转氨酶升高=肝功能受损?这7种可能要牢记!

2022-05-09 医学之声 医学之声

转氨酶升高意味着什么?

转氨酶是催化氨基酸与酮酸之间氨基转移的一类酶。普遍存在于心肌、脑、肝、肾等动物组织。种类很多,其中以谷丙转氨酶(ALT)和谷草转氨酶(AST)最为重要。

ALT是催化谷氨酸与丙酮酸之间的转氨作用,AST是催化谷氨酸与草酰乙酸之间的转氨作用。

AST以心脏中活力最大,其次为肝脏;ALT则以肝脏中活力最大,当肝脏细胞损伤时,ALT 释放到血液内,于是血液内酶活力明显地增加。

在临床上测定血液中转氨酶活力可作为诊断的指标。如测定ALT活力可诊断肝功能的正常与否,急性肝炎患者血清中ALT活力可明显地高于正常人;而测定AST活力则有助于对心脏病变的诊断,心肌梗塞时血清中AST活性显示上升。

转氨酶升高不一定代表肝脏受到损害!

当肝细胞发生炎症、坏死、中毒等,造成肝细胞受损时,转氨酶便会释放到血液里,使血清转氨酶升高。通常,体检中主要检查的转氨酶有ALTAST ,其中尤以ALT最为常用。

1%的肝脏细胞损害,可以使血中ALT的浓度增加1倍。 

因此,ALT水平可以比较敏感地监测到肝脏是否受到损害。

转氨酶高不一定都是肝炎。ALT的升高只表示肝脏可能受到了损害。除了肝炎,其他很多疾病都能引起转氨酶增高。

引起转氨酶升高的原因有7种!

肝脏本身的疾患:特别是各型病毒型肝炎、肝硬变、肝脓肿、肝结核、肝癌、脂肪肝、肝豆状核变性等,均可引起不同程度的转氨酶升高。 

其他脏器的疾患:除肝脏外,体内其他脏器组织也都含有此酶。因此当患有心肌炎、肾盂肾炎、大叶性肺炎、肺结核、乙型脑炎、多发性肌炎、急性败血症、肠伤寒、流脑、疟疾、胆囊炎、钩端螺旋体病、流感、麻疹、血吸虫病、挤压综合征等疾病时,亦均可见血中转氨酶升高。

胆管胰腺疾病:因为转氨酶是从胆管排泄的,因此如果有胆管、胆囊及胰腺疾患,胆管阻塞,也可使转氨酶升高。

药源性或中毒性肝损害:药物过敏可引起转氨酶升高,并常伴有淤胆型黄疸和肝细胞损伤。生病时吃了会损伤肝脏的药物,例如红霉素、四环素、安眠药、解热镇痛药、避孕药,还有半夏、槟榔、青黛等中药。在停用这些药物后,转氨酶水平会很快恢复正常。

妊娠期:正常妊娠、妊娠中毒症、妊娠急性脂肪肝等也是转氨酶升高的常见原因。

不良生活习惯:长期酗酒导致酒精肝,或饮食结构不合理导致脂肪肝,造成转氨酶升高。

其它情况:健康人的转氨酶水平也有可能暂时超出正常范围。剧烈运动、过于劳累或者近期吃过油腻食物,都可能使转氨酶暂时偏高。如果在检查转氨酶前一晚加班工作,没睡好觉,或是体检前早餐时吃了油炸的东西,检查结果可能就会超出正常范围。一个人刚刚在操场上跑了几圈,就立刻检查他的转氨酶水平,结果也可能会高出正常范围。

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    2022-05-12 小路非

    0

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    2022-05-10 ms7000001100972409

    这篇文章写得真好!

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