Why hepatitis B virus can cause hepatitis and other viruses can cause hepatitis? A: Yes, it is found that hepatitis can be caused by hepatophilic viruses and non-hepatophilic viruses, hepatophilic viruses are A, B, C, D, E, which can cause hepatitis, non-hepatophilic viruses, such as EBV, cytomegalovirus, which tends to cause systemic inflammation of organs, such as myocarditis, hepatitis and so on, and it is able to cause hepatitis, but it is a “passer virus”, which will not cause serious damage to the liver, and will not cause chronic inflammation of the liver. It can cause hepatitis, but it is a “passer-by virus” that does not cause serious damage to the liver or chronic inflammation of the liver. Hepatophilic viruses Hepatitis A virus and Hepatitis E virus are transmitted through the digestive tract, and they can cause acute inflammation of the liver. Hepatitis E virus is more powerful than Hepatitis A virus, and it is easy to cause severe hepatitis and even liver failure, but they do not cause chronic inflammation of the liver. Hepatitis B, C and D viruses are mainly transmitted through blood, and they can not only cause acute inflammation, but also lead to chronic inflammation of the liver, so as to cause liver cirrhosis, liver cancer and other complications. Second, what is the profile of hepatitis B in China? What is the way of its transmission? A: China is a high prevalence of hepatitis B, the world’s 350 million people with chronic HBV infection. In our country, there are about 130 million people carrying hepatitis B virus, including healthy carriers and hepatitis patients. This includes both healthy carriers and hepatitis patients, which means that about 1 in 10 people in China carries the HBV virus. Hepatitis B virus is mainly transmitted through blood and blood products, mother-to-child and broken skin and mucous membranes, and sexual contact. Daily life and contact in life, such as shaking hands, hugging, being in the same room, eating in the same restaurant or sharing toilets, etc., if there is no blood exposure, generally will not transmit HBV. there is no evidence to confirm that HBV can be transmitted by mosquitoes and insects. C. Can all hepatitis B virus infections become chronic? Answer: After being infected with HBV, the virus is called chronic HBV infection if it has not been cleared in the body after 6 months. The younger the age, the more likely to cause chronic hepatitis B infection. When newborns are infected with HBV, 90% will develop chronic infection, and when infants and young children are infected with HBV, about 25%-30% will develop chronic HBV infection. Adolescents and adults infected with HBV, only 5-10% develop into chronic. What are the three stages of HBV infection and what is their clinical significance? A: The natural history of HBV infection can be divided into three phases: immune tolerance, immune clearance and inactivity or low (non-) replication. 1, the immune tolerance period is characterized by active HBV replication, positive serum HBsAg and HBeAg, usually what we call “triple positive”, high HBV-DNA titer (> 10 * 5copies / ml), serum alanine aminotransferase (ALT) is normal, and there is no obvious abnormality in liver histology. 2.Immunoclearance stage manifested as serum HBV-DNA titer >10*5copies/ml, but generally lower than the immune tolerance stage, ALT/AST elevated or intermittently elevated, and necroinflammation of liver tissues and other manifestations. 3, inactive or low (non-)replication stage manifested as HBeAg negative, anti-HBe positive, that is, we say “small triple positive”, HBV-DNA undetectable or lower than the lower limit of detection, ALT / AST is normal, no obvious inflammation of liver histology. However, some patients may have HBV reactivation, HBeAg positive (or not positive), HBV-DNA>10*4copies/ml, manifesting active chronic hepatitis B. These patients may have recurrent episodes of hepatitis. Hepatitis can recur in these patients. V. What is the prognosis of patients with chronic hepatitis B? A: Part of chronic hepatitis B can develop into cirrhosis and hepatocellular carcinoma, the annual incidence of cirrhosis is 2.1%, the annual incidence of cirrhosis in decompensated stage is 3%, and the 5-year cumulative incidence is 16%. The 5-year morbidity and mortality rate of chronic hepatitis B is 0-2%, the 5-year morbidity and mortality rate of cirrhosis in the compensated stage is 14-20%, and the 5-year morbidity and mortality rate of cirrhosis in the decompensated stage is 70-80%. Factors that lead to cirrhosis in chronic hepatitis B include high viral load, persistent HBeAg positivity, high or repeated fluctuation of ALT level, alcoholism, and combined HCV, HDV or HIV infection. Risk factors for hepatocellular carcinoma in cirrhotic patients include male gender, age, alcoholism, aflatoxin, combined HCV or HDV infection, and persistent liver inflammation. Persistent HBeAg positivity and