What do the three plus signs of hepatitis mean?

Hepatitis B is an infectious disease caused by hepatitis B virus (HBV), which is mainly caused by inflammatory lesions of the liver and can cause multiple organ damage. This disease is common in all countries in the world, mainly affecting children and young people, and a few patients can turn into cirrhosis or liver cancer. Therefore, it has become a worldwide disease that seriously threatens human health, and it is also the most widely distributed and harmful infectious disease in China.

Hepatitis B does not have a certain epidemic period and can occur all year round, but it is mostly sporadic. In recent years, the incidence of hepatitis B has obviously increased. Fx 120 reminds you that measures such as avoiding epidemic areas, paying attention to health habits, living conditions and improving autoimmune level can effectively prevent hepatitis B.

In medicine, hepatitis can be divided into seven types: A, B, C, D, E, F and G, among which hepatitis B is the most widespread and harmful infectious hepatitis. Hepatitis B is an inflammatory injury of the liver caused by hepatitis B virus. The disease spreads all over the world, and its clinical manifestations are fatigue, anorexia, nausea, vomiting, aversion to oil, diarrhea and abdominal distension. Some cases have fever and jaundice, and about half of them have hidden symptoms, which were found during examination. After hepatitis B virus infects human body, it widely exists in blood, saliva, vaginal secretions, milk, semen and other places, and is mainly transmitted through blood, sexual contact and close contact, so the incidence of hepatitis B is familial.

But not everyone infected with the virus will become a hepatitis B patient, which is closely related to the number, virulence and infection mode of the virus infected by the patient. Everyone's physical fitness and immune response status also play an important role in the prognosis of hepatitis B. Therefore, people infected with hepatitis B virus may have the following results: disease-free and protective hepatitis B surface antibodies, long-term chronic asymptomatic carriers, mild chronic hepatitis and severe hepatitis.

Hepatitis B is difficult to cure, and there is no specific medicine to treat it at present. Therefore, hepatitis B should be treated comprehensively from many aspects: 1, to overcome the enemy's strong will, "anger hurts the liver" and maintain a happy mood; 2. Patients with viral activity must stay in bed until their condition is stable and transaminase does not rise. 3, hepatitis B drugs, such as the use of soldiers, do more harm than good, according to their own condition, under the guidance of experts, choose to take antiviral drugs, immunomodulatory drugs, drugs for promoting blood circulation and removing blood stasis, anti-fibrosis and promoting liver cell regeneration, and do not throw drugs indiscriminately; 4. Keep a regular life and arrange your diet reasonably. The diet is mainly light.

Hepatitis B is difficult to treat, but not difficult to prevent. If we all take preventive measures, hepatitis B will not be terrible. Prevention of hepatitis B includes: 1, extensive implementation of hepatitis B vaccination; 2. Maintain a positive attitude and optimism, and strengthen the confidence to overcome the disease; 3. Understand and master some knowledge about the prevention and treatment of hepatitis B, and develop and adhere to a good and scientific life rule; 4. Reasonably allocate nutrition and diet, avoid alcohol and tobacco, eat less greasy things and avoid constipation; 5. Pay attention to daily life and personal hygiene, change clothes according to the temperature, and actively prevent various infections; 6, actively cooperate with the doctor treatment, medication under the guidance of a doctor, regular review of liver function.

After hepatitis B virus infects the human body, if the body has strong resistance, normal immune function and timely treatment, then hepatitis B virus will be quickly removed, and hepatitis B can be cured in the acute stage. However, once the hepatitis B virus is not cleared in time, it will become chronic and the virus will be carried for a long time. The test shows that it is positive for hepatitis B antigen, which is what we call hepatitis B virus carriers. If hepatitis B virus moves and replicates in liver cells, clinical symptoms will appear. Common symptoms are: discomfort in the liver area, dull pain, general fatigue, fatigue, loss of appetite, nausea, aversion to oil and diarrhea. Patients sometimes have low fever, and in severe cases, jaundice may occur. At this time, they should go to the hospital in time. If the treatment is delayed, a small number of patients will develop severe hepatitis, which is characterized by acute deterioration of liver function until failure, accompanied by multiple organ dysfunction such as renal failure, and patients will have persistent jaundice, oliguria, anuria, ascites, confusion, delirium, coma and other symptoms. Chronic hepatitis B will evolve along the direction of "hepatitis B-cirrhosis-liver cancer" for a long time, which is what we often call "hepatitis B trilogy", so we should take treatment measures and have regular physical examination after suffering from hepatitis B.

