Elevated Liver Enzymes: Should You Worry?

Liver enzyme levels are normal but higher than the values from three years ago?

Hello, doctor: I am 40 years old and a carrier of hepatitis B.
I have been undergoing regular abdominal ultrasounds and blood tests every six months at Renai Hospital in Taipei.
Each time, the results have been normal, with mild fatty liver.
In March of this year, my test results showed AFP 2.42, ALT 35, and AST 27.
Although these values are higher compared to 2019, where my AFP was 2.80, ALT was 20, and AST was 21, I am concerned.
Should I be worried about liver inflammation?

Yu Yan, 40~49 year old female. Ask Date: 2022/03/29

Dr. Zeng Guosen reply Internal Medicine

Hello, the AFP level is 2.42, ALT is 35, and AST is 27, all of which are within the normal range, indicating no inflammation.
You may consider testing for hepatitis B viral load for a comprehensive assessment.
You can compare all the series of follow-up data; they should remain within the normal range, although there may be fluctuations.
Thank you for your question.

Reply Date: 2022/03/29

More Info

Elevated liver enzymes, particularly ALT (alanine aminotransferase) and AST (aspartate aminotransferase), can be a cause for concern, especially for individuals with a history of hepatitis B virus (HBV) infection. In your case, you mentioned that you are a 40-year-old individual with a history of being a hepatitis B carrier, and your recent lab results show slight increases in your liver enzymes compared to previous years.
Firstly, it is important to understand what elevated liver enzymes indicate. ALT is primarily found in the liver and is a specific marker for liver inflammation or damage. AST, on the other hand, is found in various tissues, including the liver, heart, and muscles, and is less specific to liver disease. Elevated levels of these enzymes can suggest liver inflammation, but they do not provide a definitive diagnosis on their own.
In your case, your ALT level of 35 and AST level of 27 are within the normal range for many laboratories, but they are higher than your previous values. The slight increase in these enzymes could indicate a mild degree of liver inflammation, possibly due to several factors, including:
1. Fatty Liver Disease: You mentioned having mild fatty liver, which can contribute to elevated liver enzymes. Non-alcoholic fatty liver disease (NAFLD) is common and can lead to inflammation (non-alcoholic steatohepatitis or NASH) if not managed properly.

2. Viral Hepatitis Activity: As a hepatitis B carrier, fluctuations in liver enzyme levels can occur due to changes in viral replication or immune response. Even if you are not experiencing symptoms, it is possible for the virus to reactivate, leading to increased liver inflammation.

3. Other Factors: Lifestyle factors such as diet, alcohol consumption, medications, and other underlying health conditions (like diabetes or obesity) can also affect liver enzyme levels.

Given your history of hepatitis B and the recent changes in your liver enzyme levels, it is advisable to follow up with your healthcare provider. They may recommend additional tests, such as:
- HBV Viral Load: To assess the level of viral replication and determine if there is active viral hepatitis.

- Liver Function Tests: To evaluate other liver function parameters, including bilirubin levels and albumin.

- Hepatitis B Serology: To check for HBeAg and anti-HBe antibodies, which can provide insight into the level of viral activity and the immune response.

- Liver Imaging: An ultrasound or other imaging studies may be warranted to assess the liver's condition further.

In conclusion, while your current liver enzyme levels are not alarmingly high, the increase compared to previous values warrants further investigation. It is essential to maintain regular follow-ups with your healthcare provider, adhere to a healthy lifestyle, and avoid alcohol and hepatotoxic substances. If you have any concerns about your liver health or the implications of your hepatitis B status, do not hesitate to discuss them with your doctor. They can provide personalized recommendations based on your overall health and medical history.

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