persistently high levels of HBV-DNA (≥10*5copies/ml), among others. About 25% of those infected with HBV before the age of six will develop cirrhosis and liver cancer in adulthood. HBV infection is an important correlate of liver cancer, and the higher the HBV viral load, the higher the risk of liver cancer. How to prevent HBV infection 1, prevention from the source: Hepatitis B vaccination is the most effective way to prevent HBV infection. Hepatitis B vaccination is a total of 3 injections, according to the program of 0, 1, 6 months, that is, after the first vaccination, the second and third injections will be given at an interval of 1 and 6 months. The earlier the newborn is vaccinated against hepatitis B, the better, requiring vaccination within 24 hours of birth. For newborns of HBsAg-positive mothers, Hepatitis B Immunoglobulin (HB1G) should be injected as early as possible within 24 hours after birth, and Hepatitis B vaccine should be injected at different sites at the same time. For immunocompromised or non-responders, the vaccine dose and number of injections should be increased. If anti-HBs <10m/U/ml, the immunization can be strengthened. 2.Prevention of transmission route. There are invasive examinations and treatments in medical institutions, the safety disinfection system should be strictly implemented, medical staff should carry out medical activities according to the principle of standard prevention in hospital infection management, and the possible invasive services in the service industry should also strictly implement the disinfection and other systems, pay attention to personal hygiene, do not share dental utensils, cutlery, razors, etc., carry out correct sex education, avoid multiple sexual partners, and for the spouse of HBV-infected patients, they should be vaccinated with the HBV vaccine. Hepatitis B vaccine. Is it that the higher the aminotransferase is, the more infectious it is? A: No. The infectiousness of HBV depends on the level of HBV-DNA in the blood, but has nothing to do with the level of serum ALT, AST or bilirubin. Therefore, it is not the more severe hepatitis is more contagious, nor is it the more severe jaundice is more contagious. VIII. What is meant by HBV infection? A: HBsAg-positive or HBV-DNA-positive people called HBV infection, with hepatitis B or HBsAg-positive history of more than 6 months, called chronic HBV infection. Chronic HBV infection can be divided into chronic hepatitis B, hepatitis B cirrhosis, hepatitis B virus carriers, hidden chronic hepatitis B. What is chronic hepatitis B? A: Patients with "triple positive" or "triple positive", positive HBV-DNA, persistent or recurrent abnormal ALT, or hepatitis lesions in liver histology. Ten, what is called hepatitis B cirrhosis? A: Hepatitis B only to further development, resulting in diffuse fibrosis of liver tissue and pseudofollicular formation, it is called hepatitis B cirrhosis. It is divided into compensated stage and loss of umol/L prothrombinogen activity <60%, often occurring esophageal varices rupture bleeding, hepatic encephalopathy, ascites, jaundice and other serious complications. Compensated cirrhosis without liver function loss performance, no esophageal varices rupture bleeding, no ascites, no hepatic encephalopathy and other serious complications. XI. What is viral carriage? A: It can be divided into chronic HBV carriers and inactive HBsAg carriers. 1, chronic HBV carriers: triple positive, HBV-DNA positive, more than three follow-up visits within one year, ALT and AST are within the normal range, and liver histology is generally not obvious abnormalities. 2, inactive HBsAg carriers, small triple positive people, HBV-DNA negative, more than three follow-up visits within one year, ALT are within the normal range, liver histology blood test shows: Knodell hepatitis activity index (HAL) <4 or other semi-quantitative scoring system lesions are slight. XII. What is cryptogenic hepatitis? A: HBsAg negative, but serum or liver tissue HBV-DNA positive, and have the clinical manifestations of chronic hepatitis B. XIII. Significance of common laboratory tests. Answer: ALT (alanine aminotransferase), AST (alanine aminotransferase) response to hepatocellular injury, bilirubin and the degree of hepatocellular necrosis, prothrombin time (PT) and PTP, PT reflects the synthesis of hepatic coagulation factors, PTA is another method of expression of the PT. PTA <40% often reflects liver failure, <20% suggests a poor prognosis of the disease. Cholinesterase reflects hepatic synthesis, and albumin also reflects hepatic synthesis. Significantly elevated alpha-fetoprotein (AFP) is often indicative of primary liver cancer. Elevated blood AFP may also indicate hepatocyte regeneration after massive hepatocyte necrosis. HBsAg positive indicates HBV infection, anti-HBS is protective antibody, positive suggests that the body has immunity to HBV, which is seen in the recovery of