How to correctly understand the criteria for judging the therapeutic effect of hepatitis B

Many patients think that only "all three yang turn negative" is the only purpose of hepatitis B treatment. In fact, this view is very incorrect and does not conform to the actual situation of hepatitis B treatment at present. Objective scientific criteria for judging curative effect can be divided into the following categories:

(1) The serological and biochemical indexes such as transaminase and bilirubin recovered to normal, and the clinical symptoms were obviously improved or disappeared. No matter what the virological signs were, it could be regarded as a clinical cure.

(2) Reducing infectivity On the basis of clinical cure, after treatment, E antigen and serum HBV DNA (hepatitis B virus gene) turned negative or virus replication decreased significantly. There are no complete virus particles in the blood of such patients, so the infectivity is extremely low. The liver injury is relatively mild, which should have no obvious influence on recruitment, further education and pregnancy. You can carry out normal social activities, but you should insist on reexamination and observe the changes of your condition. If the following two situations occur, we should actively treat them: the serum HBV DNA turns positive; Abnormal liver function with obvious clinical symptoms; E antigen positive conversion has obvious tendency of liver fibrosis or early signs of cirrhosis.

(3) Virus clearance showed that surface antigen in serum turned negative, and HBVDNA in blood and liver tissue turned negative. And follow-up observation for more than one year without recurrence; However, the complete elimination of hepatitis B virus is still a problem to be solved, which cannot be regarded as the only standard for the cure of hepatitis B before China.

(4) The antibody turns negative. The appearance of antibodies reflects the body's response to the virus. Generally speaking, the production of antibodies is related to treatment, and the disappearance of antibodies has nothing to do with treatment. With the disappearance of antigen, its related antibody will naturally turn negative. The rate at which antibodies turn negative varies from person to person and is also related to the type of antibodies. For example, the natural negative time of E antibody is short, while the core antibody can be maintained in the body for more than ten years. In this case, as long as the serological test of surface antigen and family antigen is negative, the serum HBV DNA is negative, and no matter whether one antibody or several antibodies are positive, there is generally no indication for treatment, and it can be observed regularly. Of course, if the surface antibody is negative, hepatitis B can be inoculated, but the dosage and procedure of inoculation are different from those of normal people, so it is best to use adjuvant at the same time.

What does the elevation of alanine aminotransferase mean?

Viral hepatitis This is the most common cause of alanine aminotransferase (GPT) elevation. CPT in patients with acute and chronic viral hepatitis can be increased, but the degree of increase is not proportional to the degree of liver damage, and the degree of CTP can never be used to judge the severity of the disease.

Many drugs and chemicals used to treat toxic hepatitis, such as erythromycin, isoniazid, phenylbutazone, etc., can all cause the increase of CPT, and CPT will soon return to normal after stopping taking drugs.

CPT of patients with liver cirrhosis and liver cancer, primary or metastatic liver cancer are often higher than normal. However, GPT index of some patients did not change significantly. At this time, other enzymes and alpha-fetoprotein in blood can be determined, and B-ultrasound or CT examination is also helpful for differential diagnosis.

Many studies on alcoholic liver disease show that the CPT level of patients with alcoholic hepatitis, liver cirrhosis and fatty liver is increased, but the cholesterol and triglyceride levels of patients with fatty liver are also increased.

In acute attack of biliary tract diseases such as cholecystitis and cholelithiasis, the CPT index of patients can also increase, but they are all accompanied by symptoms such as fever, abdominal pain, jaundice and bilirubin increase. After the inflammation is controlled, CPT can be reduced to normal.

The level of CPT increased in acute myocardial infarction, myocarditis and heart failure, but the degree of increase was not as obvious as COT.

