Questions about hepatitis B.

Hepatitis B, also known as serum hepatitis and viral hepatitis B, is an infectious disease caused by HBV. It is transmitted through blood and body fluids and has a chronic carrying state. Because it may be transmitted through sexual life, it is listed as a sexually transmitted disease internationally. This disease is widespread in China, and the infection rate is high, reaching more than 35% in some areas. According to relevant data, the number of hepatitis-positive patients has reached 65.438+0.89 billion, and the number of people (carriers) who should see a doctor is nearly 400 million. It is the most serious infectious disease that harms people's health at present. More common in children and young people.

Hepatitis B has various clinical manifestations, and it is easy to develop into chronic hepatitis and cirrhosis, and a few patients can turn into primary liver cancer.

pathology

HBV is hepatophilic deoxyribonucleic acid virus, belonging to DNA virus. It is a compound with a diameter of 42 nm, which is divided into two parts: core and shell (envelope). The core is 27 nm in diameter, containing circular double-stranded DNA and polymerase, and the outer part is lipoprotein shell. HBV resistance is very strong, and it can't be inactivated in general concentration disinfectant at 60℃ for 4 hours. After boiling 10 minutes, the infectivity disappears, but it still has antigenicity. Protein on the envelope, namely hepatitis B surface antigen (HBsAg), is synthesized in liver cells and released into the blood circulation in large quantities, so it is not contagious. The core part contains circular double-stranded DNA, DNA polymerase, core antigen (HBcAg) and E antigen (HBeAg), which is the main body of virus replication. The resistance of hepatitis B virus is very strong, and the disinfectant with a general concentration of 60 degrees can tolerate it for 4 hours. Boiling 10 minutes or high-pressure steam disinfection can be inactivated.

HBV has three antigen-antibody systems:

HBsAg (anti-HBS): HBsAg exists in the shell of virus particles. HBsAg positive is an indicator of HBV infection, but it is not the only basis for hepatitis B diagnosis. HBsAg can stimulate human body to produce antibodies (anti-HBs).

Core antigen antibody system (HBcAg);

E antigen-antibody system (HBeAg, anti-HBe):

Transmission routing

There are various sources of infection of hepatitis B, including acute and chronic patients, recessive infected persons and virus carriers, among which chronic patients and virus carriers are the most important. The infection period of acute patients begins a few weeks before onset and lasts for the whole acute period. The infectivity of HBsAg positive chronic patients and asymptomatic carriers is related to whether HBeAg and anti -HBc are positive or not. Those who are HBsAg positive in serum for more than 6 months are called persistent HBsAg carriers. Most persistent HBsAg carriers in China are HBeAg positive at the same time, accounting for 10- 15% of the population, so they are the main source of infection.

Hepatitis B virus is mainly excreted by body fluids such as blood, and enters the susceptible population through injection or non-injection. Injection routes include blood transfusion and blood products, mass vaccination, drug injection and acupuncture. With the screening of blood donors, the purification of blood products and the popularization of disposable syringes and acupuncture needles, the proportion of transmission through injection will gradually decrease. Non-injection routes, including mother-to-child transmission, close contact with life, surgery and blood contact, will be the most important routes of transmission. Because hepatitis B virus can be excreted through saliva, semen and vaginal secretions, sexual contact is also an important route of transmission of hepatitis B.

What is "big and small three yang"?

The so-called "big and small three yang" refers to two different results of "hepatitis B antigen two-and-a-half test" (referred to as hepatitis B two-and-a-half test). The first pair of "two halves" refers to surface antigen (HBsAg) and surface antibody (anti-HBs), the second pair is E antigen (HBeAg) and E antibody (anti-HBe), and the third pair is core antibody (anti-HBc) and core antigen (HBcAg). Because all the core antigens in liver cells have been assembled into hepatitis B virus, there is no free core antigen in serum, so only half of the third pair, namely the core antibody, can be detected in peripheral blood, so it is called two and a half.

"Big Three Yang" means that surface antigen, E antigen and core antibody are all positive. It is generally believed that "Big Three Yang" is highly contagious and is more likely to evolve into chronic hepatitis B..

