Hepatitis is an inflammatory disease of the liver. The causes of hepatitis may vary, most commonly caused by viruses, in addition to autoimmune causes. Alcohol abuse can also cause hepatitis.
1. Viral hepatitis
Hepatitis caused by viruses is divided into seven types of viral hepatitis, from A to G, according to their virus series. It can cause swelling of liver cells and is one of the most widespread and dangerous infectious diseases in the world.
In 1947, the original infectious hepatitis was called hepatitis A; serum hepatitis was called hepatitis B. The surface antigen of hepatitis B was first detected in humans in 1965.
In addition, viral hepatitis includes hepatitis C, hepatitis D, hepatitis E, and hepatitis G. The virus that used to be designated as hepatitis H virus is now identified as a genotype of hepatitis B virus, and therefore hepatitis H does not exist.
In terms of vaccines for viral hepatitis, vaccines for types A, B, and D have been developed successfully; there are currently no vaccines for types C, E, or F.
2.Alcoholic hepatitis
Alcoholic hepatitis can have no obvious symptoms in the early stage, but the liver has been pathologically altered, and there is often a history of heavy drinking within a short period of time before the onset of the disease. Signs included jaundice, hepatomegaly and tenderness, along with splenomegaly, pallor, puffy ascites and spider nevus, and esophageal varices. In laboratory tests, there is anemia and neutrophilia, erythrocyte volume measurement (MCV) greater than 95FL, increased serum bilirubin up to 17.1 μmoL/L or more, moderately elevated transaminases, often greater than 2.0, and mitochondrial AST (mAST) and its ratio to total AST (tAST), which is elevated up to 12.5 + 5.2%. There is also an increase in γ-GT, glutamate dehydrogenase and alkaline phosphatase activity, and prolonged prothrombin time.
3.Autoimmune hepatitis
Autoimmune hepatitis is relatively rare, mostly in conjunction with other autoimmune diseases, is one of the newly identified diseases in recent years the. The disease has a high incidence in Europe and the United States, such as the United States, the disease accounts for 10% to 15% of chronic liver disease, China is also increasing reports of the disease, it is necessary to raise awareness of the disease. Autoimmune hepatitis is a group of chronic hepatitis syndromes caused by autoimmunity, which is often confused with viral hepatitis because its manifestations are very similar to those of viral hepatitis, but the treatment of the two is very different.
Autoimmune hepatitis was first proposed in 1950 and was initially referred to as “lupus-like hepatitis” due to the existence of certain similar clinical manifestations and autoantibodies to SLE. Later, it was found that there were significant differences in the clinical manifestations and autoantibodies between the disease and SLE patients. Recently, the international conference referred to “autoimmune liver disease” and “autoimmune chronic active hepatitis” collectively as “autoimmune hepatitis”, and removed the restriction of a disease duration of more than 6 months. The restriction of 6 months or more has been removed, and the disease is defined as a non-viral autoimmune disease. The disease is a genetically predisposed disease and can be triggered by environmental, drug and infection factors in people with susceptibility genes. Patients have a deficiency in immune regulation, resulting in a response to autohepatocyte antigens that is dominated by cell-mediated cytotoxic effects and immune responses resulting from the binding of hepatocyte surface-specific antigens to autoantibodies.
The disease is characterized clinically by a female prevalence and a chronic active hepatitis presentation. The pathological changes are characterized by lamellar and bridging necrosis of hepatocytes with infiltration of plasma cells, lymphocytes and monocytes. The diagnosis of this disease requires the exclusion of other similarly presenting liver diseases, particularly viral infectious hepatitis.
Autoimmune hepatitis has a slow onset in about 70% of cases and an acute onset in a minority of cases in about 30% of cases. Patients often present with symptoms such as malaise, jaundice, hepatosplenomegaly, itchy skin and insignificant weight loss. When the disease progresses to cirrhosis, ascites, hepatic encephalopathy, and esophageal variceal bleeding may occur. Patients with autoimmune hepatitis also often have extrahepatic systemic immune diseases, most commonly thyroiditis and ulcerative colitis. Laboratory tests are most marked by elevated gamma globulin, mainly igg, which is generally more than twice the normal value.
