Abnormal Liver Enzymes: A Guide for Hepatitis B Carriers - Gastroenterology and Hepatology

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Understanding abnormal liver enzymes is crucial for individuals who are carriers of Hepatitis B, especially when considering the implications for liver health and potential treatment options. In your case, as a Hepatitis B carrier with a history of fluctuating liver enzyme levels, it is essential to interpret these changes in the context of your overall health and liver function.

Liver enzymes, specifically alanine aminotransferase (ALT or GPT) and aspartate aminotransferase (AST or GOT), are indicators of liver health. Normal levels of ALT and AST are typically below 40 U/L, but these values can vary slightly depending on the laboratory and the methods used. Elevated levels of these enzymes can indicate liver inflammation or damage, which can be caused by various factors, including viral hepatitis, fatty liver disease, alcohol consumption, and certain medications.

In your situation, the significant increase in your GPT levels to 251 and GOT to 85 is concerning. This suggests that there is ongoing liver inflammation or damage. The fact that your ultrasound showed no abnormalities is reassuring, but it does not rule out the possibility of liver inflammation or fibrosis that may not be visible through imaging alone.
The management of elevated liver enzymes in Hepatitis B carriers typically involves a comprehensive approach. Since you have fatty liver disease, it is vital to address lifestyle factors such as diet and exercise, as these can significantly impact liver health. Weight loss, if applicable, can help reduce liver fat and improve liver enzyme levels.

Regarding your current treatment with Sikan (賜康), it is important to note that while this medication may provide some support for liver health, it is not an antiviral treatment and will not directly lower your ALT or AST levels. The decision to initiate antiviral therapy, such as entecavir or tenofovir, is generally based on specific criteria, including the presence of significant liver inflammation (often indicated by elevated ALT levels), the presence of hepatitis B virus (HBV) DNA, and liver biopsy results if available.

Your doctor’s recommendation to wait for 2-3 months before re-evaluating your liver enzymes and considering antiviral therapy is consistent with standard practice. However, if your liver enzymes continue to rise or if you experience symptoms such as fatigue, jaundice, or abdominal pain, it would be prudent to follow up sooner.
In terms of the criteria for initiating antiviral therapy, the guideline you mentioned about needing two consecutive tests showing elevated liver enzymes is common. However, if your ALT levels are significantly elevated (more than twice the upper limit of normal), this may warrant earlier intervention.
It is also essential to monitor for any signs of liver dysfunction, such as changes in mental status, bleeding tendencies, or significant abdominal swelling, which could indicate more severe liver disease. Regular follow-up with your healthcare provider is crucial to ensure that your liver health is closely monitored and managed appropriately.

In summary, while Sikan may provide some supportive care, it is essential to have a thorough discussion with your healthcare provider regarding the potential need for antiviral therapy, especially given your recent elevations in liver enzymes. Lifestyle modifications, regular monitoring, and timely medical intervention are key components in managing your liver health as a Hepatitis B carrier.