Does the higher the transaminases, the worse the disease? The answer is no. Patients with acute viral hepatitis have high transaminase levels at the onset of the disease, which will soon return to normal after a short period of rest and treatment. In some patients with chronic hepatitis or even cirrhosis, transaminases may be normal. The magnitude of transaminase elevation can distinguish between acute or chronic liver injury Acute liver injury often has transaminases in excess of 400 U/L, or even thousands. In particular, very high aminotransferases are mostly seen in liver injury due to acute ischemia or toxicity. Rapid increases in aminotransferases are also often seen in acute viral hepatitis. Chronic liver damage is defined as a transaminase elevation that lasts longer than six months, or several times over a period of more than six months. The aminotransferases are usually below 400 U/L, and in some cases even below 100 U/L. It is common in chronic viral hepatitis, cirrhosis, alcoholic liver disease, fatty liver, autoimmune hepatitis, etc. In 15-50% of patients with chronic hepatitis C, transaminases are even consistently normal, while liver pathology suggests inflammation. Persistent high aminotransferases need to be alerted. A temporary high aminotransferases need to be rechecked, and if persistent high aminotransferases should be taken seriously. In particular, patients with chronic hepatitis whose transaminase levels are not very high, mostly between 100 and 200 U/L, or less than 100 U/L, need to pay the most attention because the largest number of patients in this category have a persistent disease that eventually develops into liver cirrhosis or liver cancer. It is important to note that in chronic liver damage, the presence of an acute and significant increase in transaminases must alert the possibility of an acute exacerbation of the disease. AST/ALT ratio and disease AST and ALT are the abbreviations for glutamic oxalacetic transaminase and glutamic alanine transaminase, respectively. In liver cells, ALT is present in the hepatic cytosol and can be significantly increased by minor damage to the cell membrane, while AST is mainly present in the mitochondria (a structure located in the cytosol) and is released into the bloodstream in large quantities when the liver cells are severely damaged, resulting in a significant increase in AST in the blood. In clinical practice, AST/ALT >1.0 is common in patients with cirrhosis. It is noteworthy that in alcoholic liver disease, AST/ALT >2.0 in about 80% of cases, and in drug-related liver damage, generally AST exceeds ALT. may be related to the mechanism of injury. In addition, in the case of application of enzyme-lowering drugs, some people have a faster decrease in ALT, but it is more difficult for AST to return to normal, which also affects the AST/ALT ratio. If you find high aminotransferases, don’t panic or abuse drugs, you should go to a regular hospital for a series of related tests to determine the cause and extent of the disease and then carry out targeted treatment.