Cholinesterase reflects the degree of hepatocellular damage and liver fibrosis; the more cholinesterase decreases, the more severe the hepatocellular damage. Cholinesterase (CHE) is a glycoprotein substance that exists in the body in the form of several isoenzymes, which can be divided into two different types: acetylcholinesterase and butyrylcholinesterase. Acetylcholinesterase is made by nerve cells and bone marrow neonatal erythrocytes and is sensitive to physiologic concentrations of acetylcholine, whereas butyrylcholinesterase is made primarily by liver cells and is less specific for acetylcholine. Therefore, damage to hepatocytes can be determined by examining cholinesterase. If liver cells are substantially damaged, resulting in a decrease in the number of normal hepatocytes, cholinesterase synthesis decreases. As the hepatocytes deteriorate, the liver becomes less able to compensate, resulting in a significant decrease in cholinesterase. Any abnormalities in cholinesterase should be treated promptly and the cause clarified as soon as possible under the guidance of a medical professional.