I think what is hepatitis B

Hepatitis B, also known as serum hepatitis and viral hepatitis B (hepatitis B for short), is an infectious disease caused by hepatitis B virus (HBV). It is spread through blood and body fluids and has a chronic carrier state. Because it may be transmitted through sexual intercourse, it is classified as a sexually transmitted disease internationally. This disease is widely prevalent in our country, and the infection rate among the population is high. In some areas, the infection rate reaches more than 35%. According to relevant data, the number of patients who have tested positive for hepatitis has reached 189 million, while the number of people who should seek medical treatment but do not (carriers) is nearly 400 million. It is currently the most serious infectious disease endangering people's health. More common in children and young adults.

The clinical manifestations of hepatitis B are diverse, and it is easy to develop into chronic hepatitis and cirrhosis, and a small number of patients can transform into primary liver cancer.

Pathology

HBV is a hepatotropic deoxyribonucleic acid virus, which is a DNA virus. It is a complex with a diameter of 42 nanometers and is divided into two parts: core and shell (envelope). , with a core diameter of 27 nanometers, contains circular double-stranded DNA and polymerase, and is surrounded by a lipoprotein shell. HBV is highly resistant and cannot be inactivated at 60°C for 4 hours or in disinfectants of normal concentrations. After boiling for 10 minutes, the infectivity disappears, but the antigenicity remains. The protein on the envelope, namely hepatitis B surface antigen (HBsAg), is synthesized in liver cells and released into the blood circulation in large quantities. It is not infectious in itself. The core part contains circular double-stranded DNA, DNA polymerase, core antigen (HBcAg) and e-antigen (HBeAg), and is the main body of virus replication. Hepatitis B virus is highly resistant and can withstand disinfectants at 60 degrees Celsius for 4 hours and general concentrations. It can be inactivated by boiling for 10 minutes or high-pressure steam sterilization.

HBV has three antigen-antibody systems:

Surface antigen-antibody system (HBsAg, anti-HBs): HBsAg exists in the outer shell of the virus particle. HBsAg positivity is an indicator of HBV infection, but it is not the only basis for hepatitis B diagnosis. HBsAg can stimulate the body to produce antibodies (anti-HBs)

Core antigen antibody system (HBcAg, anti-HBc):

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

Transmission routes

The sources of hepatitis B infection are diverse, including acute and chronic patients, as well as latent infections and virus carriers, among which chronic patients and virus carriers are the most important. The infectious period in acute patients begins several weeks before onset of illness and continues throughout the acute phase. The infectivity of HBsAg-positive chronic patients and asymptomatic carriers is related to whether HBeAg and anti-HBc are positive. Anyone whose serum HBsAg remains positive for more than 6 months is called a persistent HBsAg carrier. Among the persistent HBsAg carriers in China, the vast majority are also HBeAg positive, accounting for 10-15 of the population in number, and are therefore the most important source of infection.

Hepatitis B virus is mainly excreted from the body through blood and other body fluids, and enters susceptible persons through injection or non-injection routes. Injection methods include blood transfusion and blood products, collective vaccination, drug injection and acupuncture. With the screening of blood donors, purification of blood products, and the promotion 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 in daily life, surgery and blood contact will be the most important routes of transmission. Since 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 are the "three Yangs"?

The so-called "big and small three positives" refer to two different results of the "two-and-a-half hepatitis B antigen test" (referred to as hepatitis B two-and-a-half test). The first pair in the "two and a half pairs" refers to the surface antigen (HBsAg) and the surface antibody (anti-HBs), the second pair is the E antigen (HBeAg) and the E antibody (anti-HBe), and the third pair is the core Antibody (anti-HBc) and core antigen (HBcAg).

Since the core antigen has been completely assembled into hepatitis B virus in liver cells and there is no free core antigen in the serum, only half of the third pair, that is, the core antibody, can be detected in the peripheral blood, so it is called two and a half pairs. .

"Big three positives" means that the surface antigen, E antigen and core antibody tests are all positive. It is generally believed that the "big three positives" are relatively highly contagious and are more likely to evolve into chronic hepatitis B.

