Before answering the question, let’s understand what factors can lead to frequent elevation of transaminases? It should be noted that serum transaminase activity is a sensitive indicator of liver cell damage, and any factor that causes liver cell damage can lead to elevated transaminases, but among the most common causes are hepatitis virus infection, followed by long-term heavy alcohol consumption, drugs that damage the liver, non-alcoholic fatty liver, autoimmune disease, hepatobiliary system disease, EBV/cytomegalovirus or enterovirus infection. Let’s start with hepatitis virus infections. There are five common types of hepatitis viruses: A, B, C, D, and E. Among them, hepatitis A and E can obtain lifelong immunity after the disease, that is, after having the disease once, you will not get sick again; while B, C, and D can turn into chronic hepatitis, that is, the transaminases can be repeatedly abnormal, the degree of fibrosis gradually increased, and after several years, can develop into cirrhosis, of which type B accounts for the majority, and hepatitis D virus infection in China is rare. At the same time, a considerable number of patients have hepatitis B virus carriers, and transaminases can be in a stable state for a long time, especially in children, with active viral replication, which we call the immune tolerance state, and this group of patients can also cause elevated transaminases due to the breaking of immune tolerance and potential viral replication. When the elevation of aminotransferases is not obvious, there may be no conscious symptoms, or even if they feel slightly uncomfortable, they do not think that it is caused by hepatitis, so they neglect liver function tests and only go to the hospital for examination when their condition worsens and jaundice appears, which will inevitably increase the difficulty of treatment to a certain extent and cause certain damage to the liver and deposition of fibrous connective tissue. Therefore, we emphasize that for patients carrying hepatitis B and C viruses, frequent liver function checks are needed to detect abnormalities in a timely manner and to take targeted liver-protective treatment according to the causes of liver function abnormalities in a timely manner, so that we can slow down the process of liver → cirrhosis → liver cancer as much as possible in the absence of ideal antiviral and anti-fibrotic drug therapy. The second group of people who need to have their liver function checked frequently are those who drink a lot of alcohol for a long time. In recent years, with the improvement of people’s living standards in China, the incidence of alcoholic liver disease has also increased significantly. The amount of alcohol consumed that leads to alcohol damage varies from person to person, and it is generally believed that drinking 80 to 150 grams of highly concentrated alcohol per day for more than 5 years can lead to liver damage. Alcoholic liver disease can be divided into alcoholic fatty liver, alcoholic hepatitis and alcoholic cirrhosis according to the severity of the disease. We have noticed that most of the patients who come to our hospital with alcoholic liver disease have progressed to cirrhosis and have developed ascites, at which point the liver damage is irreversible and seriously affects the prognosis. The reason for this phenomenon is related to the fact that in early alcoholic liver disease, i.e., alcoholic fatty liver and alcoholic hepatitis, patients are often asymptomatic and not treated in a timely manner. Therefore, we remind those who drink a lot of alcohol for a long time to reduce the amount of alcohol as much as possible on the one hand, and at the same time to pay attention to frequent rechecking of liver function in order to delay treatment. The third group of people who need to have their liver function checked frequently are those who take liver-damaging drugs. Common ones are: anti-tuberculosis drugs (e.g. isoniazid, rifampin, etc.), antipyretic and analgesic drugs (paracetamol), antifungal drugs (ketoconazole) and certain anti-epileptic, antipsychotic, anti-thyroid drugs, antibiotics, hypoglycemic drugs, oral contraceptives. It is worth noting that some proprietary Chinese medicines have also been associated with liver damage, such as: Lei Gong Tang, Dong Qing Ye, compound Qing Dai Wan, etc.; there are also some drugs for rheumatism and skin diseases (e.g., psoriasis, psoriasis), which have also been reported to have liver damage. In addition, in recent years, with the popularity of the slimming movement, a large number of weight loss drugs have been used, and reports of related liver damage have also begun to appear. Therefore, when using the above drugs, be sure to regularly monitor liver function, and patients with liver disease should be used with caution. The fourth group of people who need to have their liver function checked frequently are patients with non-alcoholic fatty liver caused by over or poor nutrition, diabetes, long-term hormone use, etc. Here, it should be especially emphasized that over-nutrition, i.e. obesity, accounts for a considerable proportion, especially in recent years, the rapid increase in the proportion of obese children should be taken seriously, and it is reported that fatty liver can occur in about half of obese people. Fatty liver continues to develop can also progress to cirrhosis, and often the patient’s discomfort is mild. Other people who need to have their liver function checked frequently, such as those suffering from autoimmune diseases, hepatobiliary diseases, and other viral or bacterial infections, can cause an increase in transaminases, which will not be discussed here.