Uno de cada cinco españoles se encuentra en riesgo de padecer una enfermedad del hígado. Relacionadas y causadas por hábitos y estilos de vida poco saludables, como son el consumo excesivo de alcohol, una dieta poco saludable y el sedentarismo, estas enfermedades hepáticas son cada vez más prevalentes, convirtiéndose en la quinta causa de muerte en el mundo y la tercera causa de muerte prematura en España.
Uno de los marcadores que nos hablan del riesgo de padecer una enfermedad del hígado que con el tiempo puede evolucionar a cirrosis y cáncer de hígado, son las transaminasas, cuya determinación debería incluirse en los análisis bioquímicos rutinarios solicitados por el médico de atención primaria, ya que unos valores altos de transaminasas, detectables en una simple muestra de sangre, pueden indicar la existencia de una enfermedad del hígado.
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Un nivel elevado de transaminasas (GOT, GPT y GGT) es una señal de alerta de inflamación hepática, pero no siempre es grave. Antes de alarmarte, recuerda que el ejercicio intenso o ciertos suplementos pueden elevarlas temporalmente. Revisa siempre tu medicación habitual con tu médico o farmacéutico para descartar toxicidad hepática.
¿Qué son las transaminasas y por qué se elevan?
Las transaminasas son enzimas que se producen en las células de distintas partes del cuerpo, fundamentalmente en el hígado, pero también en los músculos, los riñones, el corazón o el cerebro. Su función es la de intervenir en la producción de diversos aminoácidos, pequeñas moléculas de las proteínas que son necesarias para el almacenamiento de la energía y el desarrollo del organismo.
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Los tipos más estudiados de transaminasas son la glutámico-oxalacética (GOT) y la glutamicopirúvica (GPT). La GPT está en concentraciones más elevadas en el hígado que en otros tejidos, por lo que es más específica del hígado. Se podría situar el límite superior de estas transaminasas en alrededor de 40 unidades internacionales por litro (UI/L). En el caso de una hepatitis A, por ejemplo, estos valores se pueden disparar hasta los 3.000 a 4.000 UI/L o incluso más.
Causas comunes de las transaminasas altas
La presencia de transaminasas en el hígado, el corazón, los riñones o los músculos, debe ser equilibrada y aunque no forzosamente es sinónimo de enfermedad, la elevación de los niveles de este tipo de molécula en sangre puede advertirnos de una lesión hepática o proceso inflamatorio en el hígado (hepatitis), ya que esta inflamación destruye células hepáticas que liberan transaminasas en la sangre.
¿Por qué suben las transaminasas? Causas más frecuentes
- Hígado graso (esteatosis hepática) alcohólico o no alcohólico.
- Consumo excesivo de alcohol o dietas ricas en grasas.
- Infecciones virales como la Hepatitis.
- Uso crónico de fármacos (paracetamol, estatinas o antibióticos).
- Enfermedades autoinmunes o problemas en la vesícula biliar.
Enfermedades hepáticas (más allá del alcohol)
Además de un consumo elevado de alcohol, que destruye células del hígado y con ellas se liberan transaminasas a la sangre, diversas enfermedades del hígado también elevan las transaminasas: es el caso de las hepatitis virales agudas sintomáticas (hepatitis A, hepatitis B y hepatitis C), que pueden hacer subir los niveles de transaminasas hasta 25 veces por encima de lo normal, si bien en las infecciones crónicas, los valores son muy variables y casi nunca superan los valores 10 veces por encima de la normalidad; las enfermedades autoinmunes; las infecciosas; las hepatitis isquémicas (por falta de riego sanguíneo al hígado); y la enfermedad del hígado graso (acumulación de exceso de grasa en el hígado), que a su vez, puede ser alcohólica o no alcohólica. Y entre un 5 y un 10 % de los pacientes con elevación crónica de las transaminasas presentan enfermedad celíaca.
La enfermedad hepática del hígado graso no alcohólico, también llamada hepatopatía grasa no alcohólica (HEGNA), es la causa más común de la elevación ligeramente alta de las transaminasas (menos de 5 veces por encima de lo normal) en el análisis de sangre. Esta enfermedad, que a diferencia del hígado graso por alcohol, no está relacionada con el consumo de alcohol, se asocia al sobrepeso y la obesidad, aunque también presenta otros factores de riesgo, como prediabetes, diabetes tipo II, colesterol alto, triglicéridos altos y presión arterial alta.