"Xiao Sanyang" means that all surface antigens, E antibodies and core antibodies are positive. The difference between "Big Three Yang" and it is that the former is positive for E antigen. Usually transformed from "Big Three Yang", the human body has a certain degree of immunity to E antigen. It is generally believed that "Xiao Sanyang" is less contagious. However, for some people who are negative for E antigen and E antibody, the hepatitis B virus infected by them may be infected by a mutated virus strain, and they cannot express E antigen and E antibody. However, if HBV-DMA is still positive, it means that viremia exists and is still contagious.

No matter "Big Three Yang" or "Small Three Yang", it only reflects the situation of carrying virus in human body, and can't reflect whether liver function is normal, so it can't be used to judge the severity of the disease. If you want to know the situation of liver function, it's best to go to the hospital regularly (3 months to 6 months) to have two and a half tests of liver function and hepatitis B.

"two and a half", "big three yang" and "small three yang"

What are "big three yang", "small three yang" and "two and a half"? The original "big three positive" refers to HbsAg positive, HBeAg positive and anti-HBc positive in hepatitis B examination. "Xiao San Yang" refers to HbsAg positive, anti-HBe positive and anti-HBc positive in hepatitis B examination. "Two and a half" refers to HbsAg, HbeAg, anti-HBs, anti-Hbe and anti-HBc in hepatitis B examination.

It is well known that "two and a half" are detected from the serum of hepatitis B virus infected people. In recent years, the appellation of "big three yang" and "small three yang" has appeared again, and there is misunderstanding about who is more important than who is lighter. In fact, the main difference between the two is that, on the basis that both the epitope antibody and the C antibody are positive, if the E antigen is also positive, it is called "Big Three Yang", indicating that the virus replication is active, often accompanied by hepatitis B virus DNA (deoxyribonucleic acid) positive, indicating strong infectivity; If only E antibody is positive, it is called "small three-positive", which means that the virus has basically stopped replicating. If the DNA of hepatitis B virus is negative, it is basically no longer contagious. Perhaps this is one of the main reasons why people often think that "big three yang" is seriously ill and "small three yang" is slightly ill, and hope to change from "big three yang" to "small three yang" as soon as possible.

However, it is HBV DNA, liver function and clinical symptoms that really determine the severity of patients' illness. Generally speaking, there are three situations: in the first situation, a few patients with "small three positive" are still HBV DNA positive, suggesting that virus replication is still active, which may be the result of HBV mutation. The patient's condition may be serious and develop rapidly, which should be paid attention to. In the second case, no matter whether the patient is a "big three yang" or a "small three yang", if the liver function is normal and there are no obvious symptoms, they are all called hepatitis B virus carriers and cannot be diagnosed as hepatitis B patients. Most hepatitis B virus carriers were infected with hepatitis B virus in infancy, but because the immune system was not fully developed at that time, they could not clear the virus and could not tolerate long-term peaceful coexistence with hepatitis B virus, so they became carriers. In the third case, whether it is "big three yang" or "small three yang", if the liver function is abnormal repeatedly, or accompanied by clinical symptoms, or hepatosplenomegaly, it should be judged as a patient with hepatitis B, and active liver disease should be controlled as soon as possible. Because the vast majority of patients with liver cirrhosis and liver cancer in China have experienced a long process of recurrent liver disease. In other words, as long as there is no active liver disease or repeated activities of chronic liver disease can be avoided, serious consequences such as liver cirrhosis and liver cancer can be effectively prevented. Medical research has also proved that after a certain period of time, 5%- 10% of the "big three-yang" people naturally turn into "small three-yang" every year. It is an opportunity for everyone who has "three big yang" to turn cloudy naturally, but there is no way to determine when it will turn cloudy. Therefore, people who suggest the "three suns" need not worry too much. Even if you try to use antiviral drugs to change "big three yang" into "small three yang", you must choose patients with abnormal liver function before treatment can respond.

Hepatitis B virus carriers are not suitable for drug treatment, so it is wise to wait for natural negative change. They can live, study and work normally, but they are not suitable for catering service and conservation.

