40% of patients with chronic hepatitis B will progress to cirrhosis and liver cancer. What factors affect the progression of chronic hepatitis B disease? How can hepatitis B patients predict the risk of liver cancer and achieve early prevention? For chronic hepatitis B patients, the most worrying issue is whether they will get liver cancer or not, and the shadow of “hepatitis B – cirrhosis – liver cancer” trilogy lingers in many people’s mind. It is understood that 40% of chronic hepatitis B patients will progress to cirrhosis, liver failure and liver cancer, and the incidence of liver cancer in East Asia is the highest, closely related to the prevalence of hepatitis B. What factors actually influence the progression of chronic hepatitis B disease? Can hepatitis B patients anticipate their risk of liver cancer and achieve early prevention? Chronic hepatitis B requires long-term management Chronic disease is a type of disease that requires long-term management, and this is especially true for chronic hepatitis B. Not only do hepatologists themselves need to be aware of the risk of liver cancer, but they also need to be aware of the risk of hepatitis B. It is not only important for the hepatologists themselves to be aware of this, but also to communicate this awareness and philosophy to their patients so that they understand how to manage their disease. Foreign countries have done a good job in managing chronic patients, and there are many lessons to be learned. The UK has a well-developed public health care system, and the management and tracking of patients is very process-oriented, and Japan’s health care system is also doing very well, it is understood that Japan’s Tokyo University Hospital has a patient management system, which records the data of all patients, including about 8,000 hepatitis B patients, through follow-up management can detect about 80% of early liver cancer. In our country, many patients come to the hospital only when they have symptoms and feel uncomfortable, and 80% of the liver cancer found at this time is advanced liver cancer. This has a lot to do with patients not paying attention to regular medical checkups, and good management and follow-up of chronic patients is an effective means of early detection and prevention of liver cancer. Risk factors affecting the progression of chronic hepatitis B disease Many people are afraid of becoming liver cancer after being infected with hepatitis B and worry about it all day long. This attitude is very undesirable and instead of treating hepatitis B as a kind of mental pressure, they should learn how to manage it well. To manage their disease well, chronic hepatitis B patients should first understand what risk factors will affect the development of hepatitis B and then try to avoid them in daily life, which can effectively prevent hepatitis B from developing into liver cancer. The following factors can accelerate the disease progression of chronic hepatitis B patients: 1. Age: the older the patient is, the greater the possibility of hepatitis B progression, and it is generally considered more dangerous to be over 40 years old; age and etiology are factors affecting the progression of liver disease to cirrhosis; 2. Gender: men are more likely to develop than women; 3. Family history of liver cancer: people with a family history of liver cancer are more likely to progress; in Asia many patients have a family history of liver cancer, so Asians are more likely to develop liver cancer cirrhosis. 4, poor lifestyle: such as smoking and drinking can aggravate liver disease; 5, environmental factors: poor living environment in some places, food and water sources are prone to pollution, which are also risk factors; 6, risk factors for the progression of virus-related hepatitis B disease: including high viral load, hepatitis B virus genotype, co-infection with hepatitis B and C, and viral mutations, etc. In response to the sixth point, Professor Hou Jinlin further explained According to Prof. Hou Jinlin, a high viral load indicates a rapid progression of hepatitis and a higher possibility of developing liver cancer, while the lower the viral load of hepatitis B, the lower the incidence of liver cancer. The lower the viral load of hepatitis B, the lower the incidence of liver cancer. If all these risk factors can be controlled, early intervention can be made for chronic hepatitis B, so that the disease can develop in a good direction and the chance of liver cancer can be reduced. As to whether the disease will eventually develop into liver cancer, a risk prediction for liver cancer is still needed. Because each patient’s individual condition is different and the risk of developing liver cancer will be different, how to predict the risk of developing liver cancer is a question well worth exploring. How to predict the risk of liver cancer? REACH-B is a simple and easy-to-use risk assessment model that can predict the risk of hepatocellular carcinoma in patients with chronic hepatitis B. REACH-B has 17 risk scores based on gender, age, ALT level, HBeAg status and HBV DNA viral load. The lower the REACH-B score, the lower the risk of HCC. In general, men have higher scores than women; older age has higher scores; higher ALT levels have higher scores; positive HBeAg has higher scores than negative scores; and higher HBV DNA levels have higher scores. How is this scoring model used? When a patient comes to the hospital, the doctor can calculate the score based on this model score sheet, based on the patient’s gender, age, transaminase level, e antigen level, etc. Since all these indicators are variable and vary from person to person, the calculated results are more realistic to the patient’s own situation. Based on the results, doctors can formulate a personalized management plan for the patient and optimize the examination items, that is to say, according to the patient’s likelihood of getting liver cancer, they can set for him what examinations to be done in a year, the time of examination, the frequency of examination, etc. There are two main benefits of personalized examination plan: firstly, for patients with low predicted risk of liver cancer, unnecessary examinations can be reduced; secondly, for patients with high predicted risk of liver cancer, changes in the disease can be closely monitored and early detection and prevention can be truly achieved. Predicting the risk of liver cancer is not the final goal, but the real meaning of this model is to achieve early detection and improve prognosis based on the prediction results. Based on this prediction result, patients should cooperate with doctors to make good interventions and also develop good lifestyle habits to avoid various risk factors that lead to the development of hepatitis B to reduce the occurrence of cirrhosis and liver cancer.