Patient's question:
I had a miscarriage in September and took some anti-inflammatory medication intermittently. In early October, I had a physical check-up, and my AST was 98.7 and ALT was 209.3. After that, I took about a week of azithromycin. In early November, I had another follow-up check-up and found that my AST was 121.5 and ALT was 312.5. Later, I had tests for hepatitis A, B, C, and E, as well as autoimmune globulin, and all the results were negative, indicating no issues. Could it be caused by the medication?Doctor's answer:
There are many types of aminotransferases in the human body. Clinically, blood tests are primarily used to detect liver function by measuring two main types of aminotransferases: one is Alanine Aminotransferase (ALT), and the other is Aspartate Aminotransferase (AST).??ALT and AST are mainly present in liver cells, while other organs such as the kidneys, heart muscle, pancreas, muscles, spleen, bile ducts, and lungs also contain certain amounts of ALT and AST. ALT is mainly found in the cytoplasm, while AST is primarily located in the mitochondria of the cytoplasm. When cells are damaged (e.g., in cases of hepatitis, myocarditis, pancreatitis, etc.), ALT first enters the bloodstream. When cells suffer severe damage that threatens the mitochondria, AST also enters the blood. Additionally, conditions such as malnutrition, excessive alcohol consumption, certain medications, and fever can cause mild increases in aminotransferase levels. Under physiological conditions, serum aminotransferase levels can also vary, such as during intense physical activity, exercise, or the menstrual period, when aminotransferase levels may temporarily rise.
Since ALT and AST are primarily found in liver cells, their significant elevation often suggests liver damage. Of course, there are many causes of liver damage, such as liver trauma, various acute and chronic liver inflammations, fatty liver, cirrhosis, and liver cancer. Therefore, when aminotransferase levels rise, it is neither advisable to panic nor to take it lightly—further investigation into the cause is necessary.
??Generally speaking, if the serum ALT level exceeds the normal upper limit by 2 to 3 times and persists for more than two weeks, it may indicate the possibility of liver or bile duct disease, and conditions such as alcoholism, myocarditis, chemical drug poisoning, and parasitic diseases should be ruled out. If the measured value exceeds the normal upper limit by 20 times, it indicates