Hepatitis B and those who have received Hepatitis B vaccine.HBeAg positive is an indicator of high HBV replication and infectiousness, anti-HBe positive indicates that the level of HBV replication is low (except for those who have high HBV-DNA), anti-HBcIgM positive suggests that Hepatitis B is acute stage, and anti-HBc positive suggests that Hepatitis B is acute stage. HBV-DNA reflects viral replication and infectiousness, the higher the HBV-DNA, the more active the viral replication and the higher the infectiousness, the negative HBV-DNA suggests that the disease is low replication or no replication, and the infectiousness is low or non-infectious. What are the treatments for chronic hepatitis B? A: The treatment of chronic hepatitis B includes antiviral, immunomodulation, anti-inflammatory liver protection, anti-fibrosis, symptomatic treatment and traditional Chinese medicine. Western antiviral therapy includes interferon and nucleoside analogs, and interferon includes common interferon and long-acting interferon. Nucleoside analogs commonly used include lamivudine, adefovir, entecavir, and telbivudine. Immunomodulators are commonly used, such as thymosin A1, etc. Anti-inflammatory and hepatoprotective drugs include compound glycyrrhizin, reduced glutathione, polyene phosphatidylcholine, thiopronin, etc. Anti-fibrotic drugs include ansulphated fibrin and compound turtle turtle turtle soft liver tablets, etc. In the treatment of antifibrotic therapy, traditional Chinese medicines are more advantageous. XV. Can antiviral therapy be applied under any circumstances? A: General indications include (1), HBV-DNA ≥105copies/ml (≥104copies/ml for HBeAg-positive patients); (2) ALT ≥2ULN (twice of the upper limit of the normal value), interferon indications: ALT ≤10*ULN, total bilirubin <2ULN.(3), if ALT<2ULN, then the liver histology shows that Knodell (HAL) ≥4 or ≥G2 inflammatory necrosis. XVI. How can antiviral treatment be considered effective? A: Effective antiviral therapy is called "response" in medical terminology. Response to treatment: 1. Virological response: HBV-DNA undetectable or below the lower limit of detection, or a decrease of ≥2log10 from the baseline 2. Serological response: HBeAg negative or HBsAg negative, or accompanied by the appearance of the above antibodies. 3. 3. Biochemical response: AST and AST return to normal. 4. Histological response: the degree of inflammation and necrosis or fibrosis of liver histology has been improved to a certain extent. Response at the time of treatment 1. Early response: response at 3 months of treatment. 2. End-of-treatment response: response at the end of the treatment program. 3.Long lasting response: no recurrence for 6 months or more than 1 year after the end of treatment. 4. Maintenance response: HBV-DNA is undetectable or below the lower limit of detection or ALT is normal during the treatment period. 5, rebound: there is a response at the end of 3 months of treatment, but HBV-DNA rises again without any change in treatment, or ALT and AST return to normal and then rise again without any change in treatment, of course, other causes of the rise should be excluded, such as drugs and so on. Relapse: there is a response at the end of the course of treatment, but HBV-DNA rises again or ALT and AST rise again after stopping the drug. Efficacy response 7, complete response: patients with "major triple positive" have virological response + serological response + biochemical response; patients with "minor triple positive" have virological response + biochemical response. 8. No response: those who have not achieved one response. Partial response: between complete response and no response. What kind of people can be treated with interferon? A: 1. High ALT level before treatment. 2, HBV-DNA<2X108copies/ml. 3, female. 4, short course of disease. 5, Non-mother-to-child transmission 6, Mild degree of liver fibrosis. 7, Good adherence to treatment. 8, No comorbid viral infection of other viral hepatitis, no comorbid HIV infection, of which pre-treatment HBV-DNA, ALT level, and gender were the main predictors of efficacy. Early virologic response at 3 months of treatment is also important. XVIII. Contraindications to interferon. A: Absolute contraindications: pregnancy, history of psychiatric illness (major depression), uncontrolled epilepsy, uncontrolled alcohol or drug abuse, uncontrolled autoimmune disease, decompensated cirrhosis, symptomatic cardiac disease, pre-treatment neutrophil count <1X109/L, pre-treatment platelet count <50X109/L. Relative contraindications: thyroid disorders, retinal diseases, psoriasis history of previous depression, uncontrolled diabetes mellitus, uncontrolled hypertension, total bilirubin >51umol/L, especially dominated by indirect bilirubin. Nineteen, interferon adverse reactions A: 1, influenza-like syndrome: fever, chills, headache, muscle pain, fatigue. 2, transient myelosuppression: leukocytes (neutrophils) and thrombocytopenia. 