Other infectious diseases, such as pneumonia and tuberculosis, can also increase CPT, but these diseases have their special clinical manifestations, which can be clearly diagnosed with the help of some laboratory tests.

Hepatitis B is caused by hepatitis B virus (also known as HBV), which exists in blood, sweat, saliva, menstruation, milk and tears of patients with hepatitis B. After patients with acute hepatitis B and acute chronic hepatitis come into contact with the above body fluids and secretions, HBV can enter the blood and become infected with hepatitis B..

The main route of HBV entering the blood:

① Vertical mother-to-child transmission: There are about 65.438+0.4 billion HBsAg positive people in China, of which mother-to-child transmission accounts for 85%. Vertical transmission is the main reason for the spread and high incidence of hepatitis B in China. There are also some father-son communicators. Mother-to-child transmission is mainly through birth canal infection or intrauterine infection.

② Transmission of blood or blood products: Most blood products contaminated by HBV, such as albumin, platelets or blood, will have hepatitis after blood transfusion, and HBV will also be infected during hemodialysis and renal dialysis.

③ Iatrogenic transmission: medical instruments contaminated by HBV (such as scalpels, dental drills, endoscopes, laparoscopy, etc.). ) can spread HBV.

④ Close family contact: it mainly refers to sexual contact and close contact in daily life (such as using toothbrushes, towels, teacups and chopsticks), which may be infected by HBV. HBV can enter the body of close contacts through the damaged mucosa.

⑤ Public places, barber shops, beauty salons, etc. Are easily contaminated by HBV, such as baths and razors, can be infected with HBV.

preventive measure

First of all, mother-to-child transmission is the main route of transmission of hepatitis B in China, which has been highly valued in China. Since 1980s, infants born to HBsAg-positive pregnant women have been injected with hepatitis B vaccine. After 20 years' efforts, the proportion of HBsAg carriers among babies born in Shanghai has dropped from 9.8% to 0.5%. Therefore, we can proudly say that in the near future, the number of HBsAg carriers in China will be significantly reduced, and hepatitis B is completely preventable. Secondly, strictly screen blood donors to ensure that medical blood and blood products are not polluted.

Finally, to strengthen the treatment of patients with hepatitis B, interferon-α is the first choice for chronic active hepatitis B, and to strengthen the popularization of health knowledge and develop good health habits. Through the above measures, I believe that in the near future, the number of patients with hepatitis B will be greatly reduced.

The key to eliminating hepatitis B lies in prevention. Hepatitis B virus can be transmitted in two ways:

Transmission through blood: such as transfusion of whole blood, plasma, serum or other blood products. Mosquitoes in tropical and subtropical regions and various blood-sucking insects may spread hepatitis B virus.

Mother-to-child transmission: pregnant women are carriers of hepatitis B, which is directly transmitted to newborns through the birth canal.

Transmission of body fluids: If medical equipment is contaminated by hepatitis B virus, it will be infected due to incomplete disinfection or improper handling. The spread of sexual contact. Long-term close contact with hepatitis B patients or carriers, such as saliva, urine, blood, bile, milk, etc., will cause pollution and spread hepatitis B.

The detection index of hepatitis B is "two and a half", and its detection method is mature, simple and cheap, which has important clinical significance and can explain many clinical problems. Therefore, the "two-and-a-half" examination is widely carried out in hospitals at all levels. It is customary for people to rank these five indicators in order, namely HBsAg (hepatitis B surface antigen), anti -HBs (hepatitis B surface antibody),-—HBeAg (hepatitis B E antigen), anti -HBe (hepatitis B E antibody) and anti-—HBc (hepatitis B core antibody), and then the first, third and fifth items (namely HBsAg) are all positive.

What is the significance of "three suns"? We will analyze these three positive indicators. The first is HBsAg positive. It is generally suggested that there is hepatitis B virus in the body and it is being infected now; HBeAg positive is the replication index of hepatitis B virus, which indicates that hepatitis B virus is actively replicated in the body, with more virus content and relatively strong infectivity. Anti-—HBc has little positive significance, only suggesting that it has been infected by hepatitis B virus, and now there may or may not be virus in the body. So to sum up, "Big Three Yang" means that there is a clear hepatitis B virus infection, and the virus is actively replicating, with a large number of viruses and strong infectivity.

