Hepatitis B virus infection is still a worldwide medical problem, and it is an infectious disease with high morbidity and mortality caused by hepatophilic HBV virus. In 2006, the Chinese CDC surveyed 81,715 patients aged 1-59 years at 160 monitoring sites in 31 provinces and autonomous regions and found that the rate of hepatitis B surface antigen positivity had dropped to 7.18%, i.e., about 100 million people were positive for hepatitis B surface antigen. How to prevent and treat hepatitis B virus infection is an important issue for the health of the nation.
The role of the liver in the human body
The liver is located under the right septal rib and generally weighs 1100 to 1450g, accounting for 1/40 to 1/50 of body weight, with a length and width of 25×15cm. 3/4 of the blood supply to the liver comes from the portal vein and 1/4 from the hepatic artery, with the hepatic artery supplying mainly oxygen and the portal vein supplying mainly nutrients, so whether the liver can survive depends on the blood supply from the hepatic artery and portal vein.
The liver is the largest digestive gland in the body, the liver is a chemical processing plant, the liver is a storehouse, storing sugar and vitamins, the liver is a filter, removing waste and toxic substances, the liver is an essential and vital organ for maintaining life activities.
What does hepatitis B virus infection mean?
(a) The dangers of hepatitis B virus infection
Once the human body is infected with the hepatitis B virus and develops a chronic infection, the virus is difficult to eliminate and will affect the whole life. The current treatment principle for hepatitis B virus is to inhibit the replication of the virus rather than eliminate it, but treatment for hepatitis C virus is curable. 15-25% of people infected with hepatitis B virus will eventually die of cirrhosis and liver cancer related to the hepatitis B virus, and the natural outcome is very grim. China’s annual economic loss due to chronic hepatitis B (including cirrhosis, liver cancer) is large, and the burden on individuals and families is even heavier.
(B) Hepatitis B virus infection channels
There are three main transmission routes: blood transmission; vertical transmission from mother to child; and sexual transmission. Hepatitis B is not transmitted through the digestive and respiratory tracts, so daily contact such as shaking hands, hugging, working together, eating together, etc. generally does not transmit hepatitis B. There is no need to talk about liver.
(3) Hepatitis B virus infection is divided into acute infection and chronic infection
The “two and a half” often refers to the surface antigen, surface antibody is a pair, E antigen, E antibody is a pair, and half refers to the core antibody, because the core antigen is difficult to detect in the peripheral blood, acute hepatitis B infection in adulthood 3-5% will be transformed into chronic hepatitis, in addition. It is important to note that whether it is “major triplet” or “minor triplet”, it does not represent the severity of the disease, but is merely a sign of hepatitis B infection.
(4) Hepatitis B virus carriers are not equal to hepatitis B patients, nor are they healthy people in the full sense of the word.
Guidelines: Although hepatitis B virus carriers are not hepatitis B patients, they are not healthy people in the full sense of the word and should still be followed up.
When does a person with hepatitis B virus need treatment?
(a) The terms “major tri-positive” and “minor tri-positive” are not scientific terms, but are just customary names for the different states of hepatitis B virus infection over the years. The following are different perceptions of major and minor triplets, and the wrong view is that: “major triplets” are heavy and “minor triplets” are light; “minor triplets” are not contagious; and they feel good about themselves. It is impossible to change from “small triple-positive” to “large triple-positive”; as long as “large triple-positive” is the case, it should be treated with antiviral therapy. The correct view is: the important indicators to judge the severity of the disease are transaminases and liver puncture tests, not hepatitis B serum markers; HBVDNA is a parameter of the size of the infectiousness of hepatitis B. If HBVDNA is abnormal in a “small triple-positive” person, he is also infectious; “large triple-positive “If the transaminases, HBVDNA and liver puncture tests are normal, antiviral treatment is not needed for the time being.
(B) How to do if you find out positive hepatitis B surface antigen in physical examination
After finding out positive hepatitis B surface antigen, you need to recheck liver function, ultrasound, HBVDNA quantification, blood routine, liver fibrosis index, etc. It should be noted that normal transaminases are only an indicator to judge the normal liver and not an absolute indicator. It is recommended to have regular medical checkups to grasp the timing of antiviral treatment, and not to judge the condition entirely by self-feeling.
(C) General indications for antiviral therapy
The guidelines recommend that
1.Anti-viral therapy is required for E antigen-positive patients if the viral replication is greater than the 5th power of 10; E antigen-negative patients with HBVDNA greater than 10,000 copies/mL and transaminases greater than or equal to 2 times the upper limit of normal values.
2. If the viral replication is greater than 5 times 10, but the transaminase is less than 2 times the upper limit of the normal value, and if the liver puncture suggests moderate or above damage, then antiviral treatment is also required.
For those who do not meet the above treatment criteria, changes in disease should be monitored and antiviral therapy should also be considered if there is persistent HBVDNA positivity and abnormal transaminases. In addition, chronic hepatitis B patients who are older (>40 years old) should be followed more closely, with liver biopsies to clarify inflammation and fibrosis if necessary, and antiviral therapy actively given.
It is important to note that hepatitis B carriers should not waste money by blindly pursuing surface antigen conversion. The natural conversion rate of HBsAg positivity is about 2% per year, and the few patients who find antigen conversion after taking a certain drug are likely to have a natural conversion rather than a drug effect. The rate of hepatitis B surface antigen reversion is also very low in chronic hepatitis B patients who are eligible for antiviral therapy after drug treatment. Therefore, neither hepatitis B patients nor hepatitis B carriers should blindly pursue surface antigen reversion.
