Hepatitis and enzyme-lowering drugs Transaminases, which include alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are found mainly in liver cells. When hepatitis occurs, transaminases escape from liver cells and enter the bloodstream because of liver cell damage. It has been found that as little as 1% of hepatocytes are necrotic and inflamed, which is enough to double the amount of transaminases in the blood than when they are normal. The total number of adult hepatocytes is about 2.5 x 1012. Testing the level of transaminases in the blood is one of the most commonly used methods to diagnose hepatitis, and this method has proven to be relatively sensitive, so any patient with hepatitis should be tested for transaminases more than once as a way to assess liver function. However, for a long time, many patients, including some doctors, have lacked a proper understanding of transaminases, and many have taken lowering transaminase levels as the only purpose to be achieved in the treatment of hepatitis, resulting in a detour. We found that some patients with chronic hepatitis are desperately seeking to reduce enzymes, taking a lot of enzyme-lowering drugs, such as bupropion and pentamidine, etc. As a result, the transaminases were really reduced to normal, and they were very happy, but after stopping the drugs, the transaminases soon rebounded and rose again. What is going on here? It turns out that such enzyme-lowering drugs mainly temporarily inhibit transaminase activity, affecting the test results, and generally have no effect on damaged liver cells, or very little effect, so the drug will be repeated when stopped. In other words, the enzyme-lowering effect of enzyme-lowering drugs only treats the “symptoms”, but not the “root”, and although transaminases can be reduced to normal by enzyme-lowering treatment, liver cell damage still exists. In the past, some people advocate long-term application of enzyme-lowering drugs, when the hepatocyte lesions are reduced, transaminases will not rebound. Now it is not advisable to do so, because the long-term application of enzyme-lowering drugs will affect the patient’s appetite, produce stomach discomfort, nausea, vomiting and other side effects, more importantly, can not solve the fundamental problem of hepatitis treatment. Hepatitis virus replication is active, and hepatocellular lesions always occur. The pursuit of enzyme-lowering is considered to be a treatment that puts the cart before the horse and should not be advocated. The application of enzyme-lowering drugs may conceal the truth of the condition A large number of long-term applications of enzyme-lowering drugs can indeed bring the transaminases of many patients down to the normal range, but this is an illusion that often makes patients blindly optimistic and abandon or neglect other important therapeutic measures, especially antiviral therapy. The enthusiasm to lower the enzyme instead of paying attention to the replicating virus will make the virus more rampant in the body, and the cure will be far away. “False normalcy” not only paralyzes the patient, but also paralyzes the doctor. Patients are complacent, do not take the initiative to accept medical monitoring, do not go to laboratory testing of hepatitis virus indicators, let the virus replication, trouble, the result of liver inflammation persists, liver fibrosis quietly proceeded, cirrhosis is coming. The correct understanding of the role of enzyme-lowering drugs, downplaying the role of enzyme-lowering drugs, do not rely on enzyme-lowering drugs to treat hepatitis, but should be the correct and timely use of antiviral drugs, only the virus is strongly inhibited, hepatocyte immunopathological damage can be improved, transaminases naturally decline, at this time the normal transaminases is the “real normal”. Normal aminotransferases are one of the important conditions when assessing the recovery of hepatitis patients, but only if enzyme-lowering drugs are not abused, otherwise it is difficult to assess the effectiveness of treatment. Normal aminotransferases are not the only indication for discontinuation of medication in patients with chronic hepatitis, but aminotransferases tend to fluctuate, sometimes with a small increase, even down to the normal range, or a little higher; sometimes with a larger increase, up to 10-20 times the upper limit of normal values. Enzyme-lowering drugs cannot affect the pathological process of the liver, and the normal transaminases certainly cannot be stopped. Even if the application of antiviral drugs, transaminases to normal, but also can not hastily stop treatment, because the application of antiviral drugs is not sufficient time, still make the disease rebound, at the same time, this time the normal transaminases can not exclude the hepatitis patient’s own remission. After the aminotransferase is reduced to normal, it must be normal for 2 consecutive tests (the interval between 2 tests is 1 month), provided that no enzyme-lowering drugs are used, which is considered truly normal. At this time, the hepatitis virus should also be tested, if the hepatitis B virus nucleic acid (HBVDNA) turns negative or the quantitative test is <103 copies/ml, HBeAg turns negative and anti-HBe turns positive, and the symptoms basically disappear, then the drug can be considered to be discontinued. The main reason is that the higher the aminotransferase, the more serious the disease. We had a case of a patient with hepatitis A whose transaminases were as high as 2000 units, and she fainted when she found out. It is true that a large increase in transaminases indicates a large area of liver cell damage, but this "large area" of damage or inflammation is not the same as a serious condition, because liver damage in viral hepatitis is a kind of immune damage, there are immune factors involved, transaminase level is an important indicator of the body's immune status, transaminases high means that the patient's immune response is good. A high transaminase level indicates a good immune response, while a small or normal increase in transaminase indicates a poor immune response and the presence of "immune tolerance", which means that the virus is not easily cleared. A large increase in aminotransferases is mostly transient, and the virus will be cleared quickly. On the contrary, chronic hepatitis patients have less elevated transaminases, but they are difficult to cure and even develop cirrhosis and liver cancer. There is also a clinical category of "heavy hepatitis" in which the transaminases are often very low, but the jaundice is very heavy, and the death rate is as high as 60% to 80%. Aminotransferases are one of the indicators used by doctors to assess a patient's liver function, and patients do not have to "treat enzymes like tigers", the pursuit of enzyme reduction will take a detour.