It should be pointed out that "Big Three Yang" can only explain the situation of virus in the body, but not the situation of liver function and the severity of liver injury. Some people mistakenly think that "big three yang" means serious liver damage, which is wrong. The severity of liver injury can only be determined by liver function examination and B-ultrasound examination, but it is not necessarily related to one or more positive virus indicators.

1, what is hepatitis B? What is the brief pathogenesis?

Hepatitis B is a liver disease caused by HBV infection. HBV itself has no obvious damage to the liver, and it mainly causes liver cell damage through human immune response. HBV infection can stimulate the body to produce a series of antibodies and cellular immune responses. If the body's immune response is normal, the infected virus can be removed and cured. Immune response is not enough to clear the virus, and the virus can persist and become chronic hepatitis B.

2. What is the route of transmission of hepatitis B? How to avoid contracting hepatitis B?

There are three main ways of transmission: blood transmission; Vertical mother-to-child transmission; Sexual transmission. Hepatitis B does not spread through the digestive tract and respiratory tract, so daily contact such as shaking hands, hugging, working together, eating, etc. Generally does not spread hepatitis B, so there is no need to talk about liver discoloration.

The simplest and most effective way to avoid hepatitis B infection is to inject hepatitis B vaccine. Patients exposed to hepatitis B should pay attention to avoid skin and mucous membrane damage. Special reminder: incomplete disinfection of medical devices such as filling teeth, shaving, pedicure, needles, dental instruments and endoscopes may also cause the spread of hepatitis B.

3. Immunization of newborns is the focus of hepatitis B prevention in China.

In China, most hepatitis B virus infections begin in childhood, especially mother-to-child transmission. Infants and young children are more likely to be infected with hepatitis B due to lack of self-protection and delicate and fragile skin, and are more likely to become chronic due to imperfect immune function. According to statistics, 90% of young infected people develop chronic diseases, while only 5- 10% of adult infected people turn into chronic diseases. Therefore, it is the fundamental way to solve hepatitis B at present.

Since June 5438+February, 2002, the government of China has included hepatitis B vaccine in the planned immunization of newborns, and provided hepatitis B vaccine for newborns free of charge at several hundred million yuan every year. The goal is to reduce the HBV carrier rate from165438+ 10% in 1992 to below 1% through the efforts of two generations (about 50 years). The focus of hepatitis B immunization is in rural areas. According to the existing data of the Ministry of Health, the coverage rate of hepatitis B vaccine in cities in China has reached 90%, and that in rural areas is about 40%. There is still too much work to be done.

4. How to prevent mother-to-child transmission?

Mother-to-child transmission is the main mode of transmission of hepatitis B in China. Women should check HBV-DNA before pregnancy, and it is best to consider pregnancy when DNA is negative. Children of HBV-DNA positive mothers should be injected with hepatitis B immunoglobulin as soon as possible after birth, and the success rate is about 95%. It is necessary to check whether antibodies are produced in time. Children of DNA-negative mothers can only be injected with hepatitis B vaccine, and hepatitis B immunoglobulin can also be injected for safety reasons. At present, whether mothers should inject hepatitis B immunoglobulin is still controversial, so routine injection is not recommended.

If the father is a big three-yang or a small three-yang but the DNA is positive, it is also recommended to inject hepatitis B immunoglobulin at the birth of the child to avoid close contact and transmission after birth.

5. Can patients with chronic hepatitis B get married and have children?

The vast majority of patients with hepatitis B can get married and have children if their liver function is stable and the virus does not replicate. The other party should be injected with hepatitis B vaccine to produce protective antibodies. Female patients with hepatitis B should pay special attention to prevent mother-to-child transmission. For chronic patients with severe symptoms and obvious abnormal liver function, it is not appropriate to get married for the time being, and should be actively treated before getting married after the condition is stable.

