Hepatitis B, also known as serum hepatitis and viral hepatitis B (HBV for short), is an infectious disease caused by hepatitis B virus (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 patients who have tested positive for hepatitis has reached 89 million, while the number of people (carriers) who should see a doctor is nearly 411 million. It is the most serious infectious disease that harms people's health at present. 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 few patients can turn into primary liver cancer.
pathology
HBV is hepatotropic deoxyribonucleic acid virus, belonging to DNA virus. It is a complex with a diameter of 42 nm, which is divided into two parts: core and shell (envelope). The core has a diameter of 27 nm, and contains circular double-stranded DNA and polymerase, and the outer part is lipoprotein shell. HBV is very resistant, and it can't be inactivated at 61℃ for 4 hours and in disinfectant with general concentration. After boiling for 11 minutes, infectivity disappeared, but antigenicity remained. Protein on the envelope, namely hepatitis B surface antigen (HBsAg), is synthesized in liver cells and released into blood circulation in large quantities, which 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 it can tolerate disinfectants with a general concentration of 61 degrees for 4 hours. It can be inactivated by boiling for 11 minutes or high-pressure steam disinfection.
HBV has three antigen-antibody systems:
HBsAg (anti-HBS): HBsAg exists in the outer 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, anti-HBc):
E antigen-antibody system (HBeAg, anti-HBe):
Transmission routes
The sources of infection of hepatitis B are diverse, including acute and chronic patients, as well as recessive infected people and virus carriers, among which chronic patients. The infectious period of acute patients begins several weeks before onset and lasts throughout the acute phase. The infectivity of HBsAg positive chronic patients and asymptomatic carriers is related to whether HBeAg and anti -HBc are positive or not. Those who have been HBsAg positive in serum for more than 6 months are called persistent HBsAg carriers. Most of the persistent HBsAg carriers in China are HBeAg positive at the same time, accounting for 11-15% of the population, so they are the most important sources of infection.
Hepatitis B virus is excreted mainly through blood and other body fluids, and enters susceptible people 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 and use of disposable syringes and acupuncture needles, the proportion of transmission by injection will gradually decrease. Non-injection routes, including mother-to-child transmission, close contact in 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 transmission route of hepatitis B.
what is "three yang"?
The so-called "big-small-three-yang" refers to two different results of "hepatitis B antigen two-and-a-half examination" (referred to as hepatitis B two-and-a-half examination for short). 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 the core antigens in liver cells have all been assembled into hepatitis B virus, and there is no free core antigen in serum, 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 the surface antigen, E antigen and core antibody are all positive. It is generally believed that "Big Three Yang" is relatively contagious, and it is also more likely to evolve into chronic hepatitis B.
"Xiao San Yang" means that the surface antigen, E antibody and core antibody are all positive. The difference between "Big Three Yang" and it is that the former is positive for E antigen. It is usually transformed from "Big Three Yang", and it is the human body that has a certain degree of immunity against E antigen. It is generally believed that "Xiao Sanyang" is less contagious. However, for some people whose E antigen and E antibody are negative, the hepatitis B virus it is infected with may be infected by a mutated virus strain, and it cannot express E antigen and E antibody. However, if HBV-DMA is still positive, it means that viremia exists and it is still contagious.
No matter "Big Three Yang" or "Small Three Yang", it only reflects the situation of virus in human body, but it can't reflect whether the liver function is normal or not, so it can't be used to judge the severity of the disease. If you want to know the situation of liver function, it is best to go to the hospital regularly (3 months to 6 months) for a two-and-a-half examination of liver function and hepatitis B.
"two halves", "big three yang" and "small three yang"
What are "big three yang", "small three yang" and "two halves"? Originally, "big three yang" means HbsAg positive, HBeAg positive and anti-HBc positive in hepatitis B examination. "Xiao Sanyang" 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 to detect "two and a half" from the serum of HBV-infected people. In recent years, the appellation of "big three yang" and "small three yang" has appeared again, and there are misunderstandings on who is more important than who is lighter. In fact, the main difference between them 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", which means that the virus replication is active, and it is often accompanied by hepatitis B virus DNA (deoxyribonucleic acid) positive, which means that it is highly contagious; 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 Sanyang" is seriously ill and "Little Sanyang" is slightly ill, and hope to change from "Big Sanyang" to "Little Sanyang" 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 as follows: in the first situation, a small number of patients with "small three positive" are still positive for HBV DNA, suggesting that virus replication is still active, and it may be the result of HBV mutation, and the patient's condition may be heavier and develop faster, so attention should be paid to it. 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 of the hepatitis B virus carriers were infected with hepatitis B virus in infancy, but they became carriers because the immune system was not fully developed at that time, and they were unable to remove the virus and tolerate the long-term peace between hepatitis B virus and it. 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 hepatitis B patient and needs active treatment to control active liver disease as soon as possible. Because the vast majority of patients with liver cirrhosis and liver cancer in China have experienced a long process of repeated liver diseases. In other words, as long as there is no active liver disease or the repeated activity of chronic liver disease can be avoided, serious consequences such as liver cirrhosis and liver cancer can be effectively prevented. Medical research also proves that after a certain period of time, 5%-11% of the "big three-yang" people naturally turn into "small three-yang" every year. It's an opportunity for everyone who has a "big three yang" to turn cloudy naturally, but there is no way to determine when it will happen. Therefore, those who suggest "Big 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 around for more than 31 years. This is a tiny amount of protein naturally produced when the human body is attacked by virus, which is a disease-resistant substance of the human body itself. More than a decade ago, the cost of producing this biological product was very expensive, about 51 million US dollars per gram, which was about equal to the value of 1.5 ~ 2 tons of gold at that time. Now, in addition to preparing interferon from human blood, interferon can also be successfully produced by bioengineering technology, which has opened up a broad prospect for clinical application.