Según explican desde la Federación Española del Aparato Digestivo (FEAD), la esteatosis simple es la fase 1 de esta enfermedad, producida por la acumulación excesiva de grasa dentro de las células del hígado, pero que no está relacionada con el consumo de alcohol. Hoy en día, la HEGNA es la enfermedad del hígado más frecuente, por encima de la producida por el alcohol y de la hepatitis C.
La mayoría de los enfermos presentan una lesión de tipo 1 (esteatosis simple), la menos grave y en la que se observa un exceso de grasa en el hígado. En el tipo 2, la lesión se llama esteatohepatitis e implica que, además de grasa, existe inflamación y, a veces, cicatrices (fibrosis). En el tipo 3 se produce la cirrosis, que es el grado máximo de fibrosis, es decir, ya hay un hígado con muchas cicatrices rodeando a la poca grasa e inflamación que quedan.
También la hepatitis alcohólica, enfermedad que se caracteriza por la inflamación del hígado y que se manifiesta con ictericia (piel amarilla), pérdida de apetito, náuseas, vómitos, fatiga y sensibilidad abdominal, provoca una elevación de las transaminasas en sangre 10 veces por encima del límite de normalidad.
Medicamentos que pueden alterar tus niveles hepáticos
Y por último, algunos fármacos son susceptibles de provocar inflamación del hígado, lo que se conoce como toxicidad por fármacos. Existe un registro nacional de los casos de hepatitis tóxica y los fármacos más implicados son amoxicilina-clavulánico, las sulfamidas, el paracetamol, antiinflamatorios no esteroideos (AINEs), metrotexato, fenitoína y fármacos inhibidores de la enzima convertidora de angiotensina (IECA), antihipertensivos, entre otros. También las estatinas, utilizadas para tratar la concentración elevada de colesterol, pueden aumentar los niveles de enzimas hepáticas en sangre y causar daño en el hígado.
Proceso de diagnóstico y pruebas asociadas
El diagnóstico de la enfermedad hepática suele ser tardío, en el contexto de una descompensación, cuando el pronóstico ya es poco favorable. Y precisamente, las concentraciones aumentadas de transaminasas en sangre sirven como marcador para el diagnóstico temprano.
En general, la biopsia, una punción del hígado con la que se obtiene una muestra de tejido para su estudio al microscopio, está indicada para el diagnóstico de enfermedades hepáticas, y a partir de ahí evaluar el pronóstico del paciente y tomar las decisiones adecuadas para iniciar el tratamiento.
Tratamiento y prevención
Dieta y consejos farmacéuticos para proteger tu hígado:
- Eliminando la ingesta de alcohol: ni vino, ni cerveza ni bebidas espirituosas.
- Llevando una dieta saludable, rica en frutas, vegetales y carnes magras y baja en grasa y limitada en carne grasa y embutidos. Los fritos y rebozados no son recomendables, mientras la bollería, refrescos y alimentos azucarados y procesados están totalmente desaconsejados.
- Sustituyendo los productos lácteos enteros (leche, yogures, queso…) por desnatados; las carnes grasas por carnes magras, evitando las mantequillas y priorizando el aceite de oliva virgen (grasa monoinsaturada); evitando los fritos, embutidos, yema de huevo, fritos comerciales y bollería industrial.
- Aumentando el consumo de ácidos grasos omega 3, introduciendo en la dieta al menos tres raciones a la semana de pescado azul.
- Potenciando el consumo de agua para eliminar la grasa del cuerpo en el caso de hígado graso.
- Utilizando métodos de cocinado con poca grasa como el horno, plancha, parrilla, asados y cocción al vapor.
- El consumo de infusiones a base de plantas como el cardo mariano o el boldo también sirve de ayuda pero están contraindicadas en personas con daño hepático severo o enfermedades crónicas de este órgano, como cirrosis, por lo que hay que consultar al especialista antes de consumirla.
- Practicar regularmente ejercicio físico. Un estilo de vida sedentario puede provocar un aumento de las transaminasas y predispone a padecer enfermedades del hígado.
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