6. Routine examination of hepatitis B and its significance?

Five items of hepatitis B: the basic basis for the diagnosis of hepatitis B infection. HBsAg(+) indicates infection with hepatitis B virus, but it does not indicate virus replication and infectivity; Anti -HBs(+) refers to the protective antibody and immunity to hepatitis B. After injecting hepatitis B vaccine, anti -HBs can be produced after natural infection is cured. HBeAg(+) is an indicator of hepatitis B virus replication, suggesting that it is contagious. Anti-HBe(+) generally means that hepatitis B virus has low or no replication, and in a few cases, it is combined with DNA detection to determine whether there is virus variation; Anti-HBc indicates infection with hepatitis B; Anti-HBc-IgM(+) indicates virus replication.

Positive HBVDNA indicates that the virus is replicated and infectious. At present, DNA should be quantitatively detected by PCR, which has high sensitivity but high false positive rate. DNA must be tested in a large regular hospital to avoid mistakes.

Liver function: transaminase, especially ALT, is a sensitive sign of liver cell injury; Serum total protein is divided into albumin and globulin. Decreased albumin indicates liver cell damage. Chronic hepatitis and liver cirrhosis often appear albumin decrease, globulin increase and A/G ratio inversion.

B-ultrasound: Liver imaging examination has certain prompt and diagnostic function for chronic hepatitis, liver cirrhosis, fatty liver, ascites and liver cancer.

The above results should be comprehensively analyzed by professional doctors, not blindly guessed.

7. Matters needing attention in diet and life:

Diet is mainly abstinence from alcohol and avoiding spicy food. Some statements such as "no chicken, mutton and seafood" have no scientific basis. Avoid overwork, stay away from chemical toxins, and use drugs with caution, especially those harmful to the liver. When the liver function is abnormal and the illness is active, pay attention to rest, light diet and balanced nutrition.

8. Treatment of chronic hepatitis B:

At present, the treatment of chronic hepatitis B is still a worldwide problem, and there is no specific medicine to cure it. Therefore, all the drugs and treatments on the market that promote "curing hepatitis B" and "changing three yang into yin" are complete liars. Pay attention to identification and don't take chances. Your cheating will encourage the social atmosphere of cheating.

Go to a regular hospital for specialist treatment, make a treatment plan that suits you, review it regularly, and adjust the treatment plan in time. Good living habits, reasonable diet and living, and optimistic mental state are favorable factors for treatment.

On June 5438+1October 65438+May, 2003, the State Administration for Industry and Commerce, the Ministry of Health and state administration of traditional chinese medicine issued the Notice on Standardizing Medical Advertising Activities and Strengthening Medical Advertising Supervision. Medical advertisements for 1 1 diseases including hepatitis B are temporarily prohibited, so all advertisements involving hepatitis B are illegal!

How to treat hepatitis B and avoid failure?

At present, the only effective anti-hepatitis B drugs recognized by experts at home and abroad are interferon-α and lamivudine, and oxymatrine has also been introduced into China in recent years. Several other anti-HBV drugs, such as arabinoside monophosphate and foscarnet sodium, also have certain anti-HBV effects, but due to many side effects, they are not widely used in clinic, and some drugs abroad have been eliminated. The criteria for evaluating anti-HBV drugs are firstly effective (inhibiting and killing hepatitis B virus), and secondly, the side effects are small and patients can use them for a long time. However, there are not many drugs that meet the above conditions, and doctors and patients should cherish the existing anti-HBV drugs. Chronic hepatitis B is a very complicated disease. Even if anti-HBV drugs are used, the treatment may fail. The main reasons are as follows.

Improper instructions

Interferon and lamivudine have strict indications, and not all HBV-infected people can apply them. The indications of these two drugs are chronic hepatitis B patients. The transaminase is 2 ~ 10 times higher than the upper limit of normal value, and the liver inflammation is obvious. At this time, the patient is in the "immune clearance period", that is, the immune function in the body is started and the hepatitis B virus is eliminated by encirclement and suppression. At this time, antiviral drugs are used to assist, and the effect is remarkable. In the "immune tolerance period", transaminase is normal or slightly higher than normal, and liver inflammation is slight or absent. For example, hepatitis B virus carriers "turn a blind eye" to hepatitis B virus, and it is useless to apply any antiviral drugs at this time. In this regard, the role of interferon and lamivudine is extremely limited.

