Zeitschrift für Komplementärmedizin 2021; 13(02): 54-61
DOI: 10.1055/a-1410-1677
Wissen
Refresher

Erhöhte Leberwerte

Axel Holstege

Summary

Erhöhte Leberwerte sind ein häufiger klinischer Befund, der bei symptomatischen Patienten, aber auch als symptomloser Zufallsbefund auftreten kann. Der vorliegende Beitrag erläutert, wie das Muster bestimmter pathologisch veränderter Leberwerte bereits eine erste differenzialdiagnostische Eingliederung ermöglicht und in welchen Fällen eine weiterführende Diagnostik notwendig ist.



Publication History

Article published online:
21 April 2021

© 2021. Thieme. All rights reserved.

© Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co.
KG

 
  • Literatur

  • 1 Holstege A. Überraschende Transaminasenerhöhung. MMW-Fortschr Med 2014; 156: 62-63
  • 2 Vogt W, Holstege A. Problem: Abklärung mäßig erhöhter Transaminasen und γ-GT. In: Schölmerich J, Bischoff SC, Manns MP, Hrsg. Diagnostik in der Gastroenterologie und Hepatologie. Stuttgart: Thieme;; 1997: 151-160
  • 3 Willson RA, Clayson KJ, Leon S. Unmeasurable serum alkaline phosphatase activity in Wilson's disease associated with fulminant hepatic failure and hemolysis. Hepatology 1987; 7: 613-615
  • 4 Williams AL, Hoofnagle JH. Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis. Gastroenterology 1988; 95: 734-739
  • 5 Patel K, Bedossa P, Castera L. Diagnosis of liver fibrosis: Present and future. Semin Liver Dis 2015; 35: 166-183
  • 6 Triger DR, Wright R. Hyperglobulinaemia in liver disease. Lancet 1973; 1 7818 1494-1496
  • 7 Wedemeyer H, Pischke S, Manns MP. Pathogenesis and treatment of hepatitis E virus infection. Gastroenterology 2012; 142: 1388-1397
  • 8 Manns MP, Lohse AW, Vergani D. Autoimmune hepatitis – Update 2015. J Hepatol 2015; 62 (Suppl. 01) S100-111
  • 9 Bacon BR, Adams PC, Kowdley KV. et al Diagnosis and management of hemochromatosis: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology 2011; 54: 328-343
  • 10 Ioannou GN, Dominitz JA, Weiss NS. et al The effect of alcohol consumption on the prevalence of iron overload, iron deficiency, and iron deficiency anemia. Gastroenterology 2004; 126: 1293-1301
  • 11 Bomford A. Genetics of haemochromatosis. Lancet 2002; 360 9346 1673-1681
  • 12 Sarigianni M, Liakos A, Vlachaki E. et al Accuracy of magnetic resonance imaging in diagnosis of liver iron overload: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2015; 13: 55-63
  • 13 Roberts EA, Schilsky ML. American Association for the Study of Liver Diseases (AASLD). Diagnosis and treatment of Wilson disease: An update. Hepatology 2008; 47: 2089-2111
  • 14 Fontana RJ, Seeff LB, Andrade RJ. et al Standardization of nomenclature and causality assessment in drug-induced liver injury: Summary of a clinical research workshop. Hepatology 2010; 52: 730-742
  • 15 Holstege A. Leberschäden durch Medikamente. Kapitel 6.7.2. In: Messmann H, Hrsg. Klinische Gastroenterologie. Stuttgart: Thieme;; 2012: 599-605
  • 16 Li J, Zhang YL, Chen R. et al Elevated serum liver enzymes in patients with obstructive sleep apnea-hypopnea syndrome. Chin Med J 2015; 128: 2983-2987
  • 17 Kiladjian JJ, Cervantes F, Leebeek FW. et al The impact of JAK2 and MPL mutations on diagnosis and prognosis of splanchnic vein thrombosis: A report on 241 cases. Blood 2008; 111: 4922-4929
  • 18 McDonald GB, Hinds MS, Fisher LD. et al Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: A cohort study of 355 patients. Ann Intern Med 1993; 118: 255-267
  • 19 Kechagias S, Ernersson A, Dahlqvist O. et al Fast-food-based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects. Gut 2008; 57: 649-654
  • 20 Rogal SS, Ukomadu C, Levy BD. et al A sweet source of abdominal pain. N Engl J Med 2011; 364: 1762-1767
