Am Fam Physician. 2017 Dec 1;96(11):709-715.
Mildly Elevated Liver Transaminase Levels: Causes and Evaluation.Oh RC1, Hustead TR2, Ali SM3, Pantsari MW4. Author information 1Martin Army Community Hospital, Fort Benning, GA, USA.2Hardin Memorial Health, Elizabethtown, KY, USA.3Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.4Gastroenterology Consultants of Augusta, Augusta, GA, USA.
AbstractMild, asymptomatic elevations (less than five times the upper limit of normal) of alanine transaminase and aspartate transaminase levels are common in primary care. It is estimated that approximately 10% of the U.S. population has elevated transaminase levels. An approach based on the prevalence of diseases that cause asymptomatic transaminase elevations can help clinicians efficiently identify common and serious liver disease. The most common causes of elevated transaminase levels are nonalcoholic fatty liver disease and alcoholic liver disease. Uncommon causes include drug-induced liver injury, hepatitis B and C, and hereditary hemochromatosis. Rare causes include alpha1-antitrypsin deficiency, autoimmune hepatitis, and Wilson disease. Extrahepatic sources, such as thyroid disorders, celiac sprue, hemolysis, and muscle disorders, are also associated with mildly elevated transaminase levels. The initial evaluation should include an assessment for metabolic syndrome and insulin resistance (i.e., waist circumference, blood pressure, fasting lipid level, and fasting glucose or A1C level); a complete blood count with platelets; measurement of serum albumin, iron, total iron-binding capacity, and ferritin; and hepatitis C antibody and hepatitis B surface antigen testing. The nonalcoholic fatty liver disease fibrosis score and the alcoholic liver disease/nonalcoholic fatty liver disease index can be helpful in the evaluation of mildly elevated transaminase levels. If testing for common causes is consistent with nonalcoholic fatty liver disease and is otherwise unremarkable, a trial of lifestyle modification is appropriate. If the elevation persists, hepatic ultrasonography and further testing for uncommon causes should be considered.
PMID:29431403 作者: StephenW 时间: 2018-2-15 19:18
Am Fam医师。 2017年12月1日; 96（11）：709-715。
轻度升高的肝脏转氨酶水平：原因和评估。
哦RC1，Hustead TR2，阿里SM3，Pantsari MW4。
作者信息
1
马丁军队社区医院，美国佐治亚州本宁堡。
2
哈丁纪念健康，伊丽莎白敦，肯塔基州，美国。
3
Fort Belvoir社区医院，美国弗吉尼亚州贝尔沃堡。
4
胃肠病学顾问奥古斯塔，奥古斯塔，美国乔治亚州。