What are the types of hepatitis? What are the differences between them?

Types of hepatitis

4. Hepatitis

Those caused by poisoning by poisons, toxins and other substances are called toxic hepatitis; those caused by bacteria are called bacterial hepatitis; viruses The cause is called viral hepatitis. Therefore, the term hepatitis is a general term for inflammation of the liver caused by various causes. But the current term hepatitis is a narrow definition of viral hepatitis.

5. Viral hepatitis

Currently, there are seven types of viral hepatitis: A, B, C, D, E, G and transfusion-transmitted viruses, each consisting of hepatitis A virus ( HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), hepatitis E virus (HEV), hepatitis G virus (HGV), transfusion-transmitted virus (TTV), etc. .

6. Clinical classification of viral hepatitis

Based on the uniqueness of the clinical manifestations of the seven types of viral hepatitis, the clinical types commonly used for diagnosis are:

(1) Acute jaundice hepatitis (a few can transform into chronic severe hepatitis).

(2) Acute jaundiced hepatitis (some may be delayed or relapsed, and may become chronic, with hepatitis B, C, D, and G being more common.

(3) Chronic persistent hepatitis and chronic active hepatitis

(4) Biliary hepatitis

(5) Severe hepatitis (acute severe, subacute severe, Chronic severe)

7. Infection rates of seven types of viral hepatitis

According to the second national hepatitis census in 1996: the average positive rate of hepatitis A was 80.9%. , is the total infection rate of hepatitis A in my country (but 80.9% of people are not already sick, but have only been infected by hepatitis A virus). The infection rate of hepatitis B is 57.6%; the infection rate of hepatitis C is 3.2%; The infection rate of hepatitis E virus is 1.15%; the infection rate of hepatitis E virus is 18.1%; the infection rate of hepatitis G virus has not been successfully isolated yet, and the infection rate has not been reported.

(1) Why is family emotional support crucial to recovery from liver disease?

Family is the basic element of society and the home of everyone’s soul and emotion. When a family member is sick, he must first notify him. The most important thing is other family members, especially for patients with liver disease. Because they have an infectious disease, they may be alienated by colleagues and friends. At this time, they will place all their emotions on the family, and the attitude of family members towards the patient will change. It directly affects the patient's mood, and even a word or action from a family member can cause shock or harm to the patient's sensitive mind. If the family members do not grasp their emotions well at this time, they will become pessimistic and desperate after learning about the patient's condition. , crying bitterly, will make the patient lose confidence in the treatment and affect the recovery of the disease. Others, without knowing anything about disinfection and isolation, adopt a dismissive and alienated attitude towards the hepatitis patients in the family, which will affect the patient's self-esteem. Injury not only affects the patient's treatment, but also makes him or her pessimistic and self-defeating, which aggravates the patient's condition. The above situations are not conducive to the patient's recovery. The correct approach is to sincerely care for the patient, support each other emotionally, and make them understand. to feel the warmth of family; let patients understand their important position in the family and help them build confidence in overcoming the disease; through verbal communication, eye contact and skin contact and other body language, let patients feel that they have not been abandoned by family and society, so that Their souls are nourished by love and maintain an optimistic and upward attitude, so that they can actively cooperate with treatment and strive for a speedy recovery.

(2) How do people without liver disease get along with patients with liver disease?

People without liver disease should avoid two extremes when getting along with patients with liver disease. One extreme is to be afraid of infecting themselves, alienating and isolating the patient, which will cause the patient to have an inferiority complex, which is not conducive to his recovery. The other extreme is to show that he is not close to the patient. Dislike, completely abandon the disinfection and isolation system, and have unprincipled close contact with patients, so that you are infected with hepatitis. The correct approach is:

(1) Support the patient emotionally and shorten the distance with the patient, Pay more attention to them, encourage patients to talk about their unhappiness, help them eliminate fear, inferiority, and despair, and establish a cheerful and optimistic attitude towards life for treatment and recovery, so that patients can feel that they are not isolated, and that their relatives and friends are connected spiritually with them. .