Is interferon effective in treating chronic hepatitis B? Professor He Youcheng

Interferon was discovered in 1957, and it has been more than 30 years. This is a trace protein naturally produced when the human body is attacked by viruses, and it is a disease-resistant substance of the human body itself. Ten years ago, the cost of producing this biological product was very expensive, about $50 million per gram, which was equivalent to the value of 1.5 ~ 2 tons of gold at that time. Now, besides preparing interferon from human blood, interferon can also be successfully produced by bioengineering technology, which has opened up a broad prospect for clinical application.

So far, there is no specific therapeutic drug for chronic hepatitis B, and interferon is recognized as an effective antiviral drug at home and abroad. Among them, 25 ~ 50% patients have a good response after 3 ~ 4 months of treatment. Hepatitis B virus E antigen and deoxyribonucleic acid (HBV-DNA) disappeared from the blood, then the clinical symptoms were relieved and the transaminase returned to normal. Many research results show that patients in Europe and America have better curative effect, while patients in the East (such as China and Japan) have worse curative effect. However, if patients can be carefully selected, the curative effect of interferon on chronic hepatitis B is still expected to improve. Because there are great individual differences in the body's response to interferon, it is not only a question that clinicians must consider before deciding on medication, but also a topic that many patients care about. 65438-0990 At the Seventh International Conference on Viral Hepatitis held in the United States, experts suggested that the following factors of patients would affect the therapeutic effect of interferon:

1. Adult infected with hepatitis B virus, short course of hepatitis before treatment (less than 7 years, especially about 2 years), low level of E antigen positive HBV-DNA, high serum transaminase, female patients, negative antibodies to hepatitis C and D virus, and no other diseases (such as HIV infection, nephropathy, diabetes) have better curative effect.

2. In patients with negative E antigen and positive HBV-DNA, interferon also has a certain effect, but the effect is small. The curative effect of chronic persistent hepatitis is worse than that of chronic active hepatitis.

3.3 the curative effect. Patients with liver cirrhosis who are positive for HBsAg are also poor, which may be related to the integration of HBV-DNA into the genome of hepatocytes. At this time, the body's sensitivity to interferon is reduced and its response is poor. The longer the course of disease, the greater the chance of integration and the lower the sensitivity.

4. For asymptomatic HBV carriers and those with normal serum transaminase, interferon therapy is basically ineffective. Because these patients are often infected with hepatitis B virus in the fetus or at birth, at this time, the patient's immune system is not mature enough to remove the virus, so most of them have evolved into a chronic virus-carrying state. Such patients are often not short of endogenous interferon, so the treatment with exogenous interferon is often ineffective.

In cases with effective interferon treatment, transaminase often rises temporarily at the initial stage of treatment, then E antigen and HBV-DNA disappear, E antibody appears, and then transaminase returns to normal. The increase of transaminase is related to the dissolution and destruction of virus-infected hepatocytes by killer immune cells in vivo after interferon treatment, which is one of the important signs to predict the therapeutic effect. If it is not accompanied by the aggravation of liver function damage such as jaundice and digestive tract symptoms (nausea, vomiting and obvious loss of appetite), patients do not have to worry too much about the increase of transaminase, let alone stop taking drugs or adding enzymes. However, most patients have different degrees of side effects during interferon treatment, such as fever, myalgia, nausea and vomiting. , but also pay attention to bone marrow suppression. Some patients with severe reaction should immediately adjust the dose or stop taking drugs, and it is advisable to be hospitalized for observation.

Interferon and Hepatitis B Guo Xiucang, Deputy Chief Physician

The incidence of chronic hepatitis B is the highest in viral hepatitis, and the prognosis is poor after many natural courses. After 5 years without treatment, about 50% patients develop cirrhosis, and a small number naturally develop asymptomatic HBsAg carriers (about 2%-3% per year). Inflammatory activity of chronic hepatitis B is related to viral immune response. The therapeutic effect of interferon A on chronic hepatitis B is mainly due to immune regulation mechanism. In June1996165438+10, the German Society of Digestive and Metabolic Diseases specially discussed the treatment of chronic hepatitis, and made suggestions on its indications, treatment methods, clinical observation and recurrence after treatment.

