Chronic viral hepatitis B is a common disease in gastroenterology, multi-morbidity, treatment includes several aspects, such as dietary rest, nutritional support therapy, liver protection drugs: vitamins, promote detoxification class (liver Tylenol, GSH, Caecilai), pro-metabolic drugs (ATP, inosine, pulse valium), enzyme reduction and anti-yellowing anti-fibrosis, antiviral therapy, etc.
I. General treatment: Patients should be combined with movement and rest, easy activity during the resting period, rest during the active period of the lesion, and can engage in normal work 3 months after the disappearance of symptoms and normal liver function, but should not exert, drink alcohol, take drugs that damage the liver, and follow up regularly. Eat a light diet, too much heat is likely to cause fatty liver, avoid greasy food.
Second, vitamins: B, C vitamins have a protective effect on the liver, multi-component coenzyme involved in the body’s metabolism, maintain cell function. In liver disease, bile production and secretion is reduced, and bile acid salt in the intestine is reduced, which affects the absorption of fat-soluble vitamins A, D, E and K. They should be appropriately supplemented.
III. Drugs involved in physiological metabolism of the liver.
1, inosine and sodium inosinate: inosine chemical name hypoxanthine nucleoside, the precursor of adenine nucleotide, ATP, coenzyme A, ribonucleic acid components, involved in material energy metabolism, inosine membrane permeability, into the intracellular metabolism for inosinic acid, into ATP, improve the activity of many enzymes, so that the liver cells to restore function.
2.ATP: ATP is needed for the synthesis of protein, glycogen, lipoprotein and other substances in the body, and is catalyzed by adenylate cyclase to form Camp, which is involved in intracellular metabolic regulation, promoting hepatocyte repair and regeneration, and enhancing hepatocyte metabolic activity.
3.Coenzyme A: a large molecule composed of pantothenic acid, adenine, ribonucleic acid, phosphate, combined as acetyl coenzyme A, energy supply and participate in the synthesis of glycogen, acetylcholine, etc.
4.Essential phospholipids: EzanFu (multi-dilute phosphatidylcholine): supplement exogenous phospholipid components, promote the regeneration and reconstruction of hepatocytes, improve transmembrane transport, enhance the activity of phospholipid-dependent enzymes, provide a lot of energy for hepatocytes, improve the ratio of phospholipids in bile, and prevent stones.
Fourth, to promote liver detoxification drugs.
1, glucuronolactone (hepatolactone): glucuronide and bilirubin waste, drugs, toxins combined with excretion from the bile, detoxification effect.
2, GSH: that is, reduced glutathione (Guradin), composed of glutamate cysteine and glycine, containing active sulfhydryl bonds, to protect certain protease molecules SH- from oxidation, to maintain its activity, but also to clear the body peroxide, free radicals, GSH can be combined with drugs and toxins in the liver to promote their transformation, but also to promote liver metabolism, detoxification, bile excretion, and protection of liver cell membrane function. In chronic liver disease, the serum level is reduced, and it is beneficial to the recovery of liver function after use.
3.Thiopronine (Kexilai): sulfhydryl-containing compound with similar properties to penicillamine