What does elevated liver enzyme mean. What does an increase in liver enzymes in a blood test mean?

Enzymes (or liver enzymes) take an important part in the metabolic processes of the body.

A change in their normal level often indicates the presence of a variety of diseases, most of which threaten a person's life (for example, hepatitis, cirrhosis, cancer, pancreatitis, heart failure).

Classification of enzymes, their functions

Thanks to enzymes, most of the metabolic processes in the body take place. With various diseases, the amount of these substances in the blood can increase or decrease.

Since the liver performs many different functions, enzymes are classified according to their field of activity.

Enzymes are isolated:

• secretory;
• excretory;
• indicator.

The secretory type includes prothrombinase and cholinesterase. Enzymes of this group have an effect on the blood, which affects its coagulation.

In the presence of diseases of the hepatobiliary system (liver, gallbladder and ducts), the level of enzymes in the body decreases.

Alkaline phosphatase belongs to the excretory type - this enzyme is secreted along with bile. An increase in the alkaline phosphatase in the blood indicates problems with the bile ducts.

In the event of the destruction of hepatocytes (liver cells, up to eighty percent of the mass of the organ), due to the development of certain diseases in the blood, the amount of enzymes of the indicator group sharply increases.

The following enzymes belong to this type: aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, lactate dehydrogenase and glutamate dehydrogenase (or AST, ALT, GGT, LDH and GlDH, respectively).

The above substances of the indicator group are found in the cytosol or mitochondria of cells. AST and ALT are also microsomal liver enzymes.

Not all enzymes are of diagnostic value.

Typically, a blood chemistry test for liver enzymes checks the levels of aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, lactate dehydrogenase, and alkaline phosphatase (ALP).

After receiving the results, the patient shows them to the attending physician, who will evaluate the functionality of the organ, make a diagnosis and prescribe medications.

In some cases, additional examinations (ultrasound, x-ray, liver puncture) may be prescribed.

If any liver enzyme begins to be produced in a slightly larger amount than it should be according to the norm, then usually nothing terrible happens.

The liver reacts to the intake of low-quality foods and alcohol. Regular use of certain medications can also lead to the fact that some enzyme will be produced excessively.

A cause for concern will be a situation in which the current level of the enzyme and the norm will differ very much.

The level of enzymes in the blood

In a biochemical blood test, the level of aspartate aminotransferase and alanine aminotransferase, which are produced by the liver, is first checked.

These indicators are measured in international units per liter (U/L). The norm for men will be the content of 15 - 30 U / l of the AST enzyme and 10 - 40 U / l of the ALT enzyme. In women, the healthy level of these substances is somewhat different: AST should be 20 - 40 U / l and ALT - 12 - 32.

In addition, the ratio of these two enzymes is also important: normally, aspartate aminotransferase in the blood should be thirty percent more than alanine aminotransferase.

If the AST levels are elevated, then this indicates damage to the liver cells (necrotic or mechanical). ALT levels usually rise with infectious diseases.

An increase in this enzyme allows you to detect hepatitis at an early stage and start treatment in a timely manner. If the ratio of AST to ALT (also called the de Ritis ratio) is above 2, then this indicates alcoholic liver disease.

A decrease in this indicator to one or even more is a sign of acute viral hepatitis. If the de Ritis coefficient is in the range of 1.4 - 1.7, then this indicates cirrhosis of the liver.

No less important is another elevated liver enzyme - glutamate dehydrogenase. Normally, its level should be less than 3 or 4 U / l in women and men, respectively.

If a blood test showed an increase in the content of this enzyme in the body, then this indicates the presence of infectious or oncological diseases, liver dystrophy, and poisoning with harmful substances. The level of lactate dehydrogenase enzyme should be between 140 and 350 U/L.

The enzyme gamma-glutamyltransferase changes with the development of diabetes and biliary tract diseases. Its normal level should be less than 55 or 38 U / l for men and women, respectively.

During the disease, these figures can be exceeded ten or more times. A blood test for the content of this enzyme is still used to diagnose the destruction of hepatocytes due to alcohol abuse.

Another important liver enzyme is alkaline phosphatase. This enzyme takes an active part in the digestive processes.

In case of violation of the outflow of bile (cholelithiasis, inflammation of the bile ducts), this figure can increase by three to four times.

Thus, a comprehensive blood test can show the presence in the body of various pathologies that prevent the normal functioning of the liver and gallbladder.

Decreased enzyme levels

Treatment of elevated enzyme levels is prescribed based on a biochemical blood test. According to its results, the doctor sees the pathology that affected the liver, and prescribes certain drugs.

Thus, treatment is not aimed at eliminating the symptoms, that is, lowering the level of enzymes, but at eliminating the cause of their increase.

Restrictions in the diet are primarily aimed at reducing the load on the affected liver. Under the ban are fatty, smoked, spicy and salty foods, alcoholic and carbonated drinks, coffee.

It is recommended to consume as many greens as possible (cabbage, lettuce, spinach), walnuts (reduce inflammation of the liver), avocados (they are natural antioxidants, help remove harmful substances from the body). It will be useful to use garlic and fermented milk products - kefir, fermented baked milk.

The liver is forced to process a large amount of cholesterol, which negatively affects its condition.

Fiber-rich foods increase bile production, which improves fat processing.

The amount of processed cholesterol is also reduced, thus the load on the liver is significantly reduced.

It will be useful to use foods with a high content of vitamin C - citrus fruits, rose hips.

In case of liver diseases, it will not be superfluous to take a large amount of liquid (up to two and a half liters). Water stimulates the elimination of toxins from the body.

In addition, you can drink herbal teas, which reduce the load on the liver. For their preparation, dandelion root, milk thistle, astragalus are used. Ordinary green tea will also be useful for the liver.

Pharmacies sell many different herbal preparations, which also have a positive effect on the functioning of the hepatobiliary system.

It should be noted that not all of them are tested, so you need to purchase such natural medicines only after consulting a doctor.

With an increase in the level of enzymes, it is imperative to take medications prescribed by a doctor that belong to the group of hepatoprotectors.

Regular intake of funds allows you to quickly normalize the readings of enzymes and restore the liver. Hepatoprotectors include Essentiale, Galsten, Phosphogliv, Allochol.

In addition, it is mandatory to take medications aimed at eliminating the main cause of the increase in enzyme levels.

Enzymes play a vital role in the human body. Various liver pathologies can increase the level of enzymes in the blood, so after a biochemical analysis and obtaining the results, the doctor can make a correct diagnosis and prescribe the appropriate treatment.

Taking medications and following a diet help to reduce the load on the body, lower the level of enzymes and get rid of the disease.

enzymes

By the activity of which one can judge the state of the entire organ. Determination of the activity of enzymes that are associated with the work of the liver is called

enzyme diagnostics liver diseases.

