First of all, what are the indicators of liver function?
The most common indicators of liver function are aminotransferases and bilirubin, and abnormal liver function generally refers to these indicators. In simple terms, the normal values of both glutamic aminotransferase and glutamic oxalacetic aminotransferase are 40 U/L or less, with a mild elevation of up to 3 times, a moderate elevation of 3-10 times, and a severe elevation of more than 10 times. The normal value of total bilirubin is 17.1umol/L. An elevation of 2 times or less is mild (the skin is not necessarily yellow), 2-5 times or more is moderate (the skin is yellow), and 5 times or more is severe (the skin is obviously yellow).
In detail, the liver is an important organ of the human body, there are very many important functions, different indicators also reflect the different aspects of liver function, are very important, need to look at a comprehensive.
1.Liver cell damage
The main response indicators are glutathione ALT and glutathione AST. ALT and AST exist in liver cells, and when liver cells are damaged, both are excreted in large quantities and subsequently enter the blood, resulting in a significant increase in blood ALT and AST levels, which are responsive and rapidly increase in blood ALT and AST levels after liver damage. It should also be noted that ALT and AST are also present in other organ cells, for example, if ALT is not significantly elevated, but AST is significantly elevated, it is necessary to first consider the possibility of muscle and heart muscle damage, or the possibility of alcoholic liver damage, or other organ damage, in short, it needs to be considered in combination with other indicators.
2, bile duct cell damage, biliary tract problems
The main reaction indicators are total bilirubin TB, alkaline phosphatase ALP, glutamate transpeptidase GGT, etc. Total bilirubin is further divided into direct bilirubin DB and indirect bilirubin. When bile duct cells and bile duct are damaged, bilirubin cannot be eliminated from the body through bile duct and then enter the blood; for patients with bile duct obstruction caused by tumors and other reasons, the level of indirect bilirubin may be normal or slightly increased, while direct bilirubin is significantly increased. ALP and GGT will also be increased when the biliary tract is damaged, especially when the biliary tract is infected or alcoholic liver disease, both of which are more significantly increased.
3.Liver synthesis function
Albumin, cholesterol and fat-soluble vitamins A/D/E/K are mainly synthesized by the liver. In patients with chronic end-stage liver disease or acute subacute liver failure, liver synthesis is extremely poor, usually manifested by a significant decrease in albumin and total cholesterol levels. Vitamin K, also known as the coagulation vitamin, is significantly reduced in patients with end-stage liver disease (as well as other related causes), resulting in decreased coagulation and a significant prolongation of prothrombin time PT (normal is within 14s). A PT>20s is usually indicative of extremely severe liver damage, high risk of death and poor prognosis.
4.Metabolic function of the liver
The sodium-potassium pump (Na+-K+ pump) is in decline in patients with end-stage liver disease, resulting in decreased sodium levels, hyponatremia, and intractable ascites. The presence of hyponatremia is a sign of further deterioration and aggravation in patients with end-stage liver disease.
5. Liver detoxification function
Cholinesterase level, the liver is an important detoxification organ, in clinical practice, determination of serum cholinesterase activity is an important tool to assist in the diagnosis of organophosphorus poisoning and assessment of liver parenchymal cell damage. Decreased: seen in organophosphorus poisoning, hepatitis, cirrhosis, pernicious anemia, etc., and intake of morphine, codeine, barbiturates and other drugs. Serum cholinesterase levels can be significantly reduced in patients with organophosphorus poisoning.
6.Regeneration of liver cells
Alpha-fetoprotein AFP, AFP is a tumor indicator. When AFP is significantly increased, the possibility of liver cancer increases. However, when liver cells are regenerated after liver damage, AFP may also increase, although the increase is generally not significant and the level of AFP gradually decreases to normal with the recovery of hepatitis. In patients with acute liver failure, high levels of AFP often indicate active hepatocyte regeneration, which is a sign of good prognosis. Also AFP levels are elevated in pregnant women as a result of hepatocyte regeneration in small babies.
Second: the choice of antiviral drugs for hepatitis B, the advantages and disadvantages of each, what population each is suitable for, and how long each takes.
For people who need antiviral treatment, there are two types of antiviral treatment options, 1 is interferon subcutaneous injection, 2 is long-term oral nucleoside analogues.