"Little three positives" means that the surface antigen, E antibody and core antibody tests are all positive. The difference between "Da Sanyang" and it is that the former is E antigen positive. It is usually transformed from the "big three yang", which is when the human body develops a certain degree of immunity against the E antigen. It is generally believed that "small three positives" are less contagious. But for some people who are negative for E antigen and E antibody, the hepatitis B virus they are infected with may be infected by a strain of virus that has mutated and cannot express E antigen and E antibody. However, if the hepatitis B virus DNA is checked (HBV-DMA) is still positive, indicating that viremia exists and is still contagious.

Regardless of the "major three yangs" or the "small three yangs", they only reflect the status of viruses carried in the human body, but cannot reflect whether the liver function is normal or not, so they cannot be used to judge the severity of the disease. To understand the status of liver function, it is best to go to the hospital regularly (3 months to 6 months) for a two-and-a-half checkup of liver function and hepatitis B.

"Two and a half", "Big Three Yang" and "Little Three Yang"

What are "Big Three Yang", "Little Three Yang", and "Two and a half", It turns out that the "big three positives" refer to HbsAg positive, HBeAg positive, and anti-HBc positive in the hepatitis B test. "Xiao Sanyang" means HbsAg positive, anti-HBe positive, and anti-HBc positive in the hepatitis B test. "Two pairs and a half" refers to HbsAg, HbeAg, anti-HBs, anti-Hbe, and anti-HBc in the hepatitis B test.

It is well known to detect "two and a half" from the serum of patients infected with hepatitis B virus. In recent years, the terms "big three yang" and "small three yang" have appeared, and there are misunderstandings about who is more important and who is less important. In fact, the main difference between them is that on the basis that the "surface antibody" and C antibody are both positive, if the E antigen is also positive, it is called "big three positive", which means that the virus is actively replicating and is often accompanied by hepatitis B virus DNA. (DNA) is 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 hepatitis B virus DNA is negative, it is basically no longer infectious. sex. Perhaps this is one of the main reasons why people often think that the condition of "big three yang" is serious and the condition of "small three yang" is mild, and they hope to change from "big three yang" to "small three yang" as soon as possible.

However, what really determines the severity of a patient's condition is hepatitis B virus DNA, liver function and clinical symptoms. There are roughly three situations: In the first situation, there is a small number of patients with "small three positives" whose hepatitis B virus DNA is still positive, indicating that virus replication is still active and may be the result of hepatitis B virus mutation. The patient's condition may be worse. The weight and development are faster and should be paid attention to. In the second situation, no matter whether the patient has "big three yang" or "small three yang", if the liver function is normal and there are no obvious symptoms, he is called a hepatitis B virus carrier and cannot be diagnosed as a hepatitis B patient. Among hepatitis B virus carriers, most of them were infected with hepatitis B virus in infants and young children. Because the body's immune system was not fully developed at that time and was unable to clear the virus, it tolerated the hepatitis B virus and its long-term peaceful coexistence, and became carriers. In the third situation, whether it is "big three yang" or "small three yang", if liver function is abnormal repeatedly, or is accompanied by clinical symptoms, or hepatosplenomegaly, etc., it should be judged as a hepatitis B patient and requires active treatment. To control active liver disease as quickly as possible. Because the vast majority of patients with liver cirrhosis and liver cancer in our country have experienced a long process of repeated active liver disease. In other words, as long as there is no active liver disease or the recurrence of chronic liver disease can be avoided, the occurrence of serious consequences such as cirrhosis and liver cancer can be effectively prevented. Medical research also proves that after a certain period of time, 5%-10% of people with "big three yang" will naturally turn into "small three yang" every year.

Natural transformation to yin is an opportunity for everyone with the "big three yang", but there is currently no way to determine when it will happen. Therefore, it is recommended that those with "Big Three Yangs" do not need to worry too much. Even if you try to use antiviral drugs to convert the "big three yang" into the "small three yang", you must choose those with abnormal liver function to respond to treatment.

Hepatitis B virus carriers are not suitable for drug treatment, and it is wise to wait for the virus to turn negative naturally. They can live, study and work normally, but are not suitable for catering services and childcare work.

