What is ALT/AST?_Written by Pharmguy

Always think I should do it, but one of the bothersome things to go to get it is the health checkup. After the health checkup, the result sheet you received is full of crazy moon languages, right?

 

This post is an easy-to-understand explanation of health checkup terms. Accurate information about AST/ALT Level! The Pharmguy will sort it out.

AST A:T

Key Summary about AST/ALT level

• When the liver is damaged, AST/ALT, an enzyme present in the liver, leaks into the blood.
• Absolute increase is important, but so is the AST/ALT ratio. A high AST indicates an alcoholic disease, and a high ALT indicates a non-alcoholic liver disease.
• Liver damage can be caused by taking medications such as antibiotics.
• ALT levels may be normal in patients with cirrhosis or chronic hepatitis B. AST/ALT levels alone cannot determine a patient's condition.

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AST/ALT to check for whether liver damaged

AST = SGOT (Serum glutamic oxaloacetic transaminase)

ALT = SGPT (Serum glutamate pyruvate transaminase)

• AST is an enzyme made by the liver. It is distributed not only to the liver but also to the heart, kidneys, and skeletal muscle. When the liver is damaged, AST is leaked into the blood, and the level in the blood (the level shown on a health checkup) increases.
•  ALT, unlike AST, is an enzyme found primarily in the liver. Therefore, it is an indicator that helps to determine the condition of the liver.
• Alcohol-induced liver damage increases AST more than ALT. If you are a heavy drinker, you should pay more attention to your AST levels.

Normal AST Range
Male: 10-40 IU/L
Female: 9-32 IU/L

Normal ALT Range
7-55 IU/L

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Absolute level? Important thing is The AST/ALT ratio.

It is difficult to conclusively conclude that an elevated absolute level of AST or ALT indicates a specific disease. It is more accurate to estimate health status through the ratio of AST/ALT levels.

 

When AST levels are relatively high

• Alcohol-related liver disease
• Steatohepatitis
• Cirrhosis
• Diseases not related to the liver, such as hemolysis, myopathy, thyroid disease, and lack of exercise

→ In patients with frequent/high alcohol consumption, the AST/ALT ratio is typically greater than 2:1.

→ In patients with alcohol abuse, GGT levels are often elevated along with elevated AST. However, since GGT is not highly specific for alcohol, it is difficult to judge like "high GGT = alcohol abuse". You should look at the AST level together with the GGT level.

 

When ALT levels are relatively high

• Viral hepatitis
• Nonalcoholic fatty liver disease (NAFLD)
• Liver disease such as cirrhosis and liver cancer

Actually don't usually drink alcohol, but the liver level showed high.

What happened?

Are the results wrong??

Even if you don't drink alcohol at all, there are cases where liver levels are high after a health checkup. This is usually accompanied by relatively high ALT levels.

Case 56 years old
BMI 28 kg/m², no alcohol consumption

Ultrasound findings: hepatic echogenicity showing fatty liver
Family history of type 2 diabetes
ALT 38 IU/L, AST 25 IU/L
Cholesterol 5.2 mmol/L, triglyceride 4.1 mmol/L, HDL 1.2 mmol/L
Source: Non-alcoholic fatty liver disease Naveed Sattar et al 2014

Non-alcoholic fatty liver disease has relatively high levels of ALT.

In non-alcoholic fatty liver disease (NAFLD), the AST/ALT ratio is often less than 0.8. That is, ALT>AST. Contrast with alcoholic liver disease (AST>ALT).

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I'm very, very healthy, but what if my liver levels are particularly high?

 

When we are sick, we usually take medicine.

 

The liver is an organ that digests/metabolizes the medicines you take. Therefore, if you are taking a lot of medicine on a regular basis, your liver may suffer from like overtime/night shift. This type of drug-induced liver damage is called DILI (Drug Induced Liver Injury).

Drugs cause DILI

Drugs that cause DILI are:

• Antibiotic**
• Rheumatoid Arthritis Drugs (DMARDs)
• painkiller
• antiviral agent
• + Dietary supplements have also been shown to induce DILI.

**Specifically, flomoxef, ciplofloxacin, sulfamethoxazole/trimethoprim, isoniazid, amoxicillin/clavulanate, and clarithromycin are applicable.

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Precautions when interpreting ALT and AST

• In patients with chronic hepatitis B who have progressed to severe cirrhosis (cirrhosis) or have been diagnosed with liver cancer, ALT levels may be within the normal range.
• ALT and AST are levels of liver enzymes in the blood. In addition to the liver, diseases of other organs or the environment may be affected. Therefore, it is necessary to make an accurate diagnosis by performing additional tests such as CT and ultrasound, depending on whether there is an abnormality in the blood test.

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An important organ in our body, Liver

The liver is one of the largest organs in our body and is essential for life. The main functions of the liver in our body are as follows:

 

1. Processes nutrients such as proteins, sugars, vitamins, and fats.

2. Produces bile to aid in the absorption of fats and fat-soluble vitamins.

3. It makes harmless by removing toxic substances such as alcohol, ammonia, nicotine, drugs, and harmful substances produced during digestion. (detoxification)

4. The final role is recycling of blood, which removes old red blood cells. The iron contained in old red blood cells removed by the liver is recycled to make new red blood cells in the bone marrow.

 

It was an article about AST/ALT, a key indicator of liver health.