3.Mental abnormality: depression, anxiety, delusion. 4, induce autoimmune disease, may appear anti-thyroid antibody, anti-nuclear antibody and anti-insulin antibody. Some patients may develop hyperthyroidism or hypothyroidism, diabetes mellitus, thrombocytopenia, psoriasis, leukoplakia, rheumatoid, systemic lupus erythematosus and so on. 5, other rare right kidney damage, cardiovascular damage, interstitial pneumonia, hearing loss, retinopathy and so on. XX. Treatment of nucleoside (acid) analogs. A: Currently, there are lamivudine, adefovir, entecavir, tebivudine, tenofovir and so on. If HBV-DNA is still detectable at 1 year of treatment, or if the decrease of HBV-DNA is <2logl0, other antiviral treatments should be changed (can be overlapped for 1-3 months at first), but for patients with cirrhosis or hepatic dysfunction, the medication should not be easily stopped. Immunomodulation therapy: thymopeptidea Anti-inflammatory and hepatoprotective therapy: glycyrrhizic acid preparations, silymarin, bicyclic alcohol, etc. Anti-fibrosis treatment: Chinese medicine activates blood circulation and removes blood stasis, nourishes blood and softens liver, nourishes liver and kidney, benefits qi and nourishes yin. XXI. Do chronic HBV carriers need treatment? A: HBV-DNA positive, triple positive people, do liver puncture if liver histology shows knodell HAL ≥ 4 or ≥ G2 inflammatory necrosis, need to carry out antiviral treatment. Non-therapeutic HBsAg carriers (HBV-DNA negative, small triple positive people) generally do not need treatment. XXII. Advantages and disadvantages of interferon. A: the advantages of interferon: 1, the course of treatment is relatively fixed; 2, HBsAg seroconversion rate is high, the efficacy is relatively long-lasting; 3, less drug-resistant variants. Disadvantages of interferon: 1, need to be injected to give drugs; 2, adverse reactions are more obvious; 3, not suitable for people with hepatic decompensation. Twenty-three, the advantages and disadvantages of nucleoside (acid) analogs. Answer: Advantages of nucleoside (acid) analogs: 1, oral administration; 2, strong inhibition of viral effects; 3, fewer and less adverse reactions; 4, can be used for hepatic decompensation. Disadvantages of nucleoside (acid) analogues: 1, the course of treatment is relatively unfixed; 2, HBsAg seroconversion rate is low; 3, the efficacy is not long-lasting; 4, long-term use of drug-resistant mutations can be produced; 5, after stopping the drug can be produced by the deterioration of the disease. Twenty-four, condition monitoring: 1, interferon: before treatment should be checked: (1) biochemical indicators: liver and kidney function; (2) blood and urine Rt, blood glucose, thyroid function; (3) virological markers: Hepatitis B five and HBV-DNA; (4) electrocardiogram, blood pressure; (5) exclude autoimmune diseases; (6) exclude pregnancy. Tests during treatment: (1) blood Rt once a week, then once a month; (2) biochemical indicators: once a month at the beginning, once every three months after three consecutive tests; (3) Hepatitis B Penta and HBV-DNA every three months; (4) Thyroid function, blood glucose, and urinary Rt every three months; (5) Regular assessment of mental status. 2, nucleoside (acid) analogues: before treatment should be examined: (1) biochemical indicators: liver function; (2) virological markers: Hepatitis B five and HBV-DNA; (3) blood Rt, CK, Cr. In the course of treatment, check: (1) the beginning of the liver function once a month, three times consecutively with the improvement of the condition of the liver function can be examined every three months; (2) virological markers: every three months to measure the five and HBV-DNA; (3) regular check of blood Rt, DNA; (4) regular check of blood Rt, glucose, urine Rt; (5) regular assessment of the mental state. DNA; ③ Regularly check blood Rt, CK, Cr, etc. 3. Follow-up: Measure liver function, Hepatitis B V and HBV-DNA at least once every two months within six months after stopping the drug, and then once every three to six months, with at least one year's follow-up. For those with persistent normal ALT and negative HBV-DNA, HBV-DNA, liver function, AFP and ultrasound were measured every six months. For those with normal ALT but positive HBV-DNA, it is recommended that HBV-DNA and ALT (liver function) be measured every three months, and AFP and ultrasound be performed every six months. For patients with chronic hepatitis B cirrhosis, especially those at high risk of primary liver cancer (>40 years old, male, alcoholic, liver insufficiency or those with existing AFP increase), AFP and abdominal ultrasound (CT and MRI if necessary) should be measured every 3-6 months for early detection of primary liver cancer, and gastroscopy or upper gastrointestinal angiography should be performed every 1 to 2 years in cirrhotic patients to observe esophagogastric fundus varices .