  • 21 Beuers U, Gershwin ME, Gish RG. et al Changing nomenclature for PBC: From 'cirrhosis' to 'cholangitis'. Clin Res Hepatol Gastroenterol 2015; 39: e57-e59
  • 22 Marzorati S, Invernizzi P, Lleo A. Making sense of autoantibodies in cholestatic liver diseases. Clin Liver Dis 2016; 20: 33-46
  • 23 Schwarze C, Terjung B, Lilienweiss P. et al IgA class antineutrophil cytoplasmic antibodies in primary sclerosing cholangitis and autoimmune hepatitis. Clin Exp Immunol 2003; 133: 283-289
  • 24 Holstege A, Zolinski P, Woidy L. et al The patient with unexplained elevated serum liver enzymes. Best Pract Res Clin Gastroenterol 2007; 21: 535-550
  • 25 Boonstra K, Culver EL, de Buy Wenniger LM. et al Serum immunoglobulin G4 and immunoglobulin G1 for distinguishing immunoglobulin G4-associated cholangitis from primary sclerosing cholangitis. Hepatology 2014; 59: 1954-1963
  • 26 Beuers U, Hubers LM, Doorenspleet M. et al IgG4-associated cholangitis – A mimic of PSC. Dig Dis 2015; 33 (Suppl. 02) 176-180
  • 27 Ziol M 1, Barbu V, Rosmorduc O. et al ABCB4 heterozygous gene mutations associated with fibrosing cholestatic liver disease in adults. Gastroenterology 2008; 135: 131-141
  • 28 Boyer JL. Bile formation and secretion. Compr Physiol 2013; 3: 1035-1078
  • 29 Jangouk P, Hashash JG. An unusual cause of painless jaundice. Renal cell carcinoma (Stauffer syndrome). Gastroenterology 2014; 146: 913, 1138
  • 30 Lammert F, Neubrand MW, Bittner R. et al S3-Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten und der Deutschen Gesellschaft für Viszeralchirurgie zur Diagnostik und Behandlung von Gallensteinen. Z Gastroenterol 2007; 45: 971-1001
  • 31 Zimmer V, Lammert F. Acute bacterial cholangitis. Viszeralmedizin 2015; 31: 166-172
  • 32 Burt AD, Lackner C, Tiniakos DG. Diagnosis and assessment of NAFLD: Definitions and histopathological classification. Semin Liver Dis 2015; 35: 207-220
  • 33 Tannapfel A, Denk H, Dienes HP. et al Histopathologische Diagnose der nicht alkoholischen und alkoholischen Fettlebererkrankung. Z Gastroenterol 2010; 48: 486-498
  • 34 Musso G, Gambino R, Cassader M. et al Meta-analysis: Natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med 2011; 43: 617-649
  • 35 Newsome PN, Sasso M, Deeks JJ. et al FibroScan-AST (FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: a prospective derivation and global validation study. Lancet Gastroenterol Hepatol 2020; 5: 362-373
  • 36 Eddowes PJ, Sasso M, Allison M. et al Accuracy of FibroScan Controlled Attenuation Parameter and Liver Stiffness Measurement in Assessing Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology 2019; 156: 1717-1730
  • 37 Holstege A. Leberschäden durch Alkohol. Kapitel 6.7.1. In: Messmann H, Hrsg. Klinische Gastroenterologie. Stuttgart: Thieme;; 2012: 594-599
  • 38 Alte D, Luedemann J, Rose HJ. et al Laboratory markers carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean corpuscular volume are not useful as screening tools for high-risk drinking in the general population: Results from the Study of Health in Pomerania (SHIP). Alcohol Clin Exp Res. 2004; 28: 931-940
  • 39 Strobel D, Bernatik T, Blank W. et al Diagnostic accuracy of CEUS in the differential diagnosis of small (≤ 20 mm) and subcentimetric (≤ 10 mm) focal liver lesions in comparison with histology. Results of the DEGUM multicenter trial. Ultraschall Med 2011; 32: 593-597
  • 40 Lazo M, Selvin E, Clark JM. Brief communication: Clinical implications of short-term variability in liver function test results. Ann Intern Med 2008; 148: 348-352
  • 41 Pratt DS, Kaplan MM.. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 2000; 342: 1266-1271