I. Types and clinical manifestations
Medically, hepatitis can be divided into seven types: A, B, C, D, E, H, G. Hepatitis B is the most widespread and most serious infectious hepatitis. Viral hepatitis B (hepatitis B for short) is an inflammatory damage to the liver caused by hepatitis B virus (hepatitis B virus for short). The disease is found worldwide, with clinical manifestations of malaise, loss of appetite, nausea, vomiting, aversion to oil, diarrhea and abdominal distension, fever and jaundice in some cases, and in about half of the patients, the disease starts insidiously and is detected during examination. After infecting human body, hepatitis B virus is widely present in blood, saliva, vaginal secretions, breast milk and semen, etc. It is mainly transmitted through blood, sexual contact and close contact, so the onset of hepatitis B is familial.
However, not everyone who is infected with the virus will become a hepatitis B patient, which is closely related to the number of viruses the patient is infected with, virulence and mode of infection, and other factors. The physical quality and immune response status of each person also play an important role in the regression of hepatitis B disease and course. Therefore, patients infected with hepatitis B virus may have the following outcomes: no disease and protective hepatitis B surface antibody, long-term chronic asymptomatic carrier, mild chronic hepatitis, and severe hepatitis.
Second, the prevention and treatment of hepatitis B
Hepatitis B is difficult to eradicate and there is no specific drug for its treatment. Therefore, hepatitis B should be treated in a comprehensive manner from many aspects.
1, to have a strong will to overcome the enemy, “anger will hurt the liver”, to maintain a happy mood.
2, the virus active patients must be bed rest, wait until the disease is stable, transaminases do not rise to appropriate activities.
3, hepatitis B drugs such as soldiers, more is harmful, less is ineffective, for their own conditions, under the guidance of experts to choose to take anti-viral drugs, adjust the immune drugs, blood circulation drugs, anti-fibrosis and promote the regeneration of liver cells drugs, do not have a disease to abuse drugs.
4. Keep a regular life, arrange your diet reasonably, and eat mainly light.
Hepatitis B is difficult to treat, but not difficult to prevent. If we all take good care of the prevention, hepatitis B is not terrible, the prevention of hepatitis B includes.
1, the widespread implementation of hepatitis B vaccination.
2. maintaining a positive mindset and optimism and a firm confidence in overcoming the disease
3, understanding and mastering some of the prevention and treatment of hepatitis B disease, and develop and adhere to a good, scientific life rule.
4, reasonable deployment of nutrition and dietary therapy, avoid smoking and alcohol, eat less greasy things, avoid constipation.
5, pay attention to living and personal hygiene, increase and decrease clothing according to the temperature, and actively prevent various infections.
6.Actively cooperate with doctors in treatment, use medication under the guidance of doctors, and review liver function regularly.
After the hepatitis B virus infects the human body, if the body has strong resistance, normal immune function and timely treatment, then the hepatitis B virus will be cleared quickly and hepatitis B will be cured in the acute stage. However, once the hepatitis B virus is not cleared in time, hepatitis B will become chronic and the virus will be carried for a long time, and the test will show positive hepatitis B antigen, which is what we call hepatitis B virus carriers.
If the hepatitis B virus is active in the liver cells and replicates and multiplies, clinical symptoms can appear. Common symptoms include: feeling discomfort in the liver area, vague pain, general lethargy, weakness, loss of appetite, feeling nauseous, aversion to oil, diarrhea. Patients sometimes have low-grade fever, and severe patients may develop jaundice, at which time they should go to the hospital promptly. If treatment is delayed, a few patients may develop severe hepatitis, which manifests as a rapid increase in liver function damage until failure, accompanied by multiple organ function damage such as renal failure, and patients may develop continuously increasing jaundice, oliguria, anuria, ascites, confusion, delirium, and coma. Chronic hepatitis B will evolve along the direction of “hepatitis B – cirrhosis – liver cancer”, which is often called “hepatitis B trilogy”, so you should take treatment measures after suffering from hepatitis B This is the trilogy we often call “hepatitis B”.
