Does elevated transaminase necessarily mean hepatitis?

July 28, 2024 is the 14th "World Hepatitis Day". This year, my country's publicity theme is "Eliminate Hepatitis, Take Positive Action".

Hepatitis is a general term for liver inflammation. It usually refers to the destruction of liver cells and liver function caused by a variety of pathogenic factors, such as viruses, bacteria, parasites, chemical poisons, drugs, alcohol, autoimmune factors, etc., which causes a series of physical discomfort symptoms and abnormal liver function indicators.

The hepatitis we refer to in our daily lives mostly refers to viral hepatitis caused by viruses, which is contagious to a certain extent.

Viral hepatitis can be divided into five types: hepatitis A, B, C, D and E.

According to the goal of "eliminating viral hepatitis as a public health threat by 2030" proposed by the World Health Organization (WHO), by then the new infection rate of chronic hepatitis B (CHB) will be reduced by 90%, the mortality rate will be reduced by 65%, the diagnosis rate will reach 90%, and the treatment rate will reach 80%.

Why is liver function a must-check item in physical examination?

The liver is the largest solid organ in the abdominal cavity. It has powerful functions and is responsible for four major physiological functions:

Important detoxification organ

The center of human metabolism

Secretion of bile,

Storage regulates blood.

The liver has strong compensatory properties and is a "dumb" organ. Liver damage and disease often cause no pain and no particularly obvious symptoms. Therefore, many liver diseases are discovered in the late stages.

Transaminase is a common indicator of liver function. Increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are mainly seen in acute and chronic hepatitis, toxic hepatitis, fatty liver, cholelithiasis, etc.

Therefore, in order to detect liver abnormalities and lesions early, especially to prevent liver disease from progressing to cirrhosis and liver cancer, liver function is a must-check item in physical examinations .

Does elevated transaminase necessarily mean infectious hepatitis?

Answer: An elevated transaminase level does not necessarily mean that you have infectious hepatitis.

It may be a physiological increase in alanine aminotransferase.

If the transaminase level is slightly higher than 50-70u/L, you need to rule out fatty liver and see if the color Doppler ultrasound shows any abnormalities. You cannot rely solely on a transaminase index to determine whether you have fatty liver or hepatitis.

If you exercise vigorously, stay up late, do not get enough rest, are overworked, drink alcohol, eat too greasy food, or do not fast for 4-8 hours before the liver function test, these physiological reasons will cause an increase in alanine aminotransferase.

Most of these physiological increases in alanine aminotransferase are mild increases and need to be rechecked after the cause is eliminated. If it returns to normal, there is no need to panic!

However, if alanine aminotransferase continues to increase to >2 times the normal value, this may be pathological and you need to carefully look for other causes.

Causes of elevated transaminases include :

1. Viral hepatitis;

2. Non-viral hepatitis mainly includes alcoholic liver disease, metabolism-related fatty liver disease, autoimmune hepatitis and drug-induced liver damage.

Among the many causes that can cause elevated transaminase levels, only viral hepatitis is contagious .

If the physical examination reveals elevated transaminase, screening for hepatitis B five items, hepatitis C antibodies, abdominal ultrasound, autoimmune-related antibodies, etc. is recommended.

If the HBsAg test is positive, further HBV-DNA test is required. Adherence to antiviral treatment can reduce the risk of developing cirrhosis and liver cancer.

If the hepatitis C antibody is positive, further testing for HCV-RNA is required.

In case of acute liver injury, testing for hepatitis A antibodies and hepatitis E antibodies may be considered.

Acute attacks of biliary diseases , cholecystitis, and cholelithiasis often cause fever, abdominal pain, nausea, vomiting, jaundice, and elevated blood bilirubin and alanine aminotransferase, especially during attacks of common bile duct stones.

The high-risk groups for liver cancer in my country mainly include:

People with HBV and/or HCV infection, long-term alcoholism, NASH, consumption of food contaminated with aflatoxin, cirrhosis caused by various reasons, and a family history of liver cancer, especially men aged >40, are at greater risk.

How to protect the liver?

1. Improve bad living habits .

Pay attention to food hygiene, eat a balanced diet, control your weight, quit smoking and drinking, maintain a regular work and rest schedule, and have a good attitude.

For those who often eat out, to prevent hepatitis from entering the body through the mouth, it is necessary to prevent hepatitis A and hepatitis E, which are mainly transmitted through the fecal-oral route. Viral hepatitis is very harmful. If you often travel on business or eat out, you should pay attention to food hygiene, do not drink unclean water, and try not to eat raw or undercooked seafood and meat, etc., to avoid diseases from entering the body through the mouth;

2. Take precautions.

Vaccination against hepatitis B is the most effective, safe and economical way to prevent hepatitis B.

Instruments used for haircuts, shaving, pedicures, piercings and tattoos should be strictly disinfected, and injection needles should not be shared to prevent infection with hepatitis B and hepatitis C.

High-risk groups should receive timely hepatitis A and E vaccines;

3. Don’t take medicine randomly.

When taking medication, you must understand the indications and correct usage and dosage of the medication, and try to avoid using medication that has clear liver damage, especially do not use the medication repeatedly. If you cannot avoid using it, do it under the guidance of a doctor, closely monitor changes in liver function, and stop taking the medication in time if liver damage occurs;

4. Regular physical examinations. To prevent liver cancer, physical examinations are essential. People at high risk of liver cancer must undergo regular targeted examinations.

Tips:

HBV is not transmitted through the respiratory and digestive tracts.

Therefore, daily study, work or life contacts, such as working in the same office, shaking hands, hugging, living in the same dormitory, eating in the same restaurant and sharing toilets, etc., without blood exposure, will not transmit HBV.

Non-standard invasive procedures (such as injections, surgery, and dental treatment) can spread HBV.

HBV can also be transmitted through broken skin or mucous membranes, such as occupational exposure, pedicure, tattooing, ear piercing, sharing of razors and toothbrushes, etc.

The author is a spokesperson for the Healthy China Action, associate chief physician, registered nutritionist, and health manager.