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Abstract: The patient was found to have abnormal liver function during physical examination, felt weak, and had dry stools followed by loose stools, and came to our hospital for further treatment. Based on the examination results and the patient’s performance, a preliminary diagnosis of chronic viral hepatitis B was made. After antiviral treatment with drugs, the patient’s liver function returned to normal, his high-sensitivity HBV-DNA turned negative, and his mental status and physical condition improved significantly.
Basic information】Male, 25 years old
Disease Type】Chronic viral hepatitis B
Hospital】Huangshi Hospital of Traditional Chinese Medicine (City Infectious Disease Hospital)
Time of consultation】August 2020
Treatment plan】Medication (magnesium isoglycyrrhizate injection, entecavir capsules, tenofovir disoproxil fumarate tablets, diammonium glycyrrhizate enteric capsules)
[Treatment Period] Hospitalization for 1 week, review after 1 month
Treatment effect】Liver function returned to normal, high-sensitivity HBV-DNA turned negative, mental status and physical condition improved significantly
I. Initial interview
The patient’s liver function was found to be abnormal during the physical examination. At that time, he was seen in an outpatient clinic, which showed that ALT and AST were significantly elevated, and the hepatitis B two-to-one test indicated hepatitis B virus infection. The patient felt weak, no fever or cough, no nausea or vomiting, no abdominal pain, and dry stools followed by loose stools. Based on the examination results and the patient’s performance, a preliminary diagnosis of chronic hepatitis B was made, and other causes were not excluded.
II. Treatment history
According to the patient’s examination results, for the elevation of liver function transaminase, treated with magnesium isoglycyrrhizate injection and taking anti-hepatitis B virus drug entecavir capsule. After 1 week of treatment with magnesium isoglycyrrhizate injection, the patient’s liver function recovered significantly. The high-sensitive HBV-DNA result was positive, so he was given oral diammonium glycyrrhizate enteric capsules and switched to tenofovir disoproxil fumarate tablets for antiviral, and the HBV-DNA turned negative and liver function was improved after the medication.
III. Treatment effect
After 1 week of inpatient treatment, the patient’s liver function indexes improved, the symptoms of self-conscious weakness were significantly relieved, and the urine and stool gradually returned to normal. 1 month later, the liver function returned to normal, and the high-sensitivity HBV-DNA turned negative. After 3 months of treatment, liver function and high-sensitivity HBV-DNA continued to be normal on recheck, and the patient had no special discomfort and good recovery in mental and physical condition, which is a good effect.
IV. Notes
The patient recovered very well and his condition was under control, so we are happy for him. He was instructed to quit smoking and drinking, not to stay up late and work hard, and to avoid all drugs that may cause abnormal liver function, such as common cold and flu medicines and macrolide antibiotics, etc. He was also instructed to take his medication on time and to review his liver function regularly. Avoid overexertion and take moderate exercise, such as tai chi, jogging, brisk walking, etc. Keep your mood optimistic and relaxed, avoid overeating and quit smoking and drinking. Take in enough nutrition, eat more fruits and vegetables, eat fresh food, pay special attention to the handling of seafood when eating, and pay attention to food safety and hygiene.
V. Personal insight
Since the introduction of antiviral therapy, the incidence of chronic viral hepatitis B severe and cirrhosis, liver cancer is a significant downward trend, but due to the long course of antiviral therapy, the emergence of drug-resistant mutations is almost inevitable, can be appropriate drug changes, treatment may be better. The low quantitative level of HBV-DNA in this patient belongs to hepatitis B hypervirulinaemia, but it cannot be ignored. Studies have shown that hepatitis B hypervirulinaemia not only implies viral mutation, but also may be associated with liver disease progression, and for the early diagnosis of hypervirulinaemia, the role of highly sensitive HBV-DNA testing should be emphasized.