Up to now, 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 ~ 51% patients had a good response after 3 ~ 4 months of treatment. Hepatitis B virus E antigen and deoxyribonucleic acid (HBV-DNA) disappeared from the blood, and then the clinical symptoms were relieved and 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 the 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, what type of chronic hepatitis B patients are expected to have better curative effect on interferon, which is not only a problem that clinicians must consider before deciding on medication, but also a topic of concern to many patients. At the 7th International Conference on Viral Hepatitis held in the United States in 1991, experts pointed out that the following factors of patients will affect the therapeutic effect of interferon: < P > 1. Any adult infected with hepatitis B virus, short course of hepatitis before treatment (less than 7 years, especially about 2 years), positive E antigen with low level of HBV-DNA, elevated serum transaminase, female patients, negative antibodies to hepatitis C and D virus and no other diseases (such as HIV)
in patients with negative 2. e antigen and positive HBV－DNA, interferon has a certain effect, but the effect is less. The curative effect of chronic persistent hepatitis is worse than that of chronic active hepatitis.
3. HBsAg-positive patients with liver cirrhosis also have poor curative effect, which may be related to the integration of HBV-DNA into the genome of hepatocytes. At this time, the sensitivity of the body to interferon decreases, and the 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 clear the virus, so most of them have evolved into a chronic virus-carrying state. There is often no shortage of endogenous interferon in such patients, so it is often ineffective to give exogenous interferon treatment.
In cases with effective interferon treatment, there is often a transient increase in transaminase at the initial stage of treatment, and then E antigen and HBV-DNA disappear, and E antibody appears, and then transaminase returns to normal. The increase of transaminase is related to the dissolution and destruction of virus-infected liver cells by killer immune cells in vivo after interferon treatment, and it is one of the important signs to predict the effectiveness of treatment. 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 add enzyme-lowering drugs. However, most patients have different degrees of side effects during interferon treatment, such as fever, myalgia, nausea, vomiting, etc., and attention should also be paid to bone marrow suppression. Some patients with severe reactions should adjust their doses or stop taking drugs immediately, so it is advisable to be hospitalized for observation.
Interferon and Hepatitis B Guo Xiucang, Deputy Chief Physician
Chronic hepatitis B has the highest incidence rate in viral hepatitis, and the prognosis is poor naturally. After 5 years of untreated treatment, about 51% of 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 the immune regulation mechanism. 1996-11 The German Society of Digestive and Metabolic Diseases specially discussed the treatment of chronic hepatitis, and put forward some suggestions on the indications, treatment methods, clinical observation and recurrence after treatment.
Indications for the treatment of chronic hepatitis B: Patients with chronic hepatitis B are qualitatively detected with virus replication and are the targets of interferon treatment; However, about 91% 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- variant) types of chronic hepatitis B.
Clinical observation on the dose, HBeAg positive chronic hepatitis B application. Interferon 5-6 million units, 3 times per 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 in 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 replicated hepatitis B (pre-C mutant), the response of initial treatment to interferon A is similar to that of wild strains infection. That is to say, HBV-DNA in these patients can also turn negative after interferon A treatment. However, the recurrence rate is high, so it is suggested that the treatment course should be 1 years.
Clinically, it is found that although some patients are serologically negative for HBV-DNA and persistently positive for anti -HBe, they are persistently or fluctuating positive for transaminase, which often develops into progressive liver disease. This kind of patients is because the replication of pre-C mutant is lower than the detection level, and there is no special treatment at present. In this case, liver puncture, biopsy and histological examination can be done, and it can be applied if chronic hepatitis is diagnosed by gun. Interferon combined with oral second-generation nucleotide derivatives for comprehensive treatment for 6-12 months.
the most common side effect of interferon a therapy is cold symptoms. General fatigue, fever, headache, soreness and weakness of limbs may occur. Paracetamol 1.5-1.1 g can be given 1 hour before interferon A injection to prevent and control these symptoms. There may also be some other systemic reactions, such as anorexia, nausea, vomiting, some neurological disorders, thrombocytopenia, leukopenia, rash, itching, local erythema at the injection site, etc., which can be treated symptomatically to reduce the occurrence of side effects.
HepatitisB
what is hepatitis B?
this disease is caused by liver inflammation.