Marriage, family life and employment
(A) Hepatitis B virus-infected people can have normal marriages
When falling in love, one party is hepatitis B virus infected, the other party should be vaccinated against hepatitis B. After marriage, the best measure to protect the family is hepatitis B vaccination; newborns are born with good preventive injections. Infected people also need to pay attention to their own health, insist on follow-up visits and monitor their condition.
(II) Vaccination
Vaccination targets are: newborns, infants and children, medical personnel, those who are frequently exposed to blood, those who frequently receive blood transfusions or blood products, patients who use immunosuppressive drugs, those who are prone to trauma, those who have multiple sexual partners and intravenous virus injections, and family members of HBsAg-positive people.
In mother-to-child blockade, there are two kinds of drugs, hepatitis B vaccine and hepatitis B immunoglobulin. The main method is that when a newborn baby is born within 24 hours, he needs to be injected with hepatitis B vaccine and hepatitis B immunoglobulin, and one month later, hepatitis B immunoglobulin is also injected. The birth of a woman who shows positive for hepatitis B must be blocked from mother to child in a specialized hospital, and this method can control the infection rate of the newborn to less than 10%. There are different academic views on the treatment of pregnant women, with some advocating immunoglobulin injections in the second trimester and others advocating the use of some nucleoside analogues during pregnancy.
Clinically, 5% of the population does not produce antibodies after vaccination due to the following reasons: dose and purity of the vaccine; immunization protocol; immunity, such as AIDS, immune diseases, and those with long-term glucocorticoid application; and occult infection.
In general, the titer of surface antibodies decreases or cannot be measured (negative), and the hepatitis B vaccine should be boosted, because the body has a memory response and can quickly produce effective antibodies. In addition, HIV-infected patients, hemodialysis patients, cancer chemotherapy patients and bone marrow or stem cell transplant patients have the need for booster immunization.
(3) Employment of Hepatitis B virus-infected patients
The Ministry of Personnel, the Ministry of Labor and the Ministry of Health have jointly issued a notice specifying that hepatitis B testing shall not be mandatory in employment medical examinations. Any positive hepatitis B surface antigen found in the medical examination cannot be used as a reason for non-admission or dismissal. However, in order to protect others and reduce infection, the relevant laws also clearly state that people infected with the hepatitis B virus should not be employed in the following jobs: childcare work in childcare institutions, medical jobs that come into contact with blood, military personnel, and work in service industries with potential skin breakage such as hairdressing or pedicures.
Follow up and monitor the disease
(a) Significance of adherence to follow-up visits
The infection status of hepatitis B virus is not constant. Early detection of pathological changes in the liver prevents deterioration of the disease and finds the time for antiviral treatment, so be responsible for yourself by following up regularly!
(II) Content and frequency of follow-up visits
1.Liver function tests are mainly alanine aminotransferase and aspartate aminotransferase. Alanine aminotransferase mainly reflects acute stem cell damage and is an important indicator to determine whether antiviral treatment is needed, while aspartate aminotransferase mainly reflects the degree of liver damage.
2, the detection of hepatitis B DNA: hepatitis B DNA is a direct indicator of viral replication, can understand the infectiousness of hepatitis B, as an important indicator of the need for antiviral therapy, to estimate the prognosis of the disease, patients who are on antiviral therapy, HBV-DNA testing can determine the effectiveness of antiviral therapy and monitor whether drug resistance occurs, the frequency of follow-up for 3-6 months or 1 year.
Hepatitis B DNA is not measurable means that the hepatitis B virus gene load is less than 300 copies / ml, due to differences in laboratory equipment and reagent sensitivity, some hospitals have a reference index of 1000 copies / ml or 500 copies / ml; imported reagents are more sensitive than domestic reagents; the reference significance of the results of different tests in the same hospital is greater than the comparative results of different hospitals.
3.B ultrasound examination: The purpose of B ultrasound examination is to understand the morphological changes of liver and spleen with the width of portal vein internal diameter and the presence of liver fibrosis, cirrhosis, fatty liver, substantial liver tumor, splenomegaly, etc., in order to decide the treatment plan.
Ultrasound is a non-invasive diagnostic tool, and the fear of undergoing this examination is relatively low, and more serious complications can be detected, but ultrasound examination only helps to diagnose the condition, and the frequency of follow-up is 3-6 months or 1 year.
4.CT and MRI: If small nodules are found in the liver, electronic computerized tomography (CT) and MRI should be performed to clarify the nature of the nodules, and CT is characterized by reflecting the morphological manifestations of liver pathology, such as the size, shape, location, number of lesions and the presence of bleeding and necrosis within the lesions. MRI is characterized by showing the pseudo-envelope, internal structure of tumor, the edge of liver cancer and the invasion of blood vessels, as well as distinguishing liver cancer from cirrhotic regenerative nodules better than CT examination.
5.Biopsy by liver puncture: Liver puncture, also known as liver biopsy, is mainly applied to the diagnosis of chronic hepatitis. Liver puncture is usually performed by using a special puncture needle that penetrates into the liver and stays in the liver for about 1 second, using the principle of negative pressure attraction to aspirate a small amount of liver tissue for direct observation of liver tissue lesions under a microscope. liver puncture biopsy should be performed in infected patients over 40 years of age, if necessary, for early detection of liver histological lesions.