In the clinic, we often hear patients ask: What does “major triple-positive” and “minor triple-positive” for hepatitis B mean? Does “major triple-positive” mean that the disease is more serious, and does “minor triple-positive” mean that treatment is not needed? Sometimes, non-specialist doctors can’t tell you the answer to this question. Today, we will talk to you about what is “big three yang” and “small three yang”. 1. What are “major triple yang” and “minor triple yang”? ”The terms “major third-positive” and “minor third-positive” are a way of referring to the hepatitis B “two-and-a-half” test. The “two-and-a-half” test for hepatitis B is a preliminary test to determine whether you are infected with the hepatitis B virus or to roughly estimate the level of viral replication. The two different results of the hepatitis B “two-to-one” test. The so-called hepatitis B “two-and-a-half” is a queue of five tests for hepatitis B markers, which are hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), and hepatitis B core antibody (HBcAb), in that order. Usually, the positive items 1, 3 and 5 are called “major triple-positive”, also known as e antigen-positive chronic hepatitis B. The positive items 1, 4 and 5 are called “minor triple-positive”, also known as e antigen-negative chronic hepatitis B. The positive items 1, 4 and 5 are called “minor triple-positive”, also known as e antigen-negative chronic hepatitis B. Whether hepatitis B “big three positive” or hepatitis B “small three positive”, can not reflect the normal function of the liver or not. 2.Check which one you are? 3. Is hepatitis B “major triple-positive” more serious than “minor triple-positive” patients? The “major triplet” and “minor triplet” cannot be used to determine the severity of the disease. “Major triple-positive” usually means that the hepatitis B virus is highly infectious and has a greater ability to replicate in the body. Recurrent inflammation of the liver may lead to cirrhosis and even liver cancer. A “small triple positive” usually means that the virus is less able to replicate in the body and is relatively less contagious. However, many patients with “small triple-positive” disease take it lightly and do not pay attention to review and examination, and some of them have insidious onset and no clinical manifestation, and the long-term damage to liver parenchyma is often heavier than that of “large triple-positive” disease, and the incidence of cirrhosis is even higher than that of “large triple-positive” disease. The incidence of cirrhosis is even higher than that of “major triple-positive” patients. Therefore, no matter “major triple-positive” or “minor triple-positive”, as long as HBV DNA is positive, it is recommended to test HBV DNA and liver function at least once every three months, and decide whether to treat according to the test results, and if the indication for antiviral treatment is met, then antiviral treatment should be carried out. Anti-viral treatment. 4.If I am found to have hepatitis B “major triple positive” in physical examination, am I going to get liver cancer? According to statistics, people with positive hepatitis B surface antigen have 100 times higher risk of liver cancer than normal people, and those infected in infancy have higher risk of liver cancer than those infected in adulthood. The Taiwan REVEAL-HBV study showed that patients with baseline HBV DNA levels ≥10^6 copies/mL had a 14.89% probability of liver cancer after 13 years of follow-up, while patients with baseline HBVDNA levels ≤10^4 copies/mL had only a 1.37% probability of liver cancer; patients with cirrhosis had a 30% probability of liver cancer. Therefore, the best way to prevent and treat hepatocellular carcinoma is hepatitis B antiviral therapy, which can inhibit HBV infection and replication, reduce the damage of liver tissue and delay the progress of the disease. For hepatitis B virus-infected patients aged 35-40, they should have at least one methotrexate and ultrasound examination every six months; for those who have developed cirrhosis, the number of examinations should be increased appropriately to observe whether the liver has cancerous changes. Especially for patients with high risk of HCC (primary liver cancer) (>40 years old, male, alcoholic, liver insufficiency and increased AFP), AFP and abdominal ultrasound (CT or MRI if necessary) should be tested every 3-6 months for early detection of HCC. 5.My fiancée and I are going to have a wedding soon, but during the pre-wedding examination, it was found that she has “major triple-positive “I am going to marry my fiancée soon. Is it possible to get married in this case? The so-called “major triple-positive” refers to hepatitis B surface antigen, e antigen, core antibody are positive, indicating that your fiancée currently has hepatitis B virus in her body, and in a certain state of replication. Therefore, her blood and secretions are somewhat infectious. After you get married, it is easy to transmit the virus to your spouse due to the close contact between the couple, especially when there is a break in the skin mucous membrane. Therefore, it is advisable to do several tests for hepatitis B markers before marriage, such as hepatitis B “two-to-one half” and HBV DNA quantification. If the spouse is negative for hepatitis B markers, he/she should be vaccinated with hepatitis B vaccine 0 months, 1 month and 6 months before marriage, and have the hepatitis B surface antibody quantified. If the surface antibody is positive (>10 IU/ml), you will not be infected with hepatitis B virus after marriage. In addition, your fiancée can also get pregnant after marriage, but the baby should be injected with hepatitis B immunoglobulin and hepatitis B vaccine immediately after birth, which can prevent the baby from being infected with hepatitis B virus due to vertical transmission from mother to child to the greatest extent possible. 6.I just found out that I have hepatitis B “major third-positive” in my physical examination, can I change to hepatitis B “minor third-positive”? If you are a hepatitis B carrier with normal liver function, you do not need to deliberately seek to become a “minor third-positive” during the stabilization period because of the weak inflammatory activity of the liver. For patients with chronic hepatitis B, a change from “yang” to “minor tri-positive” (i.e., e antigen serologic conversion) during the course of treatment may mean better The result is a better outcome and a better prognosis. Medical studies have demonstrated that 2%-15% of adults with chronic hepatitis B “major triple-positive” disease convert spontaneously to “minor triple-positive” hepatitis B each year. This may be related to the strength of the body’s interaction with the virus. In general, the higher the ALT, the higher the percentage of natural conversion. Interferon alpha and nucleoside (acid) analogs can facilitate this conversion process, but the patient must have an ALT equal to or greater than two times the upper limit of normal before treatment. ALT not only reflects the degree of hepatocyte damage, but also indirectly reflects the body’s immune capacity to clear the hepatitis B virus, so sometimes a moderately elevated ALT may indicate a better outcome. For hepatitis B virus carriers with normal ALT, antiviral treatment is not advisable. It is wise to actively do self-care and regularly observe and follow up HBVDNA and liver function. 7.I have hepatitis B “major third-positive”, but my liver function has been normal, should I take antiviral treatment? You may be a hepatitis B carrier. According to the hepatitis B antiviral treatment guidelines, whether it is “major triple-positive” or “minor triple-positive”, if the long-term physical examination of liver function is normal, ultrasound and other tests do not find the basis for long-term hepatitis activity, then consider the current period of peaceful coexistence with the virus, that is, hepatitis B If the liver function is normal on long-term physical examination and there is no evidence of long-term hepatitis activity on other tests such as ultrasound, the patient is considered to be in a peaceful coexistence with the virus, i.e. hepatitis B carrier status, and does not need antiviral treatment yet. However, regular follow-up of liver function and HBVDNA is still needed to detect evidence of viral activity in a timely manner.