Types of changes in enzyme activity in various diseases There are three main types of changes in enzyme activity that are characteristic of all types of general pathological processes in the body:

1. increased activity of enzymes that are constantly present in the blood
2. a decrease in the activity of enzymes that are constantly present in the blood
3. the appearance in the blood of enzymes that are normally absent

What enzymes are used to diagnose diseases of the liver and biliary tract The state of the liver can be assessed by the following enzymes:

• aminotransferases (AST and ALT)
• lactate dehydrogenase (LDH)
• alkaline phosphatase (AP)
• glutamate dehydrogenase (GlDH)
• sorbitol dehydrogenase (SDH)
• γ-glutamyltransferase (GGT)
• fructose monophosphate aldolase (FMPA)

Sensitivity of enzyme diagnostics in liver diseases The high sensitivity of enzyme diagnostics is explained by the fact that the concentration of the enzyme in liver cells ( hepatocytes) is 1000 times higher than in blood. Enzyme diagnostics is important for detecting liver damage without jaundice (eg, drug damage, anicteric viral hepatitis, chronic liver disease).
Types of enzymes - membrane, cytoplasmic and mitochondrial

Enzymes can be located in the membrane, cytoplasm or mitochondria of hepatocytes. Each enzyme has its own strict place. Easily damaged enzymes are found in the membrane or cytoplasm of hepatocytes. This group includes lactate dehydrogenase, aminotransferases and alkaline phosphatase. Their activity increases in the clinically asymptomatic phase of the disease. With chronic liver damage, the activity of mitochondrial enzymes increases (

mitochondrion- cell organelle), which include mitochondrial AST. With cholestasis, the activity of bile enzymes, alkaline phosphatase, increases.

Alanine aminotransferase (ALT, AlAT) - normal, result in liver diseases

The normal activity of ALT in the blood of men is 10-40 U / l, in women - 12-32 U / l.

antibiotics

A sharp increase in ALT activity by 5-10 times or more is an undoubted sign of acute liver disease. Moreover, such an increase is detected even before clinical symptoms appear (jaundice, pain, etc.). An increase in ALT activity can be detected 1-4 weeks before the onset of the clinic and appropriate treatment can be started, preventing the disease from developing fully. The high activity of the enzyme in such acute liver disease does not last long after the onset of clinical symptoms. If normalization of enzyme activity does not occur within two weeks, this indicates the development of massive liver damage.

Determination of ALT activity is a mandatory screening test for donors.

Aspartate aminotransferase (AST, AST) - norms, result in liver diseases The maximum activity of AST was found in the heart, liver, muscles and kidneys. Normally, in a healthy person, AST activity is 15-31 U/l in men and 20-40 U/l in women.

AST activity increases with necrosis of liver cells. Moreover, in this case, there is a directly proportional relationship between the concentration of the enzyme and the degree of damage to hepatocytes: that is, the higher the activity of the enzyme, the stronger and more extensive the damage to hepatocytes. An increase in AST activity also accompanies acute infectious and acute toxic hepatitis (poisoning with heavy metal salts and some drugs).

The ratio of AST/ALT activity is called de Ritis coefficient. The normal value of the de Ritis coefficient is 1.3. With liver damage, the value of the de Ritis coefficient decreases.

For more information about the biochemical blood test for enzymes, see the article: Blood chemistry

Lactate dehydrogenase (LDH) - the norm, the result in liver diseases LDH is a widespread enzyme in the human body. The degree of its activity in various organs in descending order: kidneys> heart> muscles> pancreas> spleen> liver> blood serum. There are 5 isoforms of LDH present in the blood serum. Since LDH is also found in erythrocytes, the blood for the study should not contain traces of hemolysis. In plasma, LDH activity is 40% lower than in serum. The normal activity of LDH in the blood serum is 140-350 U / l.

In what pathologies of the liver is the content of isoforms increased Due to the wide prevalence of LDH in various organs and tissues, an increase in the overall activity of LDH is not of great importance for the differential diagnosis of various diseases. For the diagnosis of infectious hepatitis, the determination of the activity of LDH 4 and 5 isoforms (LDH4 and LDH5) is used. In acute hepatitis, serum LDH5 activity rises in the first weeks of the icteric period. An increase in the total activity of LDH4 and LDH5 isoforms is detected in all patients with infectious hepatitis in the first 10 days. In cholelithiasis without obstruction of the bile ducts, an increase in LDH activity was not detected. With myocardial ischemia, there is an increase in the activity of the total fraction of LDH due to the phenomenon of stagnation of blood in the liver.

Alkaline phosphatase (AP) - the norm, the result in liver diseases Alkaline phosphatase is located in the cell membrane of the tubules of the bile ducts. These cells of the tubules of the bile ducts have outgrowths that form the so-called brush border. Alkaline phosphatase is located in this brush border. Therefore, when the bile ducts are damaged, alkaline phosphatase is released and enters the bloodstream. Normally, the activity of alkaline phosphatase in the blood varies depending on age and sex. So in healthy adults, the activity of alkaline phosphatase lies in the range of 30-90 U / l. The activity of this enzyme increases during periods of active growth - during pregnancy and in adolescents. Normal indicators of alkaline phosphatase activity in adolescents reach 400 U / l, and in pregnant women - up to 250 U / l.

In what pathologies of the liver is the content of With the development of obstructive jaundice, the activity of alkaline phosphatase in the blood serum increases by 10 or more times. Determination of ALP activity is used as a differential diagnostic test of obstructive jaundice. A less significant increase in the activity of alkaline phosphatase in the blood is also detected in hepatitis, cholangitis, ulcerative colitis, intestinal bacterial infections and thyrotoxicosis.

Glutamate dehydrogenase (GlDH) - the norm, the result in liver diseases Normally, glutamate dehydrogenase is present in the blood in small amounts, since it is a mitochondrial enzyme, that is, it is located intracellularly. The degree of increase in the activity of this enzyme reveals the depth of liver damage.

An increase in the concentration of glutamate dehydrogenase in the blood is a sign of the onset of dystrophic processes in the liver caused by endogenous or exogenous factors. Endogenous factors include liver tumors or liver metastases, and exogenous factors include toxins that damage the liver (heavy metals, antibiotics, etc.) and infectious diseases.

Schmidt coefficient Together with aminotransferases, the Schmidt coefficient (KSH) is calculated. KSh \u003d (AST + ALT) / GlDG. With obstructive jaundice, the Schmidt coefficient is 5-15, with acute hepatitis - more than 30, with metastases of tumor cells in the liver - about 10.

Sorbitol dehydrogenase (SDH) - the norm, the result in liver diseases Normally, sorbitol dehydrogenase is detected in the blood serum in trace amounts, and its activity does not exceed 0.4 U/l. The activity of sorbitol dehydrogenase increases 10-30 times in all forms of acute hepatitis. Sorbitol dehydrogenase is an organ-specific enzyme that reflects damage to hepatocyte membranes during the initial development of an acute process or during an exacerbation of a chronic one. γ-glutamyltransferase - norms, in which liver pathologies the content is increased This enzyme is found not only in the liver. The maximum activity of γ-glutamyltransferase is detected in the kidneys, pancreas, liver and prostate. In healthy people, the normal concentration of γ-glutamyltransferase in men is 250-1800 nmol / l * s, in women - 167-1100 nmol / s * l. In newborns, the activity of the enzyme is 5 times higher, and in premature babies it is 10 times higher.