(2) People without liver disease and patients with liver disease should have a common understanding of the disease, learn more about the transmission routes of liver disease, disinfection and isolation measures, treatment methods, etc., and take appropriate measures based on the patient's understanding. Disinfection and isolation measures. In fact, patients are unwilling to infect their relatives and friends with liver disease, and some even actively avoid them. At this time, relatives and friends should take the initiative to communicate with the patient and have friendly contact with them on the premise of a common understanding of medical knowledge.

(3) Pay attention to the details and do not let small things cause harm to the patient, such as shaking hands, hugging, taking things that the patient has just taken, etc. You will not be infected with hepatitis. At this time, you will not be infected with hepatitis. People without liver disease need not be too careful and hurt the self-esteem of people with liver disease.

(3) Can hepatitis patients get married?

In our outpatient clinics, many patients and their families often ask: Can hepatitis patients get married? Hepatitis, especially chronic hepatitis, cannot be cured after a long period of time and relapses. Some people think that getting married can cure the disease; some people are eager to get married and get married before recovering from the disease. In fact, this approach is wrong.

As we all know, hepatitis is an infectious disease. A large amount of hepatitis virus is contained in the patient's body, and the disease can be transmitted to his or her spouse through close contact such as eating, kissing, and sexual life. Therefore, hepatitis patients should not get married before they have fully recovered from the disease. Therefore, unmarried patients with hepatitis should actively cooperate with doctors for proper rest and treatment. After symptoms and signs improve, liver function returns to normal, and after a period of consolidation, marriage can be considered with the permission of the doctor. However, after marriage, be careful not to overwork yourself and have sex. It is also necessary to exercise moderation, otherwise it is easy for the disease to relapse.

As for hepatitis B virus carriers, their unmarried (wife) should be vaccinated with hepatitis B vaccine before marriage to fight infection. If a woman is a hepatitis B virus carrier, her newborn should be vaccinated with hepatitis B vaccine in time after giving birth. to prevent hepatitis B.

(4) What are the benefits of eating more vegetables and fruits?

Fresh vegetables and fruits are rich in glucose, fructose and vitamins. These sugars improve the liver’s detoxification capabilities and are also a source of energy for the body. Vitamins can enhance the liver's ability to repair, renew, detoxify, and stop bleeding. It can also reduce fatigue. Especially vitamin C, this water-soluble vitamin has the effect of inhibiting viruses. Larger doses of vitamin C can improve human immunity, promote the formation of antibodies, increase phagocytosis of white blood cells, and enhance disease resistance. Vitamin C is involved in the formation of bile acids in the liver. Vitamin C is also required for the metabolism of norepinephrine and tryptophan. Experiments have shown that vitamin C can reduce fatty degeneration of liver cells, promote the repair and regeneration of liver cells, and has the choleretic effect of eliminating excess bilirubin in the blood. It also has the ability to bind bacterial endotoxins, reducing endotoxin damage to the liver. In addition, vegetables and fruits contain inorganic salts that are indispensable for human growth.

In short, eating more vegetables and fruits will help protect the liver.

(5) Which health products are suitable for patients with liver disease?

The following types of health products are more suitable for patients with liver disease:

(1) Red dates: Red dates can protect the liver, promote liver cell regeneration and inhibit the growth of cancer cells. For this reason, patients with liver disease can often eat red dates. It is not advisable to consume too much red dates, otherwise it will damage the digestive function and cause bloating and constipation.

(2) Edible fungi: Edible fungi contain 7 of the 8 essential amino acids for the human body (all 8 are found in Pingru and Caoru), and the number and proportion of the amino acids contained are similar to those of the human body. The daily needs are very consistent; the protein contained in edible fungi has a digestibility of up to 80% in the human body; edible fungi are rich in vitamins and minerals, which are basically consistent with the needs of the human body; the fat content in edible fungi is only 2% , the unsaturated fatty acids contained in it have the effect of lowering blood lipids; the carbohydrates (polysaccharides) in edible fungi have a special effect in promoting and improving human immune function.

