Male, now 37 years old, discovered hepatitis B “major third-positive” in 1993 and took a lot of traditional Chinese medicine and proprietary Chinese medicine. At that time, the liver function was unstable, so he used Glycine and Bitter Ginseng to lower the transaminases, together with other proprietary Chinese medicines. In 1998, the liver function has been very good, HBV DNA negative, “small triple-positive”, see this result, the doctor also said can not take medicine. But I read some articles on my own, I still take anti-fibrotic drugs, and have been switching between eating turtle nail soft liver tablets and Anluo Fibro Pills. Later, my liver function tests were normal and virus-negative, and I kept taking the medication off and on. By 08, I went for liver penetration, the results of G2S3 (blogger explanation: indicates mild inflammation and moderate fibrosis), liver function, virus, methemoglobin are normal, the doctor said there is no antiviral indicators also did not antiviral, still eat Anluo Hefei Pills and beads liver Tai to anti-fibrosis. at the end of 2012 I went again for systematic examination: gastric ulcer, “small three yang “, liver function is normal, HBV DNA with the Roche test virus is 5.280E + 1IU/mL. ultrasound in the past checked very well, at this time shows liver echogenicity rough, portal vein 15.3mm. CT shows calcification foci in the right lobe of liver, multiple small pieces of nodular enhancement in the right lobe of liver adjacent to the liver edge in the arterial phase; the venous phase and delayed phase are relatively iso-dense, spleen slightly larger. Magnetic resonance imaging: cirrhosis with mild varices of the lower esophagus and fundic veins; multiple small nodular foci of rich blood supply in the liver with possible abnormal hyperperfusion. Then the doctor did an MRI liver tumor specific test for the blood supply nodules and found no exact lesions, only enlarged retroperitoneal lymph nodes. The doctor gave me Adefovir + Hepatoflav + Yunzhi capsules. 3 months later: surface antigen value of 98 IU/ml was a little higher than the value in 2008 (68 IU/ml). Liver function and nail fetus are normal, and the virus is still negative. Adefovir antiviral is only 6 months old now.
May I ask.
1. How can I have cirrhosis of the liver if I have been taking medication? Is it because I haven’t had regular antiviral for 20 years? But my viral DNA has always been very low!
2. Is the cause of cirrhosis that I stay up late and go to bed after 1 o’clock at night has an effect?
3. Is Adefovir effective for me to fight against the virus? What kind of antiviral drug is effective in the long run? Can my early cirrhosis be reversed while adhering to the antiviral therapy?
4. What is the best way to deal with blood-rich nodules in the liver? How can I improve my early stage cirrhosis? Is there any help for my above condition?
Analysis.
Liver inflammation can cause liver fibrosis, and liver fibrosis can develop into cirrhosis. Therefore, anti-fibrotic drugs have become a must-have choice for many cirrhotic patients; they are also the regular medications used by many doctors for cirrhosis. Even some hepatitis patients are happy to use them to prevent cirrhosis.
How effective are anti-fibrotic drugs? The treatment of Mr. Bad Doll is reflective and individual cases are not instructive, but it is true that these drugs have no evidence of rigorous clinical trials and are not recommended by domestic or international Hepatitis B guidelines.
How does cirrhosis develop?
Cirrhosis develops from liver fibrosis. Liver inflammation causes the destruction of liver cells, and fibrosis is the repair of the destruction of liver cells, just like the scarring of a wound on the skin.
Severe hepatitis, especially in patients with concurrent immunosuppressive disease or immunosuppressive therapy, can develop cirrhosis within 1 or 2 years, or even less; mild hepatitis over long years, minor liver cell destruction, minor fibrosis occurs, and over time, fibrosis progresses to cirrhosis unknowingly in more patients.
Liver fibrotic tissue has no hepatocyte metabolic function, but instead impedes liver circulation, increasing the destruction of liver cells and aggravating the disease.
Which is the most effective anti-fibrotic drug?
Chronic hepatitis B causes all active cirrhosis, which is characterized by both hepatitis and cirrhosis.
Anti-inflammatory then has the potential to prevent the development of liver fibrosis; anti-inflammatory also has the potential to reverse liver fibrosis.
Enzyme-lowering drugs moderate inflammation and do not completely and stably cause inflammation to subside. Leaving an accumulation of mild inflammation may instead allow liver fibrosis to progress.
Only antiviral drugs can truly clear liver inflammation: nucleoside analogs show rapid effects; effective interferon therapy is stable. The antifibrotic effect of antiviral drugs has been demonstrated in rigorous clinical trials, especially before and after treatment with repeated liver punctures clearly showing reversal of liver fibrosis. A report from Europe this year: a 5-year registration clinical trial of tenofovir in hundreds of patients, with 3 liver punctures during the course, determined a very significant reversal of liver fibrosis in 50% of cirrhosis.
There has been numerous evidence that antiviral drugs are the most effective anti-fibrotic agents for reducing cirrhosis. In the end, the ultimate goal of antiviral therapy is to prevent cirrhosis and liver cancer.
What was the lesson for Mr. Bad Doll?
He was confused and lost over the development of cirrhosis despite the long-term application of antifibrotic drugs. In fact, his lesson is not the fault of applying antifibrotic drugs, the efficacy of such drugs is not certain, but only an adjuvant drug, which may also have some benefits, but cannot replace antiviral therapy.
For chronic hepatitis B, there is no substitute for antiviral therapy. This is already common medical knowledge, but some patients stop in some specific cases.
I wish a female patient with cirrhosis who came to Guangzhou from as far away as Daqing and requested to have a baby would read this. She ended up buying back tenofovir without taking it because she was concerned about the safety of her fetus, and made me very sad when she recently came back to Guangzhou at 7 months pregnant.
In addition, there is the issue of the market. Both medicine and drugs are supposed to cure diseases and save lives, but under the influence of the market economy, some misalignment may occur. In this regard, I deeply hope that every hepatitis B patient will have a warning about the side effects of the market economy.