The activity of γ-glutamyltransferase increases in diseases of the liver and biliary system, as well as in diabetes. The highest activity of the enzyme accompanies obstructive jaundice and cholestasis. The activity of γ-glutamyl transferase in these pathologies increases by 10 or more times. When the liver is involved in a malignant process, the activity of the enzyme increases by 10-15 times, in chronic hepatitis - by 7 times. γ-glutamyl transferase is very sensitive to alcohol, which is used for differential diagnosis between viral and alcoholic liver lesions.

Determination of the activity of this enzyme is the most sensitive screening test, which is preferable to the determination of the activity of aminotransferases (AST and ALT) or alkaline phosphatase.

Informative determination of the activity of γ-glutamyltransferase and liver diseases in children.

Fructose-monophosphate-aldolase (FMFA) - the norm, the result in liver diseases

It is normally found in trace amounts in the blood. Determination of FMFA activity is used to diagnose acute hepatitis. However, in most cases, the determination of the activity of this enzyme is used to identify occupational pathology in people who work with chemicals that are toxic to the liver.

In acute infectious hepatitis, the activity of fructose-monophosphate-aldolase increases tenfold, and when exposed to toxins in low concentrations (chronic poisoning with toxins) - only 2-3 times.

Enzyme activity in various pathologies of the liver and biliary tract The ratio of increases in the activity of various enzymes in some pathologies of the liver and biliary tract is presented in the table.

Note: - slight increase in enzyme activity, - moderate, - strong increase in enzyme activity, - no change in activity.

Read more about liver diseases in the articles: Hepatitis, Cholelithiasis, Cirrhosis of the liver So, we have reviewed the main enzymes, the determination of the activity of which can help in the early diagnosis or differential diagnosis of various liver diseases. Unfortunately, not all enzymes are used in clinical laboratory diagnostics, thereby reducing the range of pathologies that can be detected in the early stages. Given the pace of development of science and technology, it is possible that in the coming years, methods for determining certain enzymes will be introduced into the practice of medical and diagnostic institutions of a wide profile.

How is a biochemical blood test for the liver performed? This question is often asked by patients.
The liver performs a number of important functions in the human body. Due to its anatomical structure, it carries out a large number of biochemical reactions. In the liver, a process of synthesizing and secreting a large number of enzymes takes place, the activity of which can be used to draw a conclusion about the work of the whole organism.

1. There is an increased activity of enzymes, which is present in the blood.
2. In the blood, a decrease in the state of enzyme activity can be observed.
3. Liver enzymes cannot be detected in the blood in a laboratory analysis, that is, all indicators are normal.

Types of blood tests for enzymes

To diagnose liver disease, the patient needs to donate blood for this type of enzyme study:

1. Aminotransfers.
2. Lactate dehydrogenase.
3. Alkaline phosphatase.
4. Glutamate dehydrogenase.
5. Sorbitol dehydrogenase.
6. Y-glutamyltransferase.
7. Fructose monophosphate aldolase.

Enzymes can be located anywhere in an organ, for example, in the membrane, cytoplasm, or mitochondria of hepatocytes. But it is worth remembering that everyone has their own habitat. If there is a slight damage to the enzyme in the membrane or cytoplasm, then this case includes the appearance of indicators such as lactate dehydrogenase, aminotransferase and alkaline phosphatase.

In the chronic process of liver damage, their activity increases, which leads to the formation of mitochondria, that is, cell organelles. During cholestasis, there is a process of increasing the activity of bile enzymes, that is, alkaline phosphatase.

Before a patient takes a biochemical blood test for research, it is necessary to follow a number of clear rules before the procedure.

The blood sampling process itself lasts about 2 minutes, and it will not cause you any pain. To accurately determine the result of a laboratory test, the following rules must be followed:

1. A biochemical blood test for the liver is taken on an empty stomach.
2. During dinner before the day of blood donation, you can not drink coffee and tea, and 2 days before the date of the scheduled procedure, it is not recommended to eat fatty foods and drink alcoholic beverages.
3. On the eve of the test, it is not recommended to visit baths and saunas, try to avoid heavy loads.
4. A blood test should be taken in the early morning before the start of medical procedures.
5. As soon as you crossed the laboratory, then try to sit for 15 minutes before taking the analysis. This is necessary so that the body can return to normal and calm down.
6. In order for the analysis to obtain correct data on the content of sugar in the blood, the doctor must warn the patient that you can not brush your teeth, drink tea in the morning.
7. Try to refrain from drinking coffee in the morning.
8. Try to stop taking hormonal, antibiotics and diuretics, as well as other medications the day before.
9. 14 days before the biochemical blood test, you can not take drugs that help reduce the concentration of lipids in the blood.
10. If it happens that you are required to retake the test, then try to do it where you already took it.

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Indicators of liver enzymes in the blood

Aminotransfers. This indicator displays problems in the heart, kidneys and liver. Aminotransfer is considered a normal activity factor in the male population from 15 to 31 U / l, and in the female - 20-40 U / l. The activity of such enzymes is observed during the development of liver necrosis. If this indicator goes off scale, then this means that extensive damage to hepatocytes occurs. Increased activity is observed in infectious and acute toxic hepatitis. The ratio of this type of enzyme is usually called the de Ritis ratio. If such indicators are present in the liver, then this may indicate that the organ is significantly damaged.

Lactate dehydrogenase. This type of enzyme is very well distributed in the human body. It can be found in blood serum, mainly this indicator for serum is 5 isoforms. This indicator is contained in erythrocytes, and the normal indicator for this environment is from 140 to 350 U / l.
With acute hepatitis, a process of isoform activity occurs, and such an indicator can be easily seen in the first 10 days upon detection of this disease. If the patient suffers from cholelithiasis, then the activity of lactate dehydrogenase in the blood will practically not be visible.

Alkaline phosphatase. The level of such an indicator directly depends on the age, gender and condition of the patient. In healthy people, the level of this enzyme ranges from 30 to 90 U/l. But during pregnancy and adolescence, adolescents undergo a process of their increase. So, in adolescents, the level of alkaline phosphatase reaches up to 400 U / l, and in pregnant women - 250 U / l.

Glutamate dehydrogenase. Such an enzyme in the liver is contained in a minimal amount, and by its presence it is possible to determine the degree of disease of the organ. If there is an increase in the concentration of the enzyme, this may indicate that the process of organ dystrophy begins. One of these indicators is the Schmidt coefficient, it is calculated by the formula:

Schmidt coefficient = (Aminotransfers + Lactate dehydrogenase) / Glutamate dehydrogenase.

During the manifestation of jaundice, its rate is from 5 to 15 U / l, acute hepatitis - more than 30, with metastases - up to 10.

Sorbitol dehydrogenase. Normally, this indicator has a value of up to 0.4 U / l. If an increase in such an enzyme many times over is found, then this means the development of acute hepatitis.

Y-glutamyltransferase. In a healthy person, this indicator is equal to: in men - from 250 to 1800, and in women - 167-1100 nmol / s * l. In newly born children, this indicator exceeds the norm by 5 times, and in premature babies - by 10 times.

