轻度升高的肝脏转氨酶水平：原因和评估。

StephenW

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

StephenW

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。

抽象

在初级保健中，轻度，无症状的升高（少于正常上限的五倍）丙氨酸转氨酶和天冬氨酸转氨酶水平很常见。据估计，约有10％的美国人口的转氨酶水平升高。基于导致无症状转氨酶升高的疾病流行的方法可帮助临床医生有效地确定常见和严重的肝脏疾病。转氨酶升高的最常见原因是非酒精性脂肪肝和酒精性肝病。不常见的原因包括药物引起的肝损伤，乙型肝炎和丙型肝炎，以及遗传性血色沉着病。罕见原因包括α1-抗胰蛋白酶缺乏症，自身免疫性肝炎和威尔逊病。肝外来源，如甲状腺疾病，腹腔疾病，溶血和肌肉疾病，也与轻度升高的转氨酶水平有关。初步评估应包括代谢综合征和胰岛素抵抗（即腰围，血压，空腹血脂水平和空腹血糖或A1C水平）的评估;血小板全血计数;测量血清白蛋白，铁，总铁结合能力和铁蛋白;和丙型肝炎抗体和乙型肝炎表面抗原检测。非酒精性脂肪肝疾病纤维化评分和酒精性肝病/非酒精性脂肪肝疾病指数可用于评估轻度升高的转氨酶水平。如果对常见原因的检测与非酒精性脂肪性肝病相一致，否则无法显示，对生活方式改变进行试验是合适的。如果海拔持续存在，应考虑肝超声检查和进一步检查不常见原因。

结论：
    29431403