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

Interferon was discovered in 1957 and has been around for more than 30 years. This is a very small amount of protein that is naturally produced when the human body is attacked by a virus. It is the body's own disease-resistant substance. The cost of producing this kind of biological product more than ten years ago was very expensive, costing about US$50 million per gram, which was approximately equivalent to the value of 1.5 to 2 tons of gold at that time. Now, in addition to using human blood to prepare interferon, bioengineering technology can also be used to successfully produce interferon, opening up broad prospects for clinical application.

There is no specific treatment drug for chronic hepatitis B so far, and interferon is a relatively effective antiviral drug recognized at home and abroad. Among them, 25 to 50% of patients have a good response after 3 to 4 months of treatment. Hepatitis B virus e antigen and deoxyribonucleic acid (HBV-DNA) disappear from the blood. Subsequently, clinical symptoms are relieved and transaminases return to normal. Many research results show that patients from European and American countries have better curative effects, while patients from the East (such as China and Japan) have worse curative effects. However, if treatment targets can be carefully selected, the efficacy of interferon in chronic hepatitis B can still be improved. Since there are large individual differences in the body's response to interferon, what type of chronic hepatitis B patients are expected to have better therapeutic effects on interferon is not only a question that clinicians must consider before deciding to take medication, but also a question that many patients topics of concern. At the Seventh International Conference on Viral Hepatitis held in the United States in 1990, experts proposed that the following factors in patients will affect the therapeutic effect of interferon:

1. Patients infected with hepatitis B virus in adulthood, with a short course of hepatitis before treatment (less than 7 years, especially around 2 years), e-antigen positivity with low-level HBV-DNA positivity, increased serum aminotransferases, female patients, and hepatitis C and D viruses Patients with negative antibodies and no other diseases (such as HIV infection, kidney disease, diabetes, etc.) will have better curative effect.

2． For patients who are e-antigen negative and HBV-DNA positive, the application of interferon also has a certain effect, but the effect is slightly less effective. The curative effect of chronic persistent hepatitis is also worse than that of chronic active hepatitis.

3． The efficacy of HBsAg-positive cirrhosis patients is also poor, which may be related to the fact that HBV-DNA has been integrated into the genome of liver cells. At this time, the body's sensitivity to interferon decreases and the response is poor. The longer the disease course, the greater the chance of integration and the lower the sensitivity.

4． For asymptomatic hepatitis B virus carriers with normal serum aminotransferases, interferon treatment is basically ineffective. Because such patients are often infected with hepatitis B virus in the womb or at birth, the patient's immune system is not yet mature at this time and cannot clear the virus, so most of them evolve into a chronic virus carrier state. Such patients are often not deficient in endogenous interferon, so exogenous interferon treatment is often ineffective.

In cases where interferon therapy is effective, there is often a transient increase in transaminase in the early stage of treatment, and then the e-antigen and HBV-DNA disappear, e-antibodies appear, and then the transaminase returns to normal. The increase in transaminase is related to the lysis and destruction of virus-infected liver cells by the body's killer immune cells after interferon treatment. It is one of the important signs for predicting the effectiveness of treatment. If it is not accompanied by jaundice and gastrointestinal symptoms (nausea, vomiting, obvious appetite For symptoms such as worsening of liver function damage such as decreased liver function, patients do not need to worry too much about elevated transaminases, and there is no need to stop medication or add enzyme-lowering drugs. However, most patients have varying degrees of side effects during interferon treatment, such as fever, myalgia, nausea, vomiting, etc. They should also pay attention to bone marrow suppression. Individual patients with severe reactions should adjust the dose or stop taking the drug immediately, so they receive interferon. Patients should be hospitalized for observation.

Interferon and Hepatitis B Guo Xiuzang, Deputy Chief Physician

Chronic hepatitis B has the highest incidence rate among viral hepatitis. Naturally, the prognosis is poor after many courses, about 50% after 5 years without treatment. Of patients develop cirrhosis, a small proportion naturally develop asymptomatic HBsAg carriers (approximately 2%-3% per year). The inflammatory activity of chronic hepatitis B is related to the viral immune response. The therapeutic effect of alpha interferon on chronic hepatitis B is mainly due to the immune regulatory mechanism. In November 1996, the German Society of Digestive and Metabolic Diseases specifically discussed the treatment of chronic hepatitis and made recommendations on treatment indications, treatment methods, clinical observations, and recurrence after treatment.

