1.Can you tell us what is liver fibrosis and how it is related to the chronic hepatitis and cirrhosis that we often talk about? Is liver fibrosis the same as liver cirrhosis?
Liver fibrosis can be said to be a disease name, is a variety of chronic liver disease to the development of cirrhosis in the process of the necessary to go through a pathological process.
Many patients mistakenly believe that liver fibrosis is cirrhosis, and when the doctor mentions liver fibrosis, they think they have cirrhosis and become very nervous. In fact, liver fibrosis is a transition to the development of cirrhosis, from liver fibrosis to cirrhosis there is a quantitative to qualitative process. Therefore, liver fibrosis ≠ cirrhosis, they are different pathological stages of disease development.
Stopping or slowing down the occurrence and development of this process of liver fibrosis can prevent the occurrence of cirrhosis and liver cancer. This shows the importance of liver fibrosis in the course of liver disease.
It has been reported that the total number of people in our country is about: 70 million, 35 million (slow B) + 20 million (slow C) 12.8 million (fatty liver) + 1.45 million (alcoholic liver). And cirrhosis is one of the main causes of death in our population.
2.What causes patients to form liver fibrosis? Why does it develop into cirrhosis?
By hepatitis virus, alcohol, drugs and toxins, metabolic and genetic, autoimmune liver disease and other factors of damage, long-term stimulation of the liver, can form liver fibrosis, in our country to hepatitis B and C most, alcoholic hepatitis, steatohepatitis is also not uncommon.
After the inflammation and necrosis of chronic hepatitis, the immune system will send “soldiers” (white blood cells in the blood) to the inflamed areas of the liver to remove the necrotic cell fragments, and then the new liver cells regenerate. As the new liver cells regenerate, the liver grows some fibrous tissue to help the new liver cells repair the previously necrotic areas. This is like a scar that is left behind when our skin is injured, and this scar is fibrous tissue. The same is true for the liver. Abnormal liver function is liver cell damage, which leaves “scars” in the liver after recovery. Liver fibrosis is actually a process by which the liver recovers from inflammation. Without liver fibrosis, the necrotic areas of the liver are not repaired. However, if liver inflammation continues to occur, these “scar” tissues will become more and more numerous, and the texture of the liver will change from soft to hard, and eventually develop into cirrhosis.
3.How long does it take to go from chronic hepatitis to liver fibrosis and develop cirrhosis? Does every person with chronic hepatitis develop cirrhosis?
Liver fibrosis is progressive, and it usually takes about 10 years to progress to cirrhosis, which can be as short as a few years or as long as several decades. It has been reported that 10-20% of patients with chronic hepatitis B can develop cirrhosis, and 6-15% of cirrhosis can develop into liver cancer. Therefore, the formation of cirrhosis can seriously affect the health and life of patients.
4.How to determine if it is liver fibrosis?
(1) A history of chronic hepatitis;
(2) Clinical symptoms are not specific, may be asymptomatic, or show symptoms of chronic hepatitis;
(3) laboratory tests, liver fibrosis indicators, including hyaluronic acid (normal value to remember), laminin, type III and IV collagen (collagen three or four) and so on, as well as liver function, blood routine to determine liver fibrosis has a role;
(4) Imaging examinations, including ultrasound and CT examinations, suggest that the liver envelope is not smooth, the distribution of liver dots is not uniform, the echogenicity is thickened and enhanced, the direction of blood vessels is unclear, etc., or the inner diameter of portal vein and splenic vein is widened and the spleen is enlarged.
(5) Histopathological examination of the liver shows different degrees of fibrous tissue hyperplasia.
5, liver fibrosis patients can be asymptomatic, then as a patient, how can you find out you have liver fibrosis in time?
This question is very practical, the diagnosis of liver fibrosis is to rely on the doctor. But as we patients to do is to focus on the examination, can not judge the disease according to their own feelings, this is very important. Because our human liver compensates very well, the progression of liver disease is often insidious and unknowingly aggravated. In clinical practice, many patients often do not do ultrasound because they are asymptomatic, check normal liver function, and only have high virus levels. Thinking that they are virus carriers and have no problems, they delay treatment. Several years later, they develop into cirrhosis, and some are found to be liver cancer, losing good treatment opportunities and causing irreversible consequences.
In general, we ask patients with chronic liver disease to
Have a checkup once every three months, including liver function, hepatitis B series (two-to-one half), hepatitis B DNA, hepatitis C virus markers, blood lipids and blood count.
Ultrasound or CT examination once every six months or once a year.
Through the examination, let the changes of the disease, in our own hands, so as not to delay the judgment of the disease, in the appropriate period to get reasonable treatment.
6.Many patients think that after cirrhosis has formed, it seems that it cannot be cured, is this true?