(3) Cordyceps sinensis: Cordyceps sinensis has the functions of regulating immune function, anti-toxin, anti-fibrosis, adjusting the albumin/globulin ratio and lowering transaminase to a certain extent.

(4) Honey: Honey is aromatic, calm in nature, beneficial to qi, nourishes the spleen and stomach, moisturizes dryness, and detoxifies, and has certain therapeutic effects on patients with chronic liver disease.

(5) Bee milk and royal jelly: Bee milk contains albumin-like substances, various amino acids, various enzymes, vitamins, fatty acids, gonadotropin-like hormones, antibiotic substances and various hydroxy acids; Royal jelly acid is an effective ingredient for lowering cholesterol.

Bee milk and royal jelly have the functions of nourishing and aphrodisiac, stimulating hematopoiesis, antibacterial, anti-cancer, analgesic, anti-ulcer, promoting the regeneration and repair of damaged tissue, and lowering blood sugar.

(6) Pollen: Pollen contains a variety of amino acids, vitamins and many trace elements; pollen can promote metabolism, improve physiological functions, and restore health and physical strength.

(7) Placenta: Placenta, also known as Zihe Che, has the effects of replenishing vitality, replenishing essence and blood, and nourishing the heart and kidneys. The placenta is rich in protein, vitamins, iron, calcium, phosphorus and other trace elements, as well as estrogen, which can treat all fatigue injuries and insufficient sperm and blood.

(8) Ants: The protein content of ants is more than 50%, and they also contain essential amino acids, vitamins, trace elements, etc. for the human body. Ants have anti-inflammatory, analgesic, antiasthmatic effects, regulate human immune function and protect the liver.

(9) American ginseng: American ginseng is cool in nature, bitter and sweet in taste. It has the functions of nourishing kidney yin, clearing the lungs and moisturizing dryness, tonifying the middle and replenishing qi, nourishing blood and softening the liver, strengthening the spleen and stomach, and has certain therapeutic effects. The effect of supplementing and strengthening. Patients with liver disease and weak spleen and stomach can take American ginseng, but it should not be taken in the acute stage of liver disease or the active stage of chronic liver disease.

(6) Which drugs are likely to cause liver damage?

The following commonly used drugs can easily cause liver damage:

Antibiotics include: anti-tuberculosis drugs such as rifampicin, isoniazid, etc., macrolide drugs such as erythromycin Penicillin, spiramycin, tetracyclines such as tetracycline and oxytetracycline, antifungal drugs amphotericin B, ketoconazole, etc., except for allergic reactions, the liver damage is relatively minor.

Antipyretic and analgesic drugs: aspirin, phenylbutazone.

Antipsychotic drugs: chlorpromazine, perphenazine, trifluoperazine; antidepressant drug amitriptyline; epilepsy drug sodium valproate; sedatives phenobarbital; narcotic drugs Halothane, chloroform, etc.

Anti-hyperthyroid drugs: propylthiouracil, methimazole, hyperthyroidism, etc.

Anti-tumor drugs: cyclophosphamide, carmustine, dactinomycin, mitomycin.

Hypoglycemic drugs: Excellent for lowering blood sugar and equal to those for lowering blood sugar.

Cardiovascular drugs: Apaclidine, alpha-methyldopa, procainamide, verapamil.

Antiviral drugs: inorganic arsenic compounds, antimonies and protozoal drugs.

(7) How does alcohol damage the liver?

After alcohol is absorbed into the blood, about 90% is metabolized in the liver, and only 10% is excreted unchanged from the kidneys or lungs. Its metabolism in the liver requires the participation of a variety of enzymes and undergoes several reactions. And finally it is oxidized into carbon dioxide and water. Obstacles in any link of this metabolic process (such as enzyme deficiency) can lead to metabolic stagnation. The accumulation of intermediate metabolites can cause toxic effects on the liver. Ethanol itself also has obvious toxic effects on liver cells, such as changes in liver function. The structure and function of mitochondria and microtubules in cells inhibit protein synthesis, secretion and transport, and inhibit glucose synthesis and gluconeogenesis. When ethanol exists in mitochondria, the oxidative metabolism of fatty acids is hindered, and the synthesis of blood lipids in the liver increases and accumulates in the liver, leading to the occurrence of fatty liver. Due to long-term and repeated damage to the liver by alcohol, it can lead to liver fibrosis. If you still don't quit drinking and are not actively treated, you can eventually develop into cirrhosis.