If the indications are selected accurately, the curative effect will be obviously improved. If the indications are not properly selected, it will not only fail to receive satisfactory curative effect, but also dampen patients' confidence in treatment, or cause resistance to antiviral treatment, resulting in "antiviral ineffectiveness theory" and affecting the normal medication of hepatitis B patients.

Anti-HBV drugs have limitations.

Chronic hepatitis B doesn't mean that everything will be fine with interferon or lamivudine, and it doesn't mean that it will definitely recover after taking the medicine. In fact, anti-HBV drugs have their limitations. At present, all antiviral drugs are ineffective against the original template (cccDNA) of hepatitis B virus replication. Once the drug is stopped, hepatitis B virus will continue to replicate with cccDNA as a template, resulting in a large number of new hepatitis B viruses rampant again, leading to the recurrence of liver disease. Physicians point out that only by persisting in long-term medication, inhibiting virus replication in the body to the maximum extent, and participating in their own immune function, can the virus be finally eliminated and patients be recovered.

When patients with chronic hepatitis B take drugs, they should eliminate the concept of quick decision and make preparations for long-term medication. The "quick-acting theory" is deceptive and cannot be believed.

Another limitation of anti-HBV drugs is that the "response rate" of patients is not 100% (response means that after taking drugs, -HBeAg turns negative, anti-HBeAg turns positive, HBVDNA turns negative and transaminase is normal). The "effective rate" of interferon in treating chronic hepatitis B is about 40%, while the long-term effective rate is only about 30%. When lamivudine is used to treat chronic hepatitis B 1 year, the negative conversion rate of HBeAg is less than 20%, and the positive rate of anti-HBeAg is only about 15%. Although the negative rate of HBVDNA is as high as 96% ~ 100%, it is easy to relapse if HBeAg does not turn negative or anti-HBeAg does not turn positive. Therefore, we should not only see the effectiveness of antiviral drugs, but also understand their limitations and correctly understand these drugs. We should not abandon them because of their limitations, nor should we be blindly optimistic because of their effectiveness.

Toxic and side effects of drugs

There are three kinds of drugs, and anti-HBV drugs also have side effects, which often vary from person to person. The application of interferon can not only cause influenza-like syndrome, but also cause leukopenia and thrombocytopenia, alopecia and depression, and sometimes the treatment is frustrated due to toxic and side effects. Lamivudine sometimes causes gastrointestinal reactions.

Hepatitis B virus mutation

Chronic hepatitis B is a complicated and changeable disease. Under the action of antiviral drugs and human immune pressure, viruses often mutate, which leads to treatment failure. During the treatment, the patient's condition often fluctuates and repeats, which is not necessarily attributed to the application of antiviral drugs. In addition, the immune dysfunction of patients with chronic hepatitis B may lead to "mixed infection" during the treatment process, such as hepatitis B+C, hepatitis B+D, hepatitis B+A, or hepatitis B complicated with fatty liver. Sometimes, the illness is complicated and the treatment is more difficult due to drug abuse and drinking, which is not the fault of antiviral drugs. Analyzing the reasons for the failure and taking measures will still achieve the curative effect.

In the process of applying anti-HBV drugs, careful observation and analysis are needed in many aspects. Anti-HBV drugs are not "panacea", and other drugs such as anti-hepatic fibrosis and adjuvant drugs for regulating immune function are also very necessary. The failure of hepatitis B treatment cannot deny antiviral drugs, and everyone should not ask for antiviral drugs. Since the development of hepatitis B therapeutics, the biggest progress has been the establishment of a comprehensive treatment strategy based on antivirus. If you don't go anti-virus, you will go back. Millions of hepatitis B patients are at a loss. Of course, scientists have long been aware of the shortage of antiviral drugs, and now they are deeply researching and developing more effective antiviral drugs. It should be said that the prospects are optimistic.