Single ALT elevation
Introduction
Introduction In China in the 1960s, the population ALT survey was widely carried out, and the asymptomatic serum ALT increased about 5%-10% of the population. After the development of HBsAg detection, the detection rate of HBsAg was found to be three times higher than that of normal people with abnormal ALT. Nearly half of the individuals with elevated ALT were hepatitis B without jaundice.
Cause
Cause
It is generally believed that no jaundice hepatitis has the characteristics of "three slow": slow onset, slow recovery, and slow progress. Under adverse conditions, jaundice-free hepatitis can also be converted to jaundice-type hepatitis, which is related to the amount of virus, the strength of viral virulence, and the level of immunity or resistance of the body.
Examine
an examination
Related inspection
Liver, gallbladder, spleen CT examination liver function test
(1) In addition to visual observation of no jaundice, serum jaundice index and bilirubin quantification are generally normal.
(2) Clinical symptoms and signs are similar to jaundice hepatitis. However, the symptoms are mild, and the fever cases are less than that of jaundice type hepatitis. Some patients are asymptomatic and found in the health screening.
(3) There are more liver enlargement and liver discomfort or pain.
(4) Liver function damage is mild, and transaminase is slightly elevated.
(5) Insidious onset, after a slow, mild symptoms. Therefore, some patients cannot be detected early after the illness, and the course of the disease is prolonged. In the absence of jaundice-type viral hepatitis, the clinical symptoms did not improve or aggravate within 36 to 9 months after the onset, 36.04%, the liver examination did not shrink or the increase was still 62.44%, and the course of recurrence was 57.2%. Cases can be extended for more than 1 to 6 years. In most cases of jaundice hepatitis (76.66%), the clinical symptoms disappeared or significantly improved in 4 to 9 weeks, and the liver retracted or returned to normal.
(6) The incidence of non-jaundice hepatitis is much higher than that of jaundice hepatitis, accounting for more than 90% of the total incidence.
Diagnosis
Differential diagnosis
Differential diagnosis of single ALT elevation:
Biliary atresia
Mainly in the presence of jaundice and the differentiation of pathological jaundice in the neonatal period. Hepatitis B is hepatic jaundice, and serum bilirubin is biphasic. However, in the early neonatal period, hepatic cell excretion is blocked first, and obstructive jaundice appears. Therefore, the most important thing is to distinguish it from biliary atresia. Because the latter must strive to diagnose the operation within 3 months after birth. Both can be identified from the following aspects:
(1) Medical history: The general condition and stomach anorexia of hepatitis B patients may be fluctuating, the degree of jaundice may fluctuate, the color of white clay soil is also fluctuating, the degree of hepatosplenomegaly is not significant, and the early transaminase is high.
(2) serum fetal globulin: hepatitis B is significantly increased, often greater than 1600ng / ml.
(3) iodine rose red excretion test: after taking phenobarbital or cholestyramine in hepatitis B, 131I rose red excretion increased and there was no change in biliary atresia.
(4) Vitamin E absorption test: Hepatitis B can reduce the hemolysis effect of hydrogen peroxide after oral administration of vitamin E, and the biliary atresia can not be improved.
(5) Lipoprotein X measurement: Hepatitis B was negative for lipoprotein X and positive for biliary atresia.
(6) Others: For example, 99mTc-IDA imaging examination, B-mode ultrasound examination, percutaneous liver biopsy, and duodenal fluid biliary pigmentation examination are more meaningful for the diagnosis of biliary atresia.
2. Metabolic deficiency diseases: such as galactosemia, 1-antitrypsin deficiency, and the like. The mother of this disease is suffering from hepatitis B, which is directly transmitted to the fetus by the mother, and the incidence of neonatal is high. Laboratory tests help to differentiate the diagnosis.
(1) In addition to visual observation of no jaundice, serum jaundice index and bilirubin quantification are generally normal.
(2) Clinical symptoms and signs are similar to jaundice hepatitis. However, the symptoms are mild, and the fever cases are less than that of jaundice type hepatitis. Some patients are asymptomatic and found in the health screening.
(3) There are more liver enlargement and liver discomfort or pain.
(4) Liver function damage is mild, and transaminase is slightly elevated.
(5) Insidious onset, after a slow, mild symptoms. Therefore, some patients cannot be detected early after the illness, and the course of the disease is prolonged. In the absence of jaundice-type viral hepatitis, the clinical symptoms did not improve or aggravate within 36 to 9 months after the onset, 36.04%, the liver examination did not shrink or the increase was still 62.44%, and the course of recurrence was 57.2%. Cases can be extended for more than 1 to 6 years. In most cases of jaundice hepatitis (76.66%), the clinical symptoms disappeared or significantly improved in 4 to 9 weeks, and the liver retracted or returned to normal.
(6) The incidence of non-jaundice hepatitis is much higher than that of jaundice hepatitis, accounting for more than 90% of the total incidence.