(8) How to treat patients with fatty liver through diet?

The principles of dietary treatment for patients with fatty liver are: control caloric intake, limit fat intake, rationally distribute various nutrients, increase vitamin intake, and change bad living habits. Specific measures are:

(1) Control caloric intake: Because excess calories can increase fat synthesis and storage and induce fatty liver, reasonable caloric control is the first principle in treating fatty liver. Taking light physical or mental workers as an example, a standard body weight requires 120 kJ (30 kcal) per kilogram of body weight per day. Overweight people need an appropriate reduction to 80-100 kJ (20-25 kcal), and those who are thin need 120 kJ (30 kcal) per kilogram of body weight per day. 140 kJ (35 kcal), which can be increased as the workload increases. Calories for obese and emaciated people are calculated based on their standard body weight (including fat in food and cooking fat).

(2) Limit fat intake: The amount of fat eaten every day should be controlled below 30% of the total calories, and the quality of fat should be paid attention to. Vegetable fats should be the mainstay, and animal fats should be avoided as much as possible. When eating, mainly consume oils containing unsaturated fatty acids (such as sesame oil and rapeseed oil), because unsaturated fatty acids have anti-thrombotic and cholesterol-lowering effects.

(3) Comprehensive distribution of various nutrients, the principle is high protein, low fat, and appropriate amount of sugar. The proportions of the three major nutrients are: protein about 20%, fat about 30%, and sugar about 50%.

(4) Increase the intake of fiber and vitamins: Fiber can delay gastric emptying and intestinal sugar absorption, which is beneficial to reducing the postprandial increase in blood sugar and lowering blood lipids in patients with fatty liver disease. Vitamin B and vitamin E participate in liver fat metabolism and protect liver cells; vitamin A and carotene prevent liver fibrosis. Therefore, daily dietary fiber consumption can be increased to 40-60 grams.

(5) Change bad living habits: quit drinking, eat regularly, and don’t overeat. For patients with diabetes, hyperlipidemia, etc., the main principle in their diet is to appropriately control the underlying disease.

(9) What should I do if the hepatitis B vaccine does not produce antibodies?

Clinically, there are the following situations where antibodies are not produced after vaccination with hepatitis B vaccine, which can be dealt with separately:

(1) Some people develop antibodies later, which is called a delayed response. , you can add 1-2 injections, or re-vaccination, and increase the dose appropriately;

(2) 0, 1, 2, and 12 months of immune treatment courses can be used;

(3) When inoculating hepatitis B vaccine, use a small dose of interleukin-2 in combination;

(4) BCG or vaccinia can increase the immune response to hepatitis B vaccine and can be used together;

(5) 5% to 10% of vaccinated people do not produce hepatitis B antibodies, or only produce low-titer antibodies, even if they are fully vaccinated against hepatitis B. These non-responders or low-responders should be vaccinated with hepatitis B vaccine multiple times. Until antibodies are produced;

(6) There are still some people who turn out to be latent infections, the virus is in a low-level replication state, and the "two and a half" test is normal, but the hepatitis B virus DNA (HBV-DNA) Positive, such people will not have surface antibodies formed after being vaccinated.

You have received 8 injections of hepatitis B vaccine and still have not produced antibodies. It is best to check the hepatitis B virus DNA in the serum first, because if the "two and a half" test is normal but the hepatitis B virus DNA is positive, it is For those with latent infection, such as the sixth situation above, no surface antibodies will form after vaccination. If the hepatitis B virus DNA test is negative, you can also use the following methods: A. Increase the dose appropriately and give 1-2 more injections; B. Vaccination according to the above mentioned methods; (3) (4) Under the premise of negative DNA, if you can produce antibodies using the above methods, it means that you are late in producing antibodies, that is, a slow responder. We need to remind you that before using these methods, you must understand the pros and cons of the methods in detail. If you use the above three methods If the method still fails to produce antibodies, you are most likely to belong to a different group of people who do not produce hepatitis B antibodies or only produce low-titer antibodies.

