Ms. Zhang was diagnosed with high blood pressure ten years ago. Since then, she has been taking antihypertensive drugs regularly and monitoring her blood pressure levels regularly. The effect has been very good, with no symptoms of discomfort during the period and no fluctuations

Ms. Zhang was diagnosed with hypertension 0 years ago. Since then, she has been taking antihypertensive drugs regularly and monitoring blood pressure levels regularly. The effect has been very good. During this period, she has not experienced any discomfort symptoms, and has not noticed any fluctuations in blood pressure. Condition.

But four years ago , I suddenly had palpitations without obvious triggers, and my body was prone to sweating and weight loss was also obvious; after a series of examinations in the hospital, I was diagnosed with hyperthyroidism and chose drugs treatment options.

Recently, Ms. Zhang developed symptoms of fatigue, loss of appetite, and pain in the right upper abdomen. The attending doctor initially suspected that there was a liver problem based on Ms. Zhang's previous medical history, and conducted auxiliary tests such as liver function and found that: alanine aminotransferase and aspartate aminotransferase were both high, and close to the diagnostic criteria for liver cancer .

is here to raise a question for everyone, "How much higher than the normal value of alanine aminotransferase and can it be closer to liver cancer?"

How high is the alanine aminotransferase, which can be judged to be liver cancer?

alanine aminotransferase is a kind of of aminotransferase. It is a group of enzymes that catalyze the amino transfer reaction between amino acid and α-keto acid. Alanine aminotransferase is mainly used to catalyze the amino transfer reaction between L-alanine and α-ketoglutarate to generate L-glutamic acid and pyruvate .

Alanine aminotransferase mainly exists in non-mitochondria of the liver (mostly in the cytoplasm of liver cells ), and only a few are present in muscles, adipose tissue, intestines and other organs.

And under normal circumstances, the activity of alanine aminotransferase in liver cells is about 3000 times that in serum . After liver cells are damaged , the permeability of the liver cell membrane increases, and alanine aminotransferase will be released into the serum . The alanine aminotransferase water value in the serum is significantly increased, which is considered to be the most sensitive marker of liver cell damage.

The more serious the liver damage is, the more alanine aminotransferase leaks from the liver cell cytoplasm, and the higher the monitored value is. However, if you want alanine aminotransferase to "spy" on liver cancer, another value is needed. The auxiliary enzyme, namely aspartate aminotransferase , is also an aminotransferase, but in liver cells, about 180% of is present in in mitochondria.

When liver cells are slightly damaged, , generally the leakage rate of alanine aminotransferase is much greater than aspartate aminotransferase. However, when cancer becomes , the mitochondrial membrane of liver cells is also damaged, which can lead to the release of aspartate aminotransferase in mitochondria. , that is, when the ratio of aspartate aminotransferase to alanine aminotransferase (DeRitis ratio) in the serum is ≥3, liver cancer is suspected..

Of course, the increase in serum alanine aminotransferase does not only represent a single type of liver cancer, but also represents the occurrence of the following diseases.

What does the elevated alanine aminotransferase mean?

The liver function test shows that alanine aminotransferase is relatively high , and fatty liver can also be considered. Most people today have more or less unreasonable diets and do not do physical exercise, which can easily lead to obesity. When excess fat in the body accumulates in the liver, there are many consequences. It is likely to cause fatty liver and lesions.

The fat content in normal liver tissue does not exceed %. If it exceeds 5% and does not reach 0%, it is mild fatty liver , and if it is greater than 5%, it is severe fatty liver; the higher the severity of fatty liver , the abnormal rate of serum alanine aminotransferase will also be significantly increased by .

The reason for this change is that excessive fat is deposited in liver cells, which causes long-term damage to liver cells, decreases liver function, and reduces the ability to metabolize and decompose substances. At the same time, it also reduces the liver's ability to metabolize and decompose substances. The active enzyme inactivates , thereby allowing transaminase to enter the bloodstream from damaged liver cells.

The more serious the liver cell damage is, the further weakening the ability to inactivate active enzymes will be, resulting in more transaminase being released into the blood, and the more obvious the increase in alanine aminotransferase will be.

Other scholars have found that patients with hyperuricemia are often found to have elevated alanine aminotransferase. However, the specific mechanism leading to elevated alanine aminotransferase is not yet clear. It may be related to the following mechanisms.

First, blood uric acid is related to non-alcoholic fatty liver , and non-alcoholic fatty liver is the primary cause of asymptomatic elevation of transaminases;

Second, hyperuricemia can cause triglycerides in liver cells The possibility of large amounts of synthesis and accumulation in the liver will indirectly cause liver cell membrane permeability to increase or rupture , causing intracellular alanine aminotransferase to be released into the blood;

Third, when eating a large amount of high-purine foods, xanthine oxidase (the key enzyme in the uric acid synthesis pathway) activity enhances , which increases the uric acid synthesized in liver cells, increases the permeability of liver cell membranes, and triggers the release of alanine aminotransferase;

Fourth, in addition to the liver, other organs and tissues in the body such as The heart, kidney, lung, brain, muscle and other parts also contain alanine aminotransferase. When the blood uric acid concentration increases, it will cause urate crystals to be deposited on the surface of the above-mentioned tissue cells, causing cell damage at the deposition site and causing the cells to Alanine aminotransferase in the body is released into the blood.

