What is the best treatment for chronic hepatitis B?
Before the emergence of nucleoside antivirals, the treatment of chronic hepatitis B in China was rather miserable, as most infectious doctors did not know Chinese medicine to treat chronic liver disease, and even some specialized Chinese hepatologists were mediocre, so the treatment methods and drugs basically relied on “liver protection and enzyme reduction” + hospitalization and rest, etc. After the emergence of nucleoside antivirals, there was a flurry of trials. After the emergence of nucleoside antivirals, people have been experimenting with them in droves, and there have been many problems, such as the article “Heptin Doubt” on the Southern Weekend, which describes the fact that antivirals are not a panacea, not the only one, and there are things that can go wrong if they are not used properly.
With the development of society and the passage of time, experience in the use of antiviral drugs is gradually accumulating, and today, it can be said to be more mature, new drugs are still emerging, even if some drugs, the virus has mutated, it does not matter, there are new drugs can be used.
The nucleosides, as long as they meet the general indications, rarely cause problems in the process of use, while interferon should be used with caution, as the side effects are large and costly. Especially in patients with vertical mother-to-child transmission, long experience has shown that the effect is not good, so do not test again.
Please remember, my fellow patients, there is no best, only better.
In addition to antiviral therapy, are liver-protective, enzyme-lowering, and anti-inflammatory treatments, which are familiar to the general public, still being used?
In other articles, I have repeatedly mentioned the issue of “rational, effective and economical” use of antiviral drugs, and the methods and drugs known to the people, such as liver protection, enzyme reduction and anti-inflammatory therapy, can still be used together. I recommend a few words, that is, silymarin is very stable and reliable, in addition to a very small number of patients nausea, almost no side effects, reliable effect of liver protection.
There are also some proprietary Chinese medicines, today, it seems that its effect on the treatment of chronic liver disease is not ideal, and even among them there are drugs that harm the liver, not the right drug, therefore, I do not recommend proprietary Chinese medicines, I hope you understand.
When is it necessary to protect the liver and lower enzymes?
The liver damage is an immune damage mechanism, not a direct result of the hepatitis B virus, of course, it wants to replicate without limit, this mechanism will also directly kill the liver cells, but the body’s immune system suppressed it, so that it can not be arbitrary, so in general, the hepatitis B virus can not directly damage the liver cells, it can only live in the liver cells, eating and drinking, so that the liver cells are very unhappy, environmental health is also bad Sometimes the immune system is more aggressive, determined to get rid of the virus completely, but the virus in the liver cells, when it gets, often the liver cells must first be killed, as a result, the final virus is not completely removed, liver cell damage is not small, serious, long lasting, liver cells always die, it is too sad, the cells grow slowly, or even whole not up, then how to do it? The body will grow a scar in this place, just like our finger injury, must grow a scar, must grow a scar, medically called “fibrous tissue”, is like a cow’s hoof like things, why to grow such things? Because this thing is not sensitive to injury, strong resistance to injury, but this tissue does not have the function of liver cells, it will not do anything, it will only be here to top, top to me, top, so that the liver, this kind of thing, happen more, too much fiber in the liver, liver fibrosis and cirrhosis will occur.
Therefore, we absolutely can not allow the long-term damage to the liver, and not stop ah, so the treatment must be timely, but also correct.
For this case, nucleoside antiviral drugs need to be used in a timely manner, can greatly suppress viral replication, after being suppressed, its viral antigen expression is reduced, indirectly can reduce the immune system’s anti-hepatitis B virus response, also reduce the liver cell damage, but there are individuals, the immune system but more vigorous, will cause cirrhosis, this I have said before, so at this time, the patient should rest, to protect the liver to lower the enzyme ah, to prevent those who are not the liver fibrosis and cirrhosis. The liver to lower the enzyme ah, to prevent those things too much out, resulting in cirrhosis, or even liver failure would be very bad.
What types of antiviral therapy are included?
Mainly interferons and nucleosides. As for the Chinese herbal medicine such as bitter ginseng, in fact, the combined use of good results in many cases. However, since not everyone has mastered them, I will not go into details.
What is the difference between interferon and nucleoside analogues?
Interferon is strictly speaking a small molecule protein, produced by our own macrophages. Under physiological conditions, the yield is very small and the distance of action is very short.
The actual fact is that, in practice, the side effects are great. As I don’t use interferon all year round, and as I work in a Chinese hospital all year round, I get patients who come to me with poor results or even cirrhosis of the liver after using interferon, so I am not impressed with interferon, to be fair, think about it objectively, how is interferon? I think so, it should be a very effective western medicine, but the side effects are somewhat large, the real fight after the effect is very good, no major side effects, too few people, I look at the data of western medicine, reliable and objective, should be about 7%, but I think the data is low
Which patients are suitable for treatment with interferon?
Young ones, especially those before puberty, can use interferon because at this time, there is a lot of plasticity, and even if it doesn’t work, often the side effects are not significant, others, need to be cautious.
I treated a girl, Henan, when she had not yet reached puberty, found out at home hepatitis C, the local doctor to play interferon, the first side effects are very big, insisted on 3 months, can not insist on it, stopped, and after half a year, the disease did not get better ah, she has a sister-in-law in Beijing, I do not know where to know me, they brought her to me to see, I see her then that situation, the economy is also bad, it only gave 2 weeks to prescribe the Chinese medicine to take away. After that, until she started to develop, go to university, go to university in Beijing, stay in Beijing to work after graduating from university, then fall in love, mood swings, made a disease, enzyme slightly higher, and came to me to eat some Chinese medicine to calm down, until now so many years have passed. The enzymes are basically normal and the liver is in good shape.
The other is that those who play interferon after cirrhosis, I have also cured, but also the effect is not obvious. This is all I know.
Patients who are interested in interferon can refer to other experts’ articles. My opinion, for your reference!
Which patients are more suitable for the application of nucleoside analogues?
Poor health, suffering from various other chronic diseases, afraid of risks, etc., because nucleoside analogs have minimal side effects, are smooth in use and easy to take. It is the drug of choice. They are suitable for almost all patients. Interferon has no significant advantage over it, although its antiviral immunity is strong, but the side effects are large and costly, inconvenient to use, etc.
What factors do patients need to take into account when choosing a drug?
Chinese medicine can have negligible side effects when used properly!
At present, Chinese medicine is getting more and more expensive, the economy is not good, sometimes it does not see the right ah, especially the anti-virus can be a good solution for small young people, general hepatitis B, do not first consider Chinese medicine, to consider nucleoside antiviral drugs.
Liver fibrosis accompanied by cirrhosis can be treated with a combination of traditional Chinese medicine.
The general chronic liver disease, are accompanied by liver fibrosis, which is the pre-cirrhosis ah, the general infectious disease doctor, not necessarily very sensitive to this, the general ultrasound doctor, also not necessarily very important and objective, the level are particularly high, so the general hospital ultrasound doctor misdiagnosis leak true possibility is very high. So, when you sit in front of me, I tell you fibrosis, cirrhosis of the liver, you should not be surprised.
If your ultrasound tells you “thickened echogenicity”, “diffuse lesions”, etc., hurry up and come to me with your labs.
What patients want, I know, is to spend less money, get better faster, and have fewer side effects from the medicine.
But these things, the patient can not control and control, only the doctor to control.
But patients can indirectly control these factors by choosing a doctor.
If you choose the right one, everything will be fine.
If you choose the wrong one, admit your own bad luck.