(10) How to use levamisole triple therapy:

(1) Mechanism of levamisole liniment (coating agent LIIS-L):

Confirmed Levamisole mainly acts on T lymphocytes, while inducing interferon, enhancing the chemotaxis and phagocytosis of monocytes, activating macrophages, and regulating the production of antibodies by B cells. Although levamisole is an old drug, in May 2000 The American College of Physicians also recommended the use of levamisole when discussing strategies for chronic HBV infection in the next century. The purpose of skin administration is to avoid the many side effects of oral levamisole, increase the dosage, and extend the duration of medication, thereby increasing its immune effect. In "triple therapy", the main functions of levamisole liniment (coating agent) are reflected in:

1) During antigen stimulation, adding levamisole liniment can increase the amount of antibody formation by 8-128 times;

2) Helps strengthen the anti-HBV-specific cellular immune response;

3) Enhances the phagocytic function of phagocytes, thereby enhancing the ability to clear HBV.

(2) Mechanism of action of dipyridamole (dipyridamole):

In clinical applications, it was further discovered that dipyridamole not only acts on the cardiovascular system; it can also affect the production of adenosine. Uptake and metabolism interfere with the expression of hepatitis B virus receptors on the cell membrane surface, thereby affecting virus adhesion or release.

1) Dipyridamole can stimulate the body’s immune function, stimulate the body to produce higher doses of interferon, and increase the body’s ability to resist viruses;

2) It can improve blood circulation in liver cells, Increase the supply of nutrients to the liver.

(3) Mechanism of action of hepatitis B vaccine: Hepatitis B vaccine plays an important role in breaking the body's immune tolerance to hepatitis B virus in triple therapy.

1) Hepatitis B vaccine is a specific immune stimulant that can stimulate B cells in the immune response system to produce -HBS antibodies;

2) It can activate CD4+ and CD8+T cells, thereby inducing the production of anti-HBV-specific cellular immune responses.

(4) Possible synergistic effects of the three-drug combination:

The combined use of adjuvants can enhance the immune response induced by the hepatitis B vaccine, thereby improving the patient's immune response ability and enhancing the immune effect. Professor Wang Juntao believes that the hepatitis B vaccine will be more effective when combined with an adjuvant. Professor Wu Shanming and others reported that hepatitis B vaccine combined with adjuvants can break the body's immune tolerance or low state, improve the efficacy, and promote HBeAg and HBeAg-DNA negative conversion.

Clinical efficacy of the three-drug combination:

Clinical research results between Beijing Military Region General Hospital and Shangqiu Fifth People's Hospital, 80 cases of hepatitis B virus carriers were treated with two drugs "Triple therapy" treatment, 12 columns in the children group, 68 columns in the adult group, the observation time of medication is 6-18 months. At the end of the treatment, the observation results show: the HBeAg and HBV-DNA negative conversion rate of the children group after 6 months of treatment The negative conversion rates of HBeAg and HBV-DNA in the adult group were 58.33% and 58.33%, respectively. The negative conversion rates of HBeAg and HBV-DNA in the adult group were 38.24% and 41.18%; after 12 months of treatment, the cumulative negative conversion rates of HBeAg and HBV-DNA in the children group reached 83.33% and 83.33% respectively, and the negative conversion rates in the adult group were 58.33% and 58.33%, respectively. The cumulative negative conversion rates of HBeAg and HBV-DNA at 18 months of treatment were 100% in the children group and 54.41% and 66.18% in the adult group respectively.

Advantages of triple therapy with levamisole liniment:

Each medication costs less than 100 yuan, has few side effects and is highly effective.

How to use levamisole liniment triple therapy:

(1) How to use levamisole liniment: twice a week, 1 tube (500mg) each time, apply to both sides On the skin of the inner thighs and calves, the dosage for children under 10 years old is halved or calculated as 10 mg/kg, and a course of treatment lasts for half a year.