In addition, when liver diseases such as acute viral hepatitis, chronic viral hepatitis, alcoholic liver disease , drug-induced hepatitis , cirrhosis and other liver diseases exist, alanine aminotransferase will be elevated to a certain extent. Take alcoholic liver disease as an example, especially patients with severe alcoholism, which can induce liver cell necrosis and even cause liver failure .

What other tests are needed to make a definite diagnosis of liver cancer?

The diagnosis of liver cancer cannot be made solely by relying on an auxiliary test of liver function. It also needs to be combined with serum tumor markers, imaging , liver biopsy and other auxiliary tests.

First of all, let’s talk about the tumor markers- alpha-fetoprotein , which is mainly synthesized by yolk sac and liver cells.

Under normal circumstances, blood content is low. When cancer cells invade the body, activates the alpha-fetoprotein synthesis gene in tumor cells, secretes a large amount of alpha-fetoprotein, and increases serum concentration. It directly acts on liver cancer cells or indirectly inhibits feedback The immune system promotes the occurrence and progression of liver cancer.

When the serum alpha-fetoprotein ≥ 400 μg /L, and after excluding some other influencing factors, such as pregnancy, chronic or active liver disease, gonad embryogenic tumors, and digestive tract tumors, is highly suggestive of liver cancer .

If the serum alpha-fetoprotein is slightly elevated, imaging examination or dynamic observation of should be performed, and comparative analysis with changes in liver function can be helpful for diagnosis.

Secondly, imaging examinations such as ultrasound, CT, and magnetic resonance imaging (MRI) are also helpful in the diagnosis of liver cancer.

Routine use of gray-scale ultrasound imaging can detect space-occupying lesions in the liver early and sensitively, especially by clearing out the cystic or parenchymal distinction and making preliminary judgments of benign and malignant . At the same time, it can also comprehensively screen whether there are metastases, intrahepatic blood vessels and bile duct invasion in the liver or other organs in the abdominal cavity.

CT and MRI enhancement methods are the imaging methods of choice for definite diagnosis when liver ultrasound and/or serum alpha-fetoprotein screening is abnormal.

often perform dynamic enhanced phase 3 scans. After the injection of contrast agent , the scan is performed around 5 seconds , which shows that portal vein begins to enhance; 0~90 seconds around the portal vein has been completely enhanced, and hepatic vein is filled with contrast agent. The liver parenchyma also often reaches the peak enhancement during this phase; scans were performed before and after 13 minutes of injection of contrast agent. It can be seen that the portal vein and hepatic vein are enhanced but lower than the portal venous phase. In addition, the liver parenchyma can be enhanced but lower than the portal venous phase.

By comparing the images obtained by the three-phase scan, it is easy to find lesions in the liver.

If the patient's lesions can be clarified by using the above examination methods, the next examination is not required; however, for liver space-occupying lesions that lack the typical imaging features of liver cancer, in order to clarify the cause of the lesions and guide subsequent treatment plans, it is necessary to carry out Liver biopsy .

Before performing liver puncture biopsy, you need to check platelets and coagulation function . We do not recommend this test for patients with severe bleeding tendencies.

Liver puncture biopsy is often performed under the guidance of ultrasound or CT. The puncture path should pass through normal liver tissue as much as possible to avoid direct puncture of liver surface nodules. And the puncture site should be selected within the tumor and adjacent to the tumor where imaging examination shows active tumor. After the sample is taken, the integrity of the sample should be visually observed to improve the diagnostic accuracy.

The doctor has something to say

When the positive blood pressure of alanine aminotransferase in liver function test is found due to other diseases or during physical examination, it attracts everyone's attention.

is not only viral hepatitis , alcoholic hepatitis , fatty liver, and high uric acid. Hyperemia is easy to occur. When the DeRitis ratio is ≥3, liver cancer needs to be suspected.

In addition, the occurrence of liver cancer can also be helped by tumor markers, imaging and liver biopsy.

References:

【1】Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2022 Edition)[J]. Journal of Clinical Hepatobiliary Diseases, 2022, 38(02):288-303.

【2】 Wang Xiaochuan, Ma Li , Wang Xiuli, Luo Hao, Wang Xiaojing. To explore the application effects of four testing methods in the diagnosis of hepatitis C [including hepatitis C antibody, hepatitis C virus (HCV) RNA, albumin (ALB) and alanine aminotransferase (ALT)][J]. Journal of Mathematical Medicine , 2021, 34(05): 656-658.

[3] Lin Caixia, Li Canran. Analysis of results of ultrasound diagnosis of fatty liver and blood lipids and alanine aminotransferase [J]. Image Research and Medical Applications, 2021,5(12):231-232.

【4】Wang Can, Miao Zhimin , Li Changgui, Han Lin, Meng Dongmei. Effect of serum uric acid levels on serum alanine aminotransferase and aspartate aminotransferase levels [J]. Shandong Medicine , 2010, 50(29): 1-3.

[5] Liu Ying, Chen Simei, Dai Houyong. Combined detection of multiple tumor markers and transaminases in the early diagnosis of liver cancer and its role in prognosis assessment[J].Clinical Medical Engineering,2022,29(2):175-176.

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