1, interferon treatment
First interferon effect is slightly better than oral drugs, the current multi-use program is long-acting interferon, subcutaneous injection of 1 needle per week, more expensive; another for short-acting interferon, domestic, subcutaneous injection of 1 needle every other day, the price is relatively cheap, the efficacy may be slightly inferior to the long-acting, but there is no exact data.
After 1-1/2 years of regular long-acting interferon treatment, about 40% of patients can achieve HBeAg serological conversion (i.e., e antigen turns negative, e antibody appears) and achieve the treatment goal – clinical “cure”; but the real cure (i.e., s antigen turns negative, s antibody However, the probability of a real cure (i.e., s-antigen conversion and appearance of s-antibodies) is about 3%. The side effects of interferon therapy can be influenza-like syndrome, liver damage, allergy, fever and other side effects, so interferon is only suitable for young patients with less severe liver function damage (ALT level within 10 times). The efficacy of interferon is generally better for patients with hepatitis B DNA genotype A (mostly type C in China and type A in Europe and the United States), young female patients, patients who do not run in families, and patients with low DNA levels (105) at the time of treatment. Interferon therapy is not recommended for older patients, or for patients with existing cirrhosis. It is also contraindicated during pregnancy.
The advantage of interferon is that the course of treatment is fixed, 1-1.5 years of treatment course, effective better, no effect does not affect the subsequent treatment, can be subsequently replaced by oral drug therapy.
2.Nucleoside analogues oral antiviral therapy
Different types of patients with different courses of medication.
(1) e antigen positive patients who have reached the antiviral indication (DNA>105, ALT elevation more than 2-fold), the total duration of medication >4 years, or after e antigen serological conversion, continue to take medication >3 years.
(2) e antigen negative patients who have reached the antiviral indication (DNA >104, ALT elevation more than 2-fold) are recommended to take medication for life.
(3) Patients with hepatitis B cirrhosis who are positive for hepatitis B DNA should be on lifelong antiviral therapy.
The choice of medication differs for different types of patients.
(1) Lamivudine: It has been used less clinically and can be used in patients with slow plus acute liver failure (slow hepatitis B basis), or chronic liver failure (hepatitis B cirrhosis basis).
(2) Adefovir: It is less commonly used in clinical practice and will not be repeated.
(3) Entecavir: currently the first-line clinical drug, is a high genetic resistance barrier drugs, is currently the first choice of clinical antiviral drugs, high efficiency, relatively few side effects, but should not be used in pregnant women.
(4) Tebivudine: the effect can be, belongs to FDA safety class B drugs, can be used in pregnant women after weighing the pros and cons. Common adverse reactions are myositis.
(5) Tenofovir: currently the first-line clinical drug, is a high genetic resistance barrier drugs, is currently the first choice of clinical antiviral drugs, high efficiency, relatively few side effects, is currently the only anti-hepatitis B virus drugs have not been found to have resistance. It also belongs to FDA safety class B and can be used in pregnant women after weighing the pros and cons. The disadvantage is that it is not yet available in China and is difficult and relatively expensive to purchase.
Third: Will hepatitis B eventually progress to cirrhosis or liver cancer, and what should I do if I become cirrhotic or have liver cancer?
Hepatitis B is a chronic disease, and if you leave it alone and let it develop freely, the chances of it progressing to cirrhosis and liver cancer increase. Of course, there are many chronic hepatitis B patients who live their whole lives without any problems. Yes, there are such people, but know that not everyone has such good luck, life is not to be gambled with! Moreover, such good “luck” is also inseparable from his or her own good habits of work and rest, diet and lifestyle, as well as the infection of hepatitis B DNA virus typing is related.
Therefore, having hepatitis B is not scary, the most important thing is to know it, understand it, and find the problem and treat it.
Effective treatment can greatly reduce the risk of progression to hepatitis B cirrhosis and liver cancer.
So, what should I do if I unfortunately have cirrhosis?
As mentioned above, active antiviral treatment should be given, along with treatment for the corresponding complications of cirrhosis and, if necessary, inpatient treatment at a regular hospital.
If you are unfortunate enough to have liver cancer, you should be hospitalized in a regular hospital for a comprehensive assessment of your condition and selection of appropriate treatment methods, such as surgery, radiofrequency ablation, interventional therapy, etc.