Side effects: Occasionally, allergic rash occurs. Dermatitis Ping can be used topically, or the application site can be washed 24 hours after application.

(2) How to use dipyridamole; 16 years old and above, 75 mg (three tablets)/day, orally (take before bed or three times a day), 15 years old and above 50 mg - 25 mg/day, The course of treatment is half a year.

Side effects: It is contraindicated for patients with blood diseases. A few people may have headaches, dizziness, nausea, diarrhea during use. There are also a few patients who experience redness in the face and ears for a short period of time after taking the medicine (vasoconstriction effect), which can be relieved by themselves. If the symptoms are severe and unbearable, the medication should be discontinued.

(3) How to use hepatitis B vaccine; hepatitis B vaccine (genetic engineering) 30 mg/day, intramuscular injection or subcutaneous injection into the deltoid muscle, and the course of treatment is half a year.

How to choose lamivudine for the treatment of hepatitis B:

In recent years, lamivudine has been used in clinical anti-hepatitis B virus drugs. It has significant effects and considerable curative effects, and many patients with chronic hepatitis B have benefited from it. If you continue to abuse it, it will inevitably lose its original effect. The most important issue at this stage is that the indications of lamivudine must be strictly controlled. The consensus of experts is that patients with chronic hepatitis B have clear indicators of hepatitis B virus replication, such as: DNA virus content is above 10×5 copies/ml, elevated transaminase range is between 2 and 10 digits of the upper limit of normal, no jaundice, age People over 12 years old and weighing more than 35 kilograms are the "golden indicators" and best indications for the application of lamivudine.

The following situations are not the best indications for lamivudine.

(1) Chronic asymptomatic hepatitis B virus carriers with normal transaminases and no symptoms should not take lamivudine regardless of whether there are virus replication indicators (regardless of "big and small three positives"). However, it is understood that it is very common for people to take this medicine, which is a waste of medicine and money. At present, there is no particularly effective drug to solve the treatment problem of hepatitis B virus carriers. The important reason why lamivudine cannot be used to treat hepatitis B carriers is that it is ineffective. Some people's DNA may drop below 10×3 copies/ml after taking it, and rebound immediately once the drug is stopped. The outpatient clinic found that someone took the drug for more than a year and a half, and the HBV-DNA turned negative, and then rebounded less than a month after stopping the drug. Moreover, the HBeAg could not turn negative at all, so this drug can no longer be used to treat hepatitis B carriers unless the liver is punctured. Application can only be considered when biopsy confirms pathological changes of chronic hepatitis.

(2) Acute severe hepatitis or acute liver failure is a serious and serious condition. At this time, the patient’s main problem is not virus replication. Some patients even have no virus replication indicators. What threatens the patient’s life is liver function. For failure, based on the principle of "treating the root cause if it is slow and treating the symptoms if it is urgent", this is the most important supportive therapy, such as fresh plasma albumin infusion, artificial supportive therapy, etc.

(3) In an acute attack of chronic hepatitis B, if the transaminase is more than 10 times the upper limit of the normal value, there is obvious jaundice or the serum bilirubin is greater than 85.5 mmol/L, it is not advisable to take lamivudine and other drugs for the time being. Antiviral drugs. The main treatments are to protect the liver, reduce jaundice, and lower enzymes. When the condition is relieved, lamivudine can be given. Although lamivudine does not have a strong impact on immune function like interferon, it is not the best policy to prevent immune damage during an acute attack of hepatitis.

(4) For those with chronic hepatitis B who are pregnant or infected with hepatitis B after pregnancy, lamivudine should not be used for the time being. The main reason is that the effect of lamivudine on the fetus has not yet been clarified. Although there are application reports abroad and it is relatively safe, Chinese experts have not yet reached complete consensus. For the sake of caution, it is a wise choice not to apply it temporarily.

(5) During the application of lamivudine to children aged 3-12 years old with hepatitis B, some patients experienced a complete virus suppression effect.