) increases the likelihood of its detection. In particular, serum amylase may be normal in acute pancreatitis associated with hyperlipemia. Serum amylase is excreted in the urine, therefore, an increase in amylase values ​​in the blood serum is also reflected in an increase in the content of amylase in the urine (see test No. than serum amylase activity, the increase in values ​​persists for a longer period after an attack.However, the diagnostic value of determining serum amylase activity is higher.

Under certain pathological conditions, amylase (usually S-type) can form complexes with immunoglobulins A and G and other high molecular weight plasma proteins (macroamylasemia). These complexes do not pass through the glomerular membrane. In this case, although the content of amylase in the blood serum increases, the normal activity of the enzyme is determined in the urine. A discrepancy between the levels of serum and urinary amylase activity is also observed in renal failure. In chronic pancreatitis without exacerbation, serum amylase activity is usually at a subnormal level. Exacerbations of chronic pancreatitis are accompanied by slight increases in serum alpha-amylase levels.

Some diseases not related to the pancreas may also be accompanied by hyperamylasemia. These include chronic renal failure (decreased clearance of serum amylase), any kind of damage to the salivary glands, diseases of the biliary tract, as a result of primary or secondary involvement of the pancreas.