Fructose monophosphate aldolase. This indicator occurs in large quantities. Determination of its activity occurs during the diagnosis of acute hepatitis. Very often, this indicator is used to determine the pathology of people working with toxic and chemical substances. During the development of infectious hepatitis, this indicator increases tenfold, and during exposure to toxins, it decreases from 2 to 3 times.

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Thymol blood test for the liver

This type of diagnosis is a biochemical test that can be used to determine the ability of the liver to synthesize protein.

Basically, a large accumulation of proteins in the blood plasma can be found in the liver. With the help of them, the liver is able to perform a number of functions:

1. Protein is able to maintain the correct blood pressure, as well as its constant volume in the body.
2. He certainly takes part in blood clotting.
3. It is able to transfer cholesterol, bilirubin, as well as medicinal drugs - salicylates and penicillin to the tissues of the body.

A valid value is the result of the analysis from 0 to 5 units. In the process of developing an organ disease, this indicator can increase tenfold. In the very first moments of the development of the disease, it is necessary to do a blood test, this moment must also be taken into account in the icteric condition of the skin. With the development of hepatitis A, this figure increases significantly.

During the development of toxic hepatitis, the thymol test will be positive. This occurs due to the fact that the process of damage to the liver tissue occurs, and therefore there is a toxic effect of substances on the liver. With cirrhosis, the liver cells are replaced by connective tissue, the function of the entire organ and its protein-synthetic ability are impaired. At this point, the biochemical test is positive.

During obstructive jaundice, there is a violation of the outflow of bile. In this case, the thymol test shows a negative result. If during the development of the disease the liver tissue is affected, then such a test becomes positive.

The liver performs neutralizing, protein-synthetic and other functions. With her diseases, her activity changes. With the destruction of part of the hepatocytes (liver cells), the enzymes contained in them enter the bloodstream. All these processes are reflected in the biochemical study of the so-called liver tests.

Main functions of the liver

The liver is a vital organ. If its functions are violated, the whole organism suffers.

The liver performs vital functions, in particular:

• removes harmful substances from the blood;
• converts nutrients;
• preserves useful minerals and vitamins;
• regulates blood clotting;
• produces proteins, enzymes, bile;
• synthesizes factors to fight infection;
• removes bacteria from the blood;
• neutralizes toxins that have entered the body;
• maintains hormonal balance.

Liver disease can significantly undermine human health and even cause death. That is why it is necessary to consult a doctor in time and pass an analysis for liver tests when such signs appear:

• weakness;
• fast fatiguability;
• unexplained weight loss;
• icteric shade of the skin or sclera;
• swelling of the abdomen, legs and around the eyes;
• darkening of urine, discoloration of feces;
• nausea and vomiting;
• permanent liquid stool;
• heaviness or pain in the right hypochondrium.

Indications for research

Liver tests provide information about the condition of the liver. They are defined in the following cases:

• diagnosis of chronic diseases, such as hepatitis C or B;
• monitoring for possible side effects of certain medications, particularly antibiotics;
• monitoring the effectiveness of therapy for already diagnosed liver disease;
• determination of the degree of cirrhosis of this organ;
• the patient has heaviness in the right hypochondrium, weakness, nausea, bleeding and other symptoms of liver pathology;
• the need for surgical treatment for any reason, as well as pregnancy planning.

Many studies are used to evaluate liver function, but most of them are aimed at determining any one function, and the results do not reflect the activity of the entire organ. That is why the following liver tests have received the greatest use in practice:

• alanine aminotransferase (ALT or ALT);
• aspartate aminotransferase (AST or AST);
• albumen;
• bilirubin.

The level of ALT and AST increases when the liver cells are damaged as a result of the disease of this organ. Albumin reflects how well the liver synthesizes protein. The level of bilirubin shows whether the liver copes with the function of detoxifying (neutralizing) toxic metabolic products and removing them with bile into the intestines.

Changes in liver tests do not always mean that the patient has a disease of this organ. Only a doctor can evaluate the result of the analysis, taking into account complaints, anamnesis, examination data and other diagnostic tests.

Most common liver tests

ALT and AST are the most important indicators that allow, in combination with the patient's complaints and data from other research methods, to evaluate the work of the liver.

Liver tests are the determination of specific proteins or enzymes in the blood. A deviation from the norm of these indicators may be a sign of liver disease.

ALT

This enzyme is found inside hepatocytes. It is necessary for protein metabolism, and when cells are damaged, it enters the bloodstream. Its increase is one of the most specific signs of the breakdown of liver cells. However, due to the peculiarities of the laboratory determination, its concentration does not increase with all pathology. So, in persons with alcoholism, the activity of this enzyme is reduced, and the analysis yields false normal values.

AST

In addition to hepatocytes, this enzyme is present in the cells of the heart and muscles, so its isolated determination does not provide information about the state of the liver. Most often, not only the level of AST is determined, but also the ratio of ALT / AST. The latter indicator more accurately reflects damage to hepatocytes.

Alkaline phosphatase

This enzyme is found in the cells of the liver, bile ducts and bones. Therefore, its increase may indicate damage not only to hepatocytes, but also to blockage of the bile ducts or, for example, a fracture or bone tumor. It also rises during the period of intensive growth in children; an increase in the concentration of alkaline phosphatase is also possible during pregnancy.

Albumen

It is the main protein synthesized by the liver. It has many important features, such as:

• keeps fluid inside blood vessels;
• nourishes tissues and cells;
• transports hormones and other substances throughout the body.

A low level of albumin indicates an impaired protein-synthetic function of the liver.

Bilirubin

The concept of "total bilirubin" includes the sum of indirect (non-conjugated) and direct (conjugated) bilirubin. During the physiological breakdown of red blood cells, the hemoglobin contained in them is metabolized with the formation of indirect bilirubin. It enters the liver cells and is neutralized there. In hepatocytes, indirect bilirubin is converted into harmless direct bilirubin, which is excreted in the bile into the intestine.

An increase in indirect bilirubin in the blood indicates either an increased breakdown of red blood cells (for example, with hemolytic anemia), or a violation of the neutralizing function of the liver. An increase in the content of direct bilirubin is a sign of impaired patency of the biliary tract, for example, gallstone disease, when part of this substance does not come out with bile, but is absorbed into the blood.

Execution of the study

If necessary, the doctor gives special instructions about which drugs should be stopped before taking a blood test. It is usually recommended not to take fatty and fried foods for 2-3 days, if possible, refuse to take medication.

Blood sampling is carried out in the treatment room from the cubital vein in the usual way.

Complications are rare. After taking a blood sample, you may experience:

• hemorrhage under the skin at the site of the vein puncture;
• prolonged bleeding;
• fainting;
• infection of the vein with the development of phlebitis.

After taking blood, you can lead a normal life. If the patient feels dizzy, it is better for him to rest a little before leaving the clinic. The test results are usually ready the next day. According to these data, the doctor will not be able to say exactly what kind of liver disease is present, but he will draw up a further diagnostic plan.