Indications for the treatment of chronic hepatitis B: Patients with chronic hepatitis B whose viral replication is qualitatively detected are candidates for interferon treatment; while about 90% of acute hepatitis B cases can be cured naturally and are not treated with interferon Indications for treatment. However, it needs to be emphasized that in recent years, it has been found that HBeAg-negative and anti-HBe-positive chronic hepatitis B patients are often accompanied by viral replication. Viral replication in HBeAg-negative patients is the replication of pre-C-mutant strains. Therefore, distinguishing between chronic hepatitis B HBeAg-positive (wild strain) and HBeAg-negative (pre-C-variant strain) types is of great significance for treatment.

Clinical observation of dosage, application in HBeAg-positive chronic hepatitis B. Interferon 5-6 million units, 3 times/week, subcutaneous injection for 6 months. If HbeAg/anti-HBe seroconversion occurs after 6 months of treatment, treatment can be continued for 2 months after seroconversion. The increase in transaminases several weeks after treatment reflects the hepatotoxic response induced by alpha interferon to HBV infection and should be regarded as a good sign, and generally there is no need to reduce the dose.

For anti-HBe-positive replicative hepatitis B (pre-C variant), the response to alpha interferon in initial treatment is similar to that of wild-type infection. In other words, HBV-DNA in such patients can also turn negative after interferon-a treatment. However, the recurrence rate is high, so some people recommend that the treatment course be 1 year.

Clinically, it has been found that some patients, although their serology is negative for HBV-DNA and persistently positive for anti-HBe, have persistent or fluctuating positive transaminase, often developing progressive liver disease. This type of patient is because the replication of the pre-C variant strain is below the detection level, and there is currently no specific treatment. In this case, liver puncture, biopsy, and histological examination can be performed. This can be used if chronic hepatitis is diagnosed. Interferon combined with oral second-generation nucleotide derivatives is a comprehensive treatment for 6 to 12 months.

The most common side effect of a interferon treatment is cold symptoms. General fatigue, fever, headache, soreness and weakness of limbs, etc. may occur. Paracetamol 0.5-1.0 g can be given 1 hour before injecting interferon-a to prevent and control these symptoms. Some other systemic reactions may also occur, such as anorexia, nausea, vomiting, some neurological reaction disorders, thrombocytopenia, leukopenia, rash, itching, local erythema at the injection site, etc., which can be treated symptomatically to reduce the occurrence of side effects.

Hepatitis B

What is hepatitis B?

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

How to get infected?

The main routes of infection: 1. Perinatal period (babies born to mothers with hepatitis B virus); 2. Intravenous injection with contaminated syringes or stab wounds; 3. Sex (due to infection Sexual semen or vaginal secretions); 4. Rarely, mucous membranes or damaged skin come into contact with infected blood.

What are the symptoms?

Abdominal pain, nausea, vomiting, sometimes joint pain, hives, or rash.

There is no fever or only low-grade fever, dark urine, and yellowing of the skin and sclera (jaundice). Some infected people have only mild symptoms or no symptoms.

When do symptoms appear?

Usually about 3 months after infection, with a range of 2-6 months.

How long is the infectious period?

The virus is present in an infected person’s body fluids weeks before symptoms appear and remains contagious for several months. If you become a virus carrier, you are potentially infectious.

How to treat?

There is an antiviral drug that works for some patients. See your doctor for information.

Are there any vaccinations?

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

How to protect yourself from infection?

People at high risk should be vaccinated. Hepatitis B carriers are not allowed to use razors, toothbrushes and other items that may be contaminated with body fluids.

Babies born to mothers with hepatitis B virus can be injected with hepatitis B immune globulin, and other contacts can also be given the vaccine within 24 hours if they are accidentally contaminated by blood or acupuncture.

For sexual contact, injections given within 14 days may also help.

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