Indications for treatment of chronic hepatitis B: Patients with chronic hepatitis B have qualitatively detected virus replication and are the targets of interferon treatment; However, about 90% cases of acute hepatitis B can be cured naturally, which is not an indication of interferon treatment. However, it should be emphasized that in recent years, it has been found that chronic hepatitis B patients with HBeAg negative and anti -HBe positive are often accompanied by virus replication, and the virus replication of HBeAg negative patients is the replication of pre-C mutant. Therefore, it is of great significance to distinguish between HBeAg positive (wild strains) and HBeAg negative (pre-C mutation) chronic hepatitis B.

Clinical observation on the dosage of HBeAg positive chronic hepatitis B. Interferon 50,000-60,000 units, 3 times a week, subcutaneous injection for 6 months. If HbeAg/ anti-HBe seroconversion occurs after 6 months of treatment, the drug can be continued for 2 months after seroconversion. The increase of transaminase within a few weeks after treatment reflects the toxic reaction of interferon A to HBV infection, which should be regarded as a good sign and generally does not need to reduce the dose.

For anti -HBe positive replication hepatitis B (pre-C mutant), the initial treatment response to interferon A is similar to that of wild strains infection. In other words, HBV-DNA of these patients can also turn negative after interferon A treatment. However, the recurrence rate is high, and the recommended course of treatment is 1 year.

Clinically, it is found that although some patients are serologically negative for HBV-DNA and continuously positive for anti -HBe, transaminase is continuously or fluctuating positive, which often develops into progressive liver disease. There is no special treatment for this kind of patients because the replication of pre-C mutant is lower than the detection level. In this case, liver puncture, biopsy and histological examination can be done, and if chronic hepatitis is diagnosed with a gun, an application can be made. Interferon combined with oral second-generation nucleotide derivatives was treated for 6- 12 months.

The most common side effect of interferon A therapy is cold symptoms. Symptoms such as general malaise, fever, headache, soreness and weakness of limbs may occur. Paracetamol 0.5-1 .0g can be given before interferon A injection/hour to prevent and control these symptoms. Other systemic reactions may occur, such as anorexia, nausea, vomiting, some nervous system disorders, thrombocytopenia, leukopenia, rash, itching, local erythema at the injection site, etc. , can be symptomatic treatment, reduce the occurrence of side effects.

hepatitis B

What is hepatitis B?

This disease is a viral infection that causes liver inflammation. The virus exists in the body fluids of infected people, but only blood, saliva, semen and vaginal secretions are contagious. The people with the highest risk of infection include: infants of hepatitis B virus mothers, drug addicts who use syringes, family members and sexual partners of hepatitis B carriers, and other risk groups include: social groups, people receiving dialysis treatment, medical staff and laboratory personnel who have direct contact with infected blood. Hepatitis B can be carried. Once infected, there is a 10% chance of becoming a lifelong carrier.

How to infect?

The main route of infection: 1, perinatal period (babies born to mothers with hepatitis B virus); 2. Injector contamination leads to intravenous injection or stabbing; 3. Sex (due to infectious semen or vaginal secretions); 4, rare mucosa or damaged skin contact with infected blood.

What are the symptoms?

Abdominal pain, nausea, vomiting, sometimes joint pain, urticaria or rash. No fever or only low fever, dark urine, yellow skin and sclera (jaundice). Some infected people have only mild symptoms or no symptoms.

When do the symptoms appear?

Generally about 3 months after infection, the range is 2-6 months.

How long is the infection period?

A few weeks before the symptoms appeared, the virus was in the body fluids of infected people, and it was still contagious in the following months. If you become a virus carrier, it is potentially contagious.

How to treat it?

There is an antiviral drug that is effective for some patients. Consult a doctor.

Is there a preventive vaccine?

Yes Hepatitis B vaccine is safe and effective. This vaccine is recommended for all babies born in Hawaii, as well as high-risk groups, such as family members, sexual partners and immigrants from countries where hepatitis B is prevalent.

How to avoid infection?

Vaccination for high-risk groups. Hepatitis B carriers are not allowed to use razors, toothbrushes and other items that may be contaminated by body fluids.

Babies born to mothers of hepatitis B virus carriers can be injected with hepatitis B immunoglobulin and can also be used for other contacts. If you are accidentally contaminated by blood or after acupuncture, you should be vaccinated within 24 hours.

For sexual contact, injection within 14 days may also be helpful.

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