Three, how to correctly understand the criteria for determining the effectiveness of hepatitis B treatment
Many patients believe that the only purpose of hepatitis B treatment is to turn all the major and minor triplets negative. In fact, this view is very incorrect and does not match the current actual situation of hepatitis B treatment. A more objective and scientific standard for determining efficacy can be divided into the following categories.
1, clinical cure serological biochemical indicators such as transaminases, bilirubin and other normalization, clinical symptoms significantly improved or disappeared, regardless of its virological signs, can be considered as clinical cure.
2, reduce the infectiousness on the basis of clinical cure, after treatment e antigen and serum HBV DNA (hepatitis B virus gene) negative or viral replication is significantly reduced, such patients do not have intact virus particles in the blood, so the infectiousness is very low. Liver damage is relatively mild and should have no significant effect on job recruitment, schooling and pregnancy, and normal social activities can be carried out, but patients should insist on review and observe changes in their condition. If two of the following conditions occur, the patient should be treated actively: serum HBV DNA turns positive; liver function is abnormal with obvious clinical symptoms; e antigen turns positive with obvious tendency of liver fibrosis or early signs of cirrhosis.
3. Viral clearance is demonstrated by negative surface antigen in serum and negative HBVDNA test in blood and liver tissue. And follow-up for more than one year without recurrence; but the complete clearance of hepatitis B virus is still a problem that has yet to be solved, and it cannot be taken as the only criterion for hepatitis B cure before the country.
4, the conversion of antibodies to negative. The appearance of antibodies reflects the reactivity of the body to the virus, in general, the production of antibodies is related to treatment, while the disappearance of antibodies is not related to treatment, with the disappearance of antigens, their associated antibodies will naturally negative. The rate of antibody reversion varies from person to person and is also related to the type of antibody. For example, e antibodies have a short natural negative time, while core antibodies can be maintained in the body for up to 10 years. Therefore, as long as the serological test is negative for surface antigen and e antigen and negative for serum HBV DNA, regardless of whether it is positive for one or several antibodies, there is generally no indication for treatment and can be observed regularly. Of course, if the surface antibody is negative, hepatitis B vaccination can be given, but the dose and procedure of vaccination are different from normal people, and it is better to use adjuvant at the same time.
IV. Preventive measures
First of all, mother-to-child transmission is the main transmission route of hepatitis B in China, and the country attaches great importance to it. Since the 1980s, babies born to HBsAg-positive pregnant women have been commonly vaccinated against hepatitis B. Through 20 years of efforts, the number of HBsAg carriers among infants born in Shanghai has dropped from 9.8% to 0.5%. Thus, we can proudly say that the number of HBsAg carriers in China will be significantly reduced in the near future and that hepatitis B is completely preventable. Secondly, blood donors should be strictly screened to ensure that medical blood and blood products are not contaminated.
Finally, we should strengthen the treatment of hepatitis B patients, and alpha-interferon antiviral therapy is preferred for chronic active hepatitis B. The popularization of general health awareness should be strengthened to develop good hygiene habits. Through the various measures mentioned above, it is believed that the number of hepatitis B patients will be greatly reduced in the near future.
The key to eradicating hepatitis B is prevention. The transmission of hepatitis B virus is summarized in three ways.
Transmission through blood: such as the importation of whole blood, plasma, serum or other blood products. Mosquitoes in the tropics and subtropics, as well as various blood-sucking insects, may transmit the hepatitis B virus.
Mother-to-child transmission: Pregnant women are hepatitis B carriers and transmit it directly to their newborns through the birth canal.
Transmission from body fluids: If medical equipment is contaminated with the hepatitis B virus and then incompletely disinfected or improperly disposed of causing transmission. Transmission by sexual contact. Long-term close contact with hepatitis B patients or carriers, such as saliva, urine, blood, bile and breast milk, can cause contamination and transmission of hepatitis B.