In liver function test reports, transaminase is the most sensitive and crucial indicator of liver function. It can assess the degree of liver damage and is an important basis for deciding whether antiviral treatment is necessary.

First, transaminase is only a single indicator

Liver function should be assessed through multiple indicators, not just by transaminase levels alone. For example, taking enzyme-lowering medication can bring transaminase levels back to normal, but hepatitis activity may be masked. Therefore, before initiating antiviral treatment, a clear understanding of the condition is necessary to avoid delaying therapy.

In addition to liver function tests, clinical evaluation should also include comprehensive assessments such as ultrasound, hepatitis B virus DNA (HBVDNA), and liver elasticity measurements to determine the level of hepatitis B virus replication, infectivity, liver stiffness, and structural changes in the liver. When necessary, liver biopsy for pathological examination may also be considered. Some hepatitis B patients may have transaminase levels within the standard range, yet their liver damage could be progressing slowly and progressively, with no obvious physical discomfort. However, through the comprehensive tests mentioned above, it can be determined that liver damage is occurring, and active treatment should be pursued at that time.

Second, under what circumstances should antiviral treatment be considered?

1. If a liver biopsy clearly shows liver tissue necrosis and fibrosis, antiviral treatment should be considered even if liver function is normal.

2. For individuals aged 30 and above, with a family history of liver cirrhosis or liver cancer, positive HBV DNA results, and normal transaminase levels, antiviral therapy is also recommended to prevent the occurrence of liver cirrhosis and liver cancer.

3. For patients with liver cirrhosis, more proactive intervention is required. As long as the virus is positive, treatment is recommended, and it is advised to use high-sensitivity detection reagents for HBV DNA testing. Regardless of transaminase levels, treatment is recommended as long as the virus is positive.

III. Elevated transaminase levels are not necessarily caused by hepatitis B

Elevated transaminase levels in individuals infected with the hepatitis B virus are not necessarily due to hepatitis B. This is because many factors can cause elevated transaminase levels, including alcohol, medications, intense exercise, and insufficient sleep. Therefore, after detecting elevated transaminase levels, it is important to rule out the above factors before attributing it to hepatitis B-related transaminase elevation and considering treatment.