Evaluation of results

In the form of a blood test, the concepts of "general", "indirect", "direct bilirubin" may appear. Deviation from the norm of any of the indicators is a sign of some pathological process in the liver or the body as a whole.

The normal content of the studied parameters may differ in different laboratories and is noted on the result form. However, there are guidelines.

• ALT: 0.1-0.68 µmol/L or 1.7-11.3 IU/L.
• AST: 0.1-0.45 µmol/l or 1.7-7.5 IU/l.

The reasons for the increase in the level of both enzymes:

• acute or chronic hepatitis, cirrhosis, fatty degeneration of the liver;
• inflammation of the bile ducts;
• obstructive jaundice (for example, with cholelithiasis);
• cancer or toxic damage to this organ;
• acute fatty degeneration in pregnant women;
• severe burns;
• hemolytic anemia;
• Infectious mononucleosis;
• side effects of anticoagulants, anesthetics, oral contraceptives;
• muscle injury, dermatomyositis, myocardial infarction, myocarditis, myopathies.

Causes of an increase in ALT with a normal or slightly elevated level of AST:

• infarction of the lung or mesentery;
• acute pancreatitis;
• the action of chloroform, carbon tetrachloride, vitamin C, dopegyt, salicylates and the poison of the pale toadstool.

The ratio AST / ALT is called the de Ritis coefficient, it is equal to 1.33. With liver pathology, it decreases, with diseases of the heart and muscles it increases by more than 1.

Alkaline phosphatase: 0.01-0.022 IU/l.

Reasons for the increase:

• hepatitis, cirrhosis, liver cancer;
• cholangitis;
• neoplasm of the gallbladder;
• liver abscess;
• primary biliary cirrhosis;
• metastatic liver disease;
• bone fractures;
• hyperparathyroidism;
• Cushing's syndrome;
• Ewing's sarcoma;
• tumor and metastatic lesions of bones;
• ulcerative colitis;
• microbial intestinal infections, such as dysentery;
• thyrotoxicosis;
• the effect of drugs for anesthesia, albumin, barbiturates, dopegyt, NSAIDs, nicotinic acid, methyltestosterone, methylthiouracil, papaverine, sulfonamides.

Albumin: the norm in serum is 35-50 g / l.

Reasons for the decline:

• starvation and other causes of protein malabsorption in the body;
• acute and chronic hepatitis, cirrhosis;
• malignant tumors;
• severe infectious diseases;
• pancreatitis;
• diseases of the kidneys, intestines, skin (burns);
• cystic fibrosis;
• a significant increase in the activity of the thyroid gland;
• Itsenko-Cushing's disease.

Bilirubin: total 8.5-20.5 µmol/l, direct 2.2-5.1 µmol/l.

Causes of an increase in the level of total bilirubin:

• hepatitis, cirrhosis, liver tumors;
• hemolytic anemia;
• fructose intolerance;
• Crigler-Najjar or Dubin-Johnson syndrome;
• Gilbert's disease;
• neonatal jaundice.

Causes of an increase in direct bilirubin in the blood:

• jaundice of mechanical origin;
• various hepatitis;
• cholestasis;
• the action of androgens, mercazolil, penicillin, aminoglycosides, sulfonamides, oral contraceptives and nicotinic acid;
• Dubin-Johnson or Rotor syndrome;
• decreased activity of the thyroid gland in newborns;
• abscess in the liver tissue;
• leptospirosis;
• inflammation of the pancreas;
• liver dystrophy in pregnant women;
• intoxication with the poison of the pale toadstool.

Causes of an increase in indirect bilirubin in the blood:

• anemia of hemolytic origin;
• prolonged compression syndrome;
• Crigler-Najjar syndrome, Gilbert's disease;
• erythroblastosis;
• galactosemia and fructose intolerance;
• paroxysmal hemoglobinuria;
• Botkin's disease (hepatitis A);
• leptospirosis;
• thrombosis of the veins of the spleen;
• the action of benzene, vitamin K, dopegyt, anesthetics, NSAIDs, nicotinic acid, tetracycline, sulfonamides, fly agaric poison.

Biochemical syndromes

Changes in liver tests are possible with various pathologies. To highlight liver damage, doctors use the appropriate biochemical syndromes:

• cytolytic (decay of hepatocytes);
• inflammatory (inflammation, including autoimmune nature);
• cholestatic (stagnation of bile).

The cytolytic variant of the lesion is expected with an increase in ALT and AST. To confirm it, additional tests are used for the content of fructose-1-phosphate aldolase, sorbitol dehydrogenase, ornithylcarbamoyltransferase, succinate dehydrogenase.

The concentration of ALT and AST can determine the activity of hepatitis and cirrhosis:

If an autoimmune process is suspected, signs of a mesenchymal-inflammatory lesion are determined:

• an increase in thymol test more than 7 at. e.;
• decrease in sublimate test less than 1.6 at. e.;
• an increase in gamma globulins above 18 g / l or 22.5%.

In case of liver pathology without an autoimmune component, these samples may not change.

Cholestatic syndrome is associated with damage to the walls of the bile ducts. It can be suspected with an increase in the amount of alkaline phosphatase and bilirubin. For diagnostics, additional indicators are used:

• gamma-glutamyl transpeptidase (normal 0-49 IU / l);
• total cholesterol (normal 3.3-5.2 µmol / l);
• LDL cholesterol (normal 1.73-3.5 µmol/l);
• VLDL cholesterol (normal 0.1-0.5 µmol/l).

Interpreting a biochemical blood test can be difficult even for an experienced doctor. That is why self-diagnosis based on the results of liver tests is not recommended. You should contact a gastroenterologist and undergo additional diagnostics of the liver condition (ultrasound, CT, MRI, blood and urine tests, hepatitis markers and other studies).

A specialist at the Moscow Doctor clinic talks about AlAT and AsAT:

ALT and AST in a biochemical blood test

The liver is an important organ, on the work of which the general condition of a person depends, since it is involved in all types of metabolism and performs many different functions. It produces a number of enzymes, which are commonly called enzymes.

They take an important part in the biochemical processes that take place in the body.

What are liver enzymes?

Since the organ performs many different functions, enzymes are divided into several groups:

To diagnose problems in the functioning of the hepatobiliary system, in most cases they are guided by the indicators of AST, ALT, GGT, LDH and the alkaline phase. First of all, it is important to do a biochemical analysis for women who are in a position to monitor their own health and the condition of the fetus in order to quickly determine possible pathologies.

Metabolic processes in the body proceed thanks to enzymes, most of which can be broken down. Some of them are excreted along with bile.

Various laboratory studies make it possible to determine different types of liver enzymes in the blood.

They are assigned in such cases:

• The occurrence of symptoms of diseases of the organ, for example, pain or heaviness on the right side under the ribs, yellowing of the skin, fever and nausea;
• Monitoring the course of existing diseases, for example, regularly need to take samples for hepatitis A, B and C, and also for stagnation of bile;
• With prolonged use of drugs that can damage the organ;
• Abuse of alcoholic beverages.

To diagnose diseases, the ratio of AST (norm - 10-30 U / l) and ALT (norm - 10-40 U / l) is used. So, the first enzyme is in the myocardium, musculature of the skeleton and kidneys, but the second one is only in the liver.

There are several options for the ratio of ALT and AST:

• If the indicator is 1, then this means the presence of acute hepatitis;
• More than 2, then a person is diagnosed with an alcoholic disease;
• When AST is greater than ALT, then we can talk about the presence of cirrhosis.

An increase in the activity of these liver enzymes in the blood indicates that a person has hepatocyte necrosis, obstructive jaundice and fatty degeneration. If activity, on the contrary, is reduced, then this indicates extensive necrosis and cirrhosis.

It is also worth mentioning that AST and ALT levels increase with prolonged use of anticoagulants, barbiturates, hormonal contraceptives, vitamin C, morphine and other drugs. A decrease is observed during pregnancy.

In addition to the main enzymes AST and ALT, others are also detected:

• GGT - the norm is up to 40 U / l. This type of enzyme is found not only in the liver, but also in the kidneys, pancreas and the walls of the bile ducts. This indicator is most sensitive in pregnant women and in children. An increase in GGT is observed if a person has hepatitis, cirrhosis, a tumor, alcohol intoxication, cholangitis, and obstructive jaundice. Activity drops with cirrhosis. It is worth saying that GGT is highly sensitive to toxic substances;
• ALP - the indicator is normal up to 270 U / l. There are such enzymes not only in the liver. So, they contain bone tissue, walls of the bile ducts and kidneys. Do this analysis if there are violations in the hepatobiliary system. ALP increases with cholestasis, hepatitis, biliary cirrhosis and obstructive jaundice. When using glucocorticosteroids, the indicator decreases;
• LDH - the indicator is normal up to 250 U / l. There are they in the liver, and also contains their myocardium, erythrocytes and skeletal muscles. The indicators increase if acute hepatitis, obstructive jaundice, tumors, pregnancy and with increased physical exertion are detected.

What to do if liver enzymes in the blood are elevated?

The liver performs many different functions that remove toxins from the body, but at the same time it is subjected to great stress, which brings significant harm. Increased enzyme levels are a symptom of severe stress on the liver.

To reduce it, sometimes it is enough to make changes to your diet:

If an increase in enzyme levels is the result of inflammation or damage, then in order to reduce them, it is necessary to correctly determine the cause that provokes this condition and carry out appropriate treatment.

How to Lower Enzyme Levels

In folk medicine, in order to make the blood cleaner, reduce the activity of enzymes and improve liver function, it is recommended to drink herbal preparations, the dosage of which should be determined by the doctor.

Useful plants are:

1. Milk thistle. It is recommended for diseases that arise due to alcohol abuse, hepatitis and cirrhosis. The permitted amount is no more than 480 mg per day;
2. Astragalus. Drink tincture 3-4 times a day, and the dosage is 200-500 mg;
3. Dandelion roots. To reduce the activity of enzymes, the amount of bad cholesterol and the load on the liver, you need to drink 2-4 tablespoons per day. tinctures, for which 2-4 g of raw materials are taken;
4. Fees. Pharmacies sell various collections that can purify the blood and improve the functioning of the body. There are combinations designed for detox and regeneration, and these should include dandelion root or thistle.

If the liver does not cope with its work and increased activity of enzymes is found, then it is recommended to take nutritional supplements with antioxidants, which are recommended to be selected together with a doctor.

Useful is alpha-lipoic acid, which is important for the metabolism of sugar, and it also reduces the risk of developing alcoholic hepatosis.

Usually prescribed 100 mg 3 times a day. N-acetylcysteine ​​is important for the production of the main antioxidant in the human body.

In most cases, 200-250 mg is prescribed 2 times a day. Rarely, but still, there are cases that acetylcysteine ​​increases the level of enzymes.

Now you know that you need to donate blood regularly to check the level of enzyme activity. Be aware of the rules of nutrition and other recommendations that will help normalize the level of enzymes.

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Reasons for the increase

• cirrhosis;
• fatty hepatosis of the liver;
• myocardial infarction;
• heart failure.

• loss of appetite;
• itching of the skin;
• yellowness of the sclera and skin;

Indicators during pregnancy

Hepatic transaminases - what is it? Causes of increased enzyme levels

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

The role of hepatic transaminases in the human body

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

The very name "transaminase" has long been outdated, and "aminotransferase" has come to replace it. But nevertheless, in practice, the outdated term is more firmly rooted and more actively used by physicians than keeping up with the times.

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

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

Causes of increased levels of hepatic transaminases

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

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

ALT and AST levels in the blood

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

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

De Ritis coefficient

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

where k is the coefficient. de Ritis;

Numerous studies have shown that the formula can serve as a significant element of diagnostics, but only if the values ​​of its constituent markers exceed the limits of the norm:

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

How to lower ALT and AST levels?

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

Vigilance and attention to the state of one's own health is an important component of a happy and long life. At the first symptoms and suspicions, consult a specialist. Let the suspicion turn out to be unconfirmed, and the time spent, but you will be sure that order and stability reign in your body.

Who said that curing the liver is hard?

• You are tormented by a feeling of heaviness and a dull pain in your right side.
• A bad breath will not add confidence.
• And somehow it's a shame if your liver still causes digestive problems.
• In addition, the medicines recommended by doctors for some reason are ineffective in your case.

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What does elevated liver enzymes mean?

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

Liver health affects the general condition of a person, his appearance and even the psyche. In everyday life, this organ is subject to serious stresses that harm it even before any symptoms appear. Elevated liver enzymes just indicate the presence of an excessive load on this biochemical laboratory of the human body.

Reasons for the increase

A slight increase in the level of liver enzymes in the blood is a fairly common phenomenon. This may be the result of medication or the accumulation of toxins. After all, the liver reacts to the state of the environment and to low-quality products, and to water. If discomfort is felt in the right hypochondrium, it is worth going for a consultation with a doctor in order to identify the causes. The results of liver enzyme tests will help specialists identify possible diseases. Increased activity of liver enzymes may indicate serious diseases, such as hepatitis.

Many diseases can affect the increase in liver enzymes. After studying and analyzing the symptoms and signs that accompany the increased level of enzymes taken by drugs, the specialist will be able to identify the cause of this.

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

Of course, the most common causes are certain diseases. Among them are hepatitis A, B and C, and heart failure, cirrhosis and liver cancer, mononucleosis and inflammation of the gallbladder, pancreatitis and hypothyroidism, and many others.

Identification of the content of liver enzymes in the blood

The fact that liver enzymes are elevated is most often detected during a preventive blood test. In many cases, this is a temporary minor increase that does not signal serious problems. In addition, it should be remembered that the norm may differ slightly from person to person and depends on gender, height and weight.

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

The most common increase in blood enzymes is alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

Alanine aminotransferase is an enzyme that promotes the production of alanine, which is necessary for the formation of proteins in the body. ALT is present in trace amounts in most cells of the body. In the case of liver damage, its level is greatly increased. It can be used to determine the activity of the inflammatory process in the liver.

Aspartate aminotransferase is involved in amino acid metabolism. The enzyme is present in the nervous tissue, skeletal muscles, in the tissues of the heart and kidneys. AST is most active in the liver, and the presence of hepatitis C is diagnosed by its level.

When diagnosing diseases and assessing the level of elevated liver enzymes, not only the indicators of each of them are important, but also the ratio of ALT and AST activity.

With viral damage to the liver or with excessive death of red blood cells, bilirubin may increase, which is accompanied by yellowing of the skin and eye sclera.

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

Treating elevated enzyme levels

Since an increase in the level of liver enzymes is the result of its inflammation or damage, the doctor first of all tries to find the cause of this condition, which must be eliminated. That is, the treatment is not aimed at reducing the level of enzymes in the blood as such, but at eliminating the disease that caused such a reaction in the body.

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

In addition to drugs that treat the disease directly, hepatoprotectors are also prescribed. These drugs repair already damaged liver cells and protect them from further damage. In addition, they facilitate the work of this body, helping to perform some of its functions. But do not forget that any drugs should be prescribed by a specialist. It is not uncommon for cases when self-treatment and taking drugs to cleanse the liver lead to opposite consequences.

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

To restore liver function, you just need ...

ALT ratio. AST = 1 (alanine aminotransferase level greater than or equal to aspartate aminotransferase) indicates acute hepatitis. If ALT. AST higher than 2.1, then this ratio indicates an alcoholic disease. AST ratio. An ALT greater than 1 (AST greater than ALT) indicates cirrhosis.

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

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

What other liver tests are there?

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

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

Dynamics of ALT, AST, GGT, alkaline phosphatase depending on age

Decreased GGT activity - in decompensated cirrhosis. GGT is a highly sensitive indicator, especially for toxic effects. If you do an analysis and the levels of aminotransferases are normal, then the GGT indicators will be increased.

The norm of alkaline phosphatase is up to 270 U / l. It is also found in bone tissue, the walls of the bile ducts, and the kidneys. An analysis is made in violation of the functions of the hepatobiliary system.

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

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

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

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

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

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

Liver enzymes (enzymes) maintain constancy in the body, acting in a way that is invisible to humans. With the development of pathological conditions, the level of liver enzymes changes up or down, which is an important sign and is used in differential diagnosis.

Enzyme groups

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

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

These are microsomal liver enzymes, the level of which is controlled by a biochemical blood test. AST is an endogenous enzyme produced inside hepatocytes. It is also synthesized by cells of other organs, but in smaller quantities (heart, brain, kidneys, intestinal tract). A change in the level of the enzyme in the blood indicates the development of the disease, even if there are no visible symptoms yet.

ALT is produced by the cells of the liver, heart muscle, kidneys (a small amount). It is determined by a blood test in parallel with the first enzyme. An important diagnostic point is the clarification of the ratio of ALT and AST.

Reasons for the increase

An increase in liver enzymes can be insignificant, arising from the intake of a number of drugs or the accumulation of toxic substances in the body, or pronounced, appearing with the development of diseases.

Enzymes can increase with long-term treatment with painkillers, statins (drugs that are used to remove "bad" cholesterol from the body), sulfonamides, Paracetamol. Provoking factors may be the intake of alcoholic beverages and the abuse of fatty foods. This includes long-term use of herbal medicine (ephedra, skullcap and hay grass can increase the level of liver enzymes in a blood sample).

If the blood test for liver enzymes is elevated, this indicates the following pathological conditions:

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

Signs of elevated enzyme levels

Such manifestations may not have visual symptoms or be accompanied by a number of complaints from the patient:

• decreased performance, constant fatigue;
• abdominal pain syndrome;
• loss of appetite;
• itching of the skin;
• yellowness of the sclera and skin;
• frequent bruising, nosebleeds.

Excretory and secretory enzymes

A blood test for enzymes involves not only an assessment of the level of the well-known ALT and AST, but also other enzymes. Alkaline phosphatase, GGT have an important diagnostic value. The level of these enzymes goes beyond the normal range in pathologies of the biliary system, for example, in cholelithiasis, tumor processes.

Together with these enzymes, the rate of bilirubin, which is a bile pigment, is evaluated. Clarification of its numbers is important for cholecystitis, cholelithiasis, cirrhosis, giardia, vitamin B12 deficiency, poisoning with alcohol, toxic substances.

Indicators during pregnancy

During the period of bearing a child, a number of changes occur in a woman's body. Her organs and systems begin to work for two, which is reflected not only in the general condition, but also in laboratory parameters.

The level of ALT and AST during pregnancy is up to 31 U / l. If toxicosis develops at 28-32 weeks of gestation, the numbers increase. The first two trimesters may be accompanied by a slight overshoot, which is not considered a problem, since the load on the liver during this period becomes maximum.

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

The norm of alkaline phosphatase is up to 150 U / l. Active growth of the fetus from the 20th week until the moment of delivery causes an increase in the numbers of the enzyme. The level of alkaline phosphatase changes against the background of taking large doses of ascorbic acid, antibacterial drugs, with calcium and phosphorus deficiency.

Permissible indicators of the main important enzymes are indicated in the table.

Patient management

When determining elevated liver enzymes, the doctor prescribes a number of additional examinations to clarify the patient's condition. Immediately, the specialist recommends that the patient begin treatment with a correction of the diet. The goal is to reduce the load on the liver, reduce the level of fatty deposits in it, remove toxins and toxins.

It is important to increase the amount of vegetables in the body. Spinach, kale, greens, lettuce, dandelion greens are considered especially useful. You also need to increase the amount of foods consumed, which include antioxidants (avocados, nuts).

The daily menu should contain at least 50 g of dietary fiber, in particular fiber. Such substances cleanse the body of "bad" cholesterol and contribute to the normalization of the biliary system. Fiber rich foods:

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

Treatment includes the intake of a sufficient amount of protein, because it is protein substances that are considered the necessary basis for the restoration of damaged hepatocytes. However, how much it should be present in the daily diet, the doctor will tell you. It is important not to consume too much, so as not to overload the liver's protein processing mechanism.

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

Taking herbs and supplements

Phytotherapy favorably affects the state of the liver and reduces the pathological parameters of enzymes. Treatment consists in the use of teas based on herbal ingredients. It is important to consult with your doctor about the possibility of such events.

Useful herbal ingredients:

In food, you need to add turmeric, which reduces the manifestations of inflammatory processes, and garlic, which has an antitumor effect. With the permission of a doctor, you can use nutritional supplements rich in antioxidants.

Treatment of diseases

If during the diagnosis a pathological process is detected, which was the reason for the increase in liver enzymes, it must be treated. A qualified specialist will select a therapy regimen for the patient according to a specific clinical case.

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

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

This organ produces several types of enzymes:

The concentration of enzymes in the blood changes if:

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

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

A blood test for liver disease helps physicians narrow the range of pathologies, if necessary, refer the patient for additional examination, and make a diagnosis. The method shows at what concentration in the blood serum there are enzymes of each of the 3 groups:

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

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

Physicians, conducting a liver examination, take into account the indicators of ALT and AST. Norm of the first:

In hepatitis, the concentration of ALT increases sharply before the onset of symptoms. Therefore, timely examination allows you to quickly start treatment.

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

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

Normal GGT values ​​are up to 38 U/l (in women) and up to 55 U/l (in men). An increase in concentration of more than 10 times is observed in diabetes and diseases of the biliary tract. Norm GdG - up to 3 U / l (in women) and up to 4 U / l (in men). The concentration increases with severe poisoning, oncology, infectious processes. Norm LDH - 140-350 U / l.

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

Bad blood tests are no reason to panic. After making a diagnosis, the doctor prescribes treatment, taking into account the characteristics of the course of the disease and the patient's body. One of the drugs that are prescribed to normalize enzymes is Galstena. You can not self-medicate by taking medicine without consulting a qualified specialist. Folk remedies are used on the recommendation of the attending physician.

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

With hepatitis, the patient may not have jaundice, the level of bilirubin is normal, but the concentration of transferases is increased. This may indicate the following pathologies:

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

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

Indications DR (de Ritis ratio) help in the diagnosis of the following pathologies:

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

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

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

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

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

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

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

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

In addition to drug treatment, patients are advised to adjust their diet:

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

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

In an advanced state, the disease can lead to death. Having found the symptoms of cirrhosis, you can not self-medicate. It is recommended to seek help from a doctor, pass the necessary tests for liver cancer. This condition is dangerous during pregnancy. During this period, the patient should be under constant medical supervision (examination of the liver). If necessary, the expectant mother will need to lie down for preservation or a medical abortion is performed.

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The liver acts as a protective filter in the human body. With the help of this organ, all cells and tissues are cleansed of harmful and toxic substances. The liver helps to cleanse the body of its enzymes or enzymes that are contained inside the parenchymal organ. When an organ disease occurs, substances are released from it and enter the blood in large quantities. According to the analysis of enzymes, one can judge the disease occurring in the human body.

Liver enzymes play an important role in the human body - they are needed for the metabolic process (digestion of nutrients, blood clotting function). If a blood test reveals an increase or decrease in certain enzymes, this is the first sign that a pathological process is taking place in the body, or the parenchymal organ is damaged. Liver enzymes are divided into 3 groups:

1. indicator- these include enzymes such as alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase. These substances are found inside the liver cells. When an organ is damaged, enzymes are released from the cells and enter the blood in large quantities;
2. Secretory- Enzymes cholinesterase and prothrombinase belong to this group. These substances are needed for the process of blood clotting, and if this function of the body is disturbed, enzymes decrease;
3. excretory- this group of enzymes includes such an enzyme as alkaline phosphatase. This substance is synthesized and excreted along with bile. In violation of the outflow of bile, the level of alkaline phosphatase significantly exceeds the norm.

Why enzymes can be elevated

Elevated levels of liver enzymes may indicate certain pathologies in the human body. A slight increase in enzymes in the blood is observed with the use of any medications (sulfonamides painkillers), the accumulation of toxic substances (excessive consumption of alcohol and heavy food). A pronounced excess of the norm of enzymes almost always indicates the development of diseases:

• liver hepatosis (fatty);
• viral hepatitis;
• malignant and benign tumors;
• cirrhosis of the liver;
• heart failure;
• infectious myocarditis;
• infarction of the heart muscle (myocardium);

AST, ALT, and alkaline phosphatase levels may increase in women during pregnancy. While waiting for the baby, the female body works with a double load, especially for the liver. A slight excess of these enzymes in the blood does not pose a clear threat, however, if the level of enzymes is much elevated, this may indicate the development of gestational diabetes mellitus, inflammation of the bile ducts.

What tests need to be done

The most common analysis to determine the presence of the disease is blood biochemistry. It is prescribed for suspicion of any pathology in the human body, as well as for prevention. The doctor pays attention to the levels of AST and ALT in the human blood and to the level of alkaline phosphatase. These enzymes are measured in U/L (international unit per litre).

In the male and female half of the population, the indicators of enzymes differ slightly:

1. For men, 10 to 40 U/l ALT and 15 to 30 U/l AST are considered normal.
2. For women, the ALT norm is from 12 to 32 U / l and from 20 to 40 U / l AST.
3. With an increase in AST levels, damage to the liver cells (mechanical or necrotic) is considered.
4. An elevated ALT level indicates the development of an infectious process in the body.

Enzymes such as glutamate dehydrogenase and lactate dehydrogenase are also considered important indicators of liver enzymes. GDH in women should not exceed 3 U / l, and in men 4 U / l. The level of LDH is normal - 140-350 U / l. A significant excess of these enzymes indicates the development of infectious processes, oncological neoplasms, intoxication with toxic substances and degeneration of the parenchymal organ (liver).

A very important indicator in a biochemical blood test is the level of alkaline phosphatase. For the male population, this substance should not exceed 120 U / l; in women, alkaline phosphatase should be less than 90 U / l. If this enzyme is exceeded by 3-4 times the norm, this indicates problems with the outflow of bile (inflammatory process of the bile ducts, gallstones, etc.).

The ratio of AST and ALT

In a biochemical blood test, the AST and ALT indicator is always taken into account, the deviations of these enzymes make it possible to clarify the violations occurring in a particular organ:

• AST is present in all tissues of the human body, but the heart muscle (myocardium) contains the most of this enzyme. That is why the excess of this substance indicates diseases of the heart.
• The ALT enzyme is found in the highest quantities only in the liver, so a significant excess of its norm indicates a violation of the work of this parenchymal organ.

The ratio of AST and ALT in the medical language is called the de Ritis coefficient, therefore, with a biochemical blood test, it is possible to determine which organ is affected. With problems with the heart, the level of AST increases up to 8-10 times more than normal, while ALT increases by only 1.5-2 times more. With such indicators, the patient is diagnosed with a heart muscle infarction.

In liver diseases, such as hepatitis, the picture is reversed:

• ALT rises up to 8-10 times, and AST only up to 2-4 times.
• In most cases, the de Ritis coefficient has a lower figure, since the ALT enzyme increases in values ​​more often than AST.
• But in some diseases (alcoholic hepatitis, cirrhosis of the liver, damage to muscle tissue), it is the level of AST that rises, which makes it possible to differentiate one pathology from another.

In a healthy person, the de Ritis coefficient does not exceed 0.91-1.75. If the coefficient exceeded the permissible norm, a person is diagnosed with problems with cardiac activity. With a heart muscle infarction, the de Ritis coefficient (the ratio of AST to ALT) will be more than 2. If the coefficient is below the norm, the patient is diagnosed with a violation of the liver (for example, with hepatitis A or B, the ratio of AST to ALT will be from 0.55 to 0.83) .

Any person, even considering himself absolutely healthy, needs to regularly take a biochemical blood test for liver enzymes. The parenchymal organ does not have nerve endings, so very often the liver may not get sick and not bother a person for a long time. Only a blood test for liver enzymes is able to detect the presence of serious diseases, which will allow the patient to begin the earliest possible and effective treatment of the pathology.

You can also, by watching this video, find out which three tests you need to take in order to prevent many liver diseases in time.