With the economic development and the increasing standard of living, people pay more attention to the health of the body, often physical examination, but the abnormal indicators in the liver function, often confused, do not know how to deal with, adding to the trouble! The following combined with my more than 20 years of experience in the diagnosis and treatment of liver disease, to relieve your worries!
I. What is the function of the liver?
The liver is one of the most complex organs in the human metabolic function, it undertakes the metabolism of protein, fat and sugar, decomposition and transformation of toxic substances, synthesis and secretion of bile and other functions.
Second, common liver function items: including bilirubin, enzymology, protein, coagulation function and other multiple indicators.
1, bilirubin abnormalities: increased generation, processing and transfer disorders, outlet disorders. There are specific hemolytic, hepatocellular, obstructive
jaundice, etc. Fava beans and products, some drugs, abnormal metabolic syndrome, etc. can lead to hemolytic jaundice. Viruses, poisoning, drugs, immunity, heart failure, ischemia, and metabolic disorders can lead to hepatocellular jaundice; cholestasis, capillary cholangitis, primary sclerosing cholangitis, intrahepatic hepatic ducts, bile duct stones, inflammation, and tumors can easily cause obstructive jaundice. In recent years, we have found that some previously rare jaundice such as: pregnancy-related jaundice, hyperthyroidism-related jaundice, ischemic jaundice, congenital metabolic abnormal jaundice, jaundice due to autoimmune diseases, jaundice due to alcoholic liver failure is not uncommon!
2. Enzyme abnormalities: There are about a thousand enzymes in the liver, and about a few dozen are used for clinical diagnosis. The principle of enzyme abnormality: inflammation, necrosis, mitochondrial damage or increased permeability of hepatocyte membrane in hepatocellular carcinoma, and possibly hyperproduction of enzymes by hepatocellular carcinoma cells or necrosis and increased permeability of cell membrane in carcinoma group, infiltration and destruction of carcinoma tissue or obstruction due to compression of bile ducts also cause enzyme abnormality.
The common enzyme abnormalities and causes are as follows.
(1) Glutathione transaminase (ALT) abnormalities and causes: hepatocyte inflammation, swelling, necrosis, increased cell permeability; myocarditis, myocardial infarction; post-traumatic skeletal and muscle injury, this type of ALT abnormalities are seen in extracerebral, icu, orthopedics.
(2) Abnormal glutathione aminotransferase (AST) and causes: when hepatocytes are severely necrotic or destroyed, such as cirrhosis, hepatocellular carcinoma, alcoholic liver, drug-induced hepatitis; when myocardial damage or ischemia and hypoxia; polymyositis, progressive myotonic dystrophy, nephritis, pancreatitis, cholecystitis, pneumonia, heart failure, etc.
(3) Glutamyl transpeptidase (G-GT) abnormalities and causes: significant elevation (more than 10 times): seen in primary or metastatic hepatocellular carcinoma, pancreatic cancer, biliary tract obstruction, drug-induced liver damage; moderate elevation: seen in acute or chronic hepatitis, cholestasis, alcoholic cirrhosis, heart attack, etc.; mild elevation: seen in cirrhosis, fatty liver, pancreatitis, barbiturate poisoning, normal pregnancy, etc.
(4) Alkaline phosphatase (ALP) abnormalities and causes.
Physiological elevation : Pregnant women, infancy to childhood in the state of bone growth;
Pathological elevation: Hepatitis jaundice can be mildly to moderately elevated, ALP can be significantly elevated in bilious hepatitis, and this enzyme is significantly elevated in obstructive jaundice, and cancerous obstruction is more obvious than stone; ALP is significantly elevated in primary or metastatic hepatocellular carcinoma, and the reference value of this enzyme is greater when ALP is elevated in the absence of clinical suspicion of jaundice; liver abscess, liver tuberculosis, bone The enzyme is also seen to be elevated in liver abscess, liver tuberculosis, bone disease, hyperparathyroidism, and leukemia.
(5) Lactate dehydrogenase (LDH) abnormalities and causes: seen in active hepatitis, acute myocardial infarction, acute leukemia, pernicious anemia, renal infarction, pulmonary infarction, intestinal obstruction, myositis, malignancy, myotonic dystrophy, and DIC.
3.Protein abnormality: Serum protein is almost all made in the liver, so its dynamic changes can reflect the state of protein in the liver, measurement and analysis of serum protein composition and changes can reflect the function of liver protein metabolism.
Decreased albumin can be seen in chronic hepatitis, cirrhosis, heavy hepatitis, malnutrition, chronic gastrointestinal diseases, chronic infectious diseases, pernicious anemia, high fever, malignant tumor, diabetes, hyperthyroidism, nephrotic syndrome, and late pregnancy.
Elevated globulin is seen in: chronic moderate hepatitis, cirrhosis, reticuloendothelial system and immune system diseases.
White Globulin (A/G) Ratio.
This value is not necessarily meaningful on its own, but is more valuable when combined with quantitative measurements of A and G. If A decreases and G increases, and A/G is less than 1.5, it can be called inverted and is of great value in determining the prognosis of cirrhosis and severe hepatitis. If both A and G are higher than normal, or the ratio may be less than 1.5, the prognosis of chronic hepatitis, cirrhosis, and severe hepatitis is of little significance. There are also some immunocompromised patients with very low G, whose ratio is not less than 1.5, but their prognosis is often poor.
Third, how to deal with?
Liver function tests have an important reference value for the diagnosis, treatment and prognosis judgment of liver disease, but there is not yet a single experiment that can fully reflect the situation of the liver, the reasons are complex, and there may be a variety of causes affecting and interacting with each other, and a small number of causes are unknown, so the results of various tests should be carefully analyzed and scientifically handled by infectious disease specialists!