In the past, many people mistakenly believed that once liver fibrosis or cirrhosis has formed, it can never get better, in fact, such a perception is wrong. The surgical incision will leave a scar, which will gradually soften after a few years. If this scar is relatively small, it is possible that the skin will become very flat and the scar will become invisible. The same is true for inflammation in the liver. In acute hepatitis, when the inflammation in the liver recovers, there is also a certain amount of fibrosis formation, but it is less damaged and recovers faster, and after a few years it can be left without a trace. But chronic hepatitis is different, liver inflammation keeps happening, it is repaired here and there, as long as there is inflammation, liver fibrosis will keep increasing, the scar will get bigger and bigger, and cirrhosis will be formed. When inflammation stops, liver fibrosis will gradually stop or improve.
For example, a controlled study of liver penetration pathology found that chronic hepatitis B patients had significantly better liver fibrosis than before treatment after 1 year of treatment with effective antiviral drugs, and some patients even reduced from grade 4 to grade 2.
7.That means the earlier the anti-fibrotic treatment, the better it will be
Yes, from a biochemical point of view, once collagen, the main component of fibrous tissue, is “covalently cross-linked”, the structure will become quite stable and not easily degraded, so it is a more aggressive treatment strategy to prevent the deposition of extracellular matrix in the liver by “blocking” collagen before it is covalently cross-linked. A more aggressive treatment strategy.
8. A patient with hepatitis B said that his viral test and liver function test were normal, but the ultrasound indicated that the spleen was slightly enlarged and the liver light spot was thick, some people said he did not need treatment, while others said he still needed treatment.
The mechanism of liver fibrosis formation is: active progression, that is, not dependent on the cause – the hepatitis B virus, the patient’s virus is very low or temporarily no viral replication, but fibrosis may still be progressing, just like the car once started, to stop, there will be an inertia going forward. So these patients should still be treated with anti-fibrotic therapy.
9.Please tell us briefly how to fight against liver fibrosis at present?
(1) Anti-virus to eliminate the cause of the disease is the primary countermeasure against liver fibrosis, such as effective inhibition of viral replication, alcohol cessation, etc. can promote the repair of fibrotic liver tissue.
(2) Chronic inflammation is a prerequisite for fibrosis formation, and anti-liver inflammation is an important measure against liver fibrosis.
(3) Inhibiting liver fibrous tissue generation and deposition and promoting its degradation are important countermeasures for anti-liver fibrosis treatment.
Anti-virus to get rid of the cause, treatment of the original disease, is an effective means of anti-liver fibrosis, this treatment is currently from doctors or patients have a clearer understanding, but the cause and anti-inflammatory treatment is not equal to, and can not replace the anti-liver fibrosis treatment, this understanding, perhaps many patients are still not in place at present.
10.What are the advantages of Chinese medicine in treating liver fibrosis? It is better to give an example to illustrate.
There is no concept of liver fibrosis in TCM, but TCM has accumulated a wealth of experience in liver fibrosis research in recent decades. TCM believes that the basic pathogenesis of liver fibrosis is Zheng deficiency and blood stasis. The basic treatment is to support positive energy and activate blood circulation to remove blood stasis. However, at different stages of liver fibrosis and in different patients, different types of symptoms can be manifested, including liver-biliary damp-heat, liver-depression, spleen-deficiency and liver-kidney-yin deficiency. In the identification and treatment, the disease should be combined with the evidence, and the basic treatment method should be used flexibly in combination with the evidence-based treatment to achieve individualized treatment. At present, there are many Chinese patent medicines such as Fu Zheng Hua Yu Capsules, Fuxiang Turtle Nail Soft Liver Tablets, Anluo Hua Fibers Pills, Da Huang Hibiscus Pills, Xiao Chai Hu Tang, Turtle Nail Decoction Pills and Bitter Ginseng Capsules, all of which follow the above theory and have good effect.
Example: A patient, 30 years old, with repeated abnormal liver function, high level of hepatitis B virus, thick liver light spot, enlarged spleen, 5 cm thick, diagnosed chronic hepatitis with fibrosis. Repeatedly hospitalized. We used a combination of antiviral and anti-fibrotic treatment, which is a combination of removing the cause and anti-fibrotic, antiviral with lamivudine, anti-fibrotic with herbs, after 3 months of treatment, liver function was normal, virus turned negative, 1 year later ultrasonography spleen shrunk, 3, 7 cm, liver light spot slightly thicker, liver fibrotic changes had a very obvious improvement. The disease is stable.
Therefore, at present, in the treatment of liver disease, it is an effective treatment method to block, control and reverse the occurrence, development and postponement of the process of liver fibrosis with new achievements in Chinese medicine scientific research.