We often encounter patients or friends who are puzzled by the elevated aminotransferases on the checklist, and there are many people who find elevated aminotransferases in their physical examinations. What is aminotransferase? Aminotransferase is an intracellular “catalyst” that exists mainly in liver cells. It comes from the cells and does the job of maintaining nutrient metabolism. When the cells die or are damaged, transaminases are released into the bloodstream. The two most common clinical tests are alanine aminotransferase and aspartate aminotransferase. Does aminotransferase refer to liver function? No. The liver has many functions, mainly substance metabolism, bile secretion, detoxification, and immune defense. Aminotransferases are only an indicator of liver cell damage, and liver function will only be abnormal if the cells in the liver are damaged to a certain extent and proportion. If liver cells are extensively necrotic, there may even be a decrease in aminotransferases and deepening jaundice. Elevated aminotransferases are directly related to the metabolic functions of the liver, such as metabolism, bile secretion and detoxification. What does elevated aminotransferases mean? Elevated transaminases indicate liver cell damage or death. There are many reasons behind liver cell damage or death, including viral hepatitis, fatty liver, and drug-related hepatitis. A mild rise in aminotransferases generally does not have obvious accompanying symptoms, while a large rise in aminotransferases (several hundred) generally results in symptoms such as loss of appetite. If it exceeds the normal range, it is recommended to check again to rule out the possibility of physiological high transaminases. If the aminotransferase level is still high and much higher than the reference value (tens or even hundreds) it is most likely due to viral hepatitis or other liver diseases. In addition, aminotransferases are not only found in the liver, but also in the heart and muscles, and lesions in these areas may also cause an increase in aminotransferases. Common causes of elevated aminotransferases are caused by fatty liver. Fatty liver is the most common type of liver damage, including steatosis, steatohepatitis and cirrhosis, which is caused by the accumulation of lipids in liver cells and damage to liver cells. Peroxidative damage occurs during lipid metabolism, leading to steatosis, ballooning and necrosis of hepatocytes, thus becoming a fatty liver. High transaminases in obese and alcoholic people are usually caused by fatty liver. Viral causes Viral hepatitis is the most common cause of high aminotransferases, and the development of chronic hepatitis (hepatitis B and C), cirrhosis and liver cancer is almost always accompanied by high aminotransferases. Transaminases and viral load are two important indicators for monitoring chronic hepatitis. Drug-induced A large proportion of drugs are metabolized and eliminated in the liver, and drug-induced liver injury is very common, accounting for almost 20-30% of all liver injuries. If you have no history of hepatitis, you should pay attention to whether you have recently taken any drugs that damage the liver, and if so, you must first rule out the possibility of drug-induced hepatitis. Other common causes of pathological aminotransferases 1, biliary tract diseases such as “cholelithiasis” acute attack, in addition to fever, abdominal pain, nausea, vomiting, jaundice, etc., can also cause high blood bilirubin and aminotransferases; 2, heart disease acute myocardial infarction, myocarditis, heart failure, can cause high aminotransferases; 3, some other Infectious diseases: In addition to the liver, other organ tissues in the body such as heart, kidney, lung, brain, testes and muscle also contain this enzyme. Therefore, elevated blood transaminases can also be seen in patients with myocarditis, pyelonephritis, lobar pneumonia, tuberculosis, polymyositis, hyperthyroidism, acute sepsis, enteric typhoid, rheumatoid fever, malaria, leptospirosis, influenza, measles, schistosomiasis, and extrusion syndrome. Physiological elevations Transaminases are very sensitive and many factors can cause them to fall outside the reference range, so an elevated transaminase does not necessarily mean that there is a health problem (normal values range from 0-40). Many human behaviors and lifestyles can lead to elevated hepatocyte permeability and subsequently to abnormalities in that one test: strenuous exercise, overexertion, alcohol consumption, greasy diet, irregular work and rest, and even anger are all possible, physiologically elevated but generally not more than 2-fold. To sum up, elevated transaminases alone do not represent any disease, but require a comprehensive analysis of what causes it, whether it is persistent or transient. If it is abnormal or sharply elevated, it is important to be alert. If a physical examination reveals a rise in transaminases, you should consider whether you have recently drunk too much alcohol, eaten too much fatty food, or have a fatty liver that is not well controlled. We need to pay attention to adjust our living habits, after adjusting our living habits, the review may return to normal. After the review or long-term high, we need to pay attention to whether we have taken any drugs that can damage the liver recently, whether viral hepatitis is under control, etc. Elevated transaminases suggest the possibility of physical disease, to find out the cause also need to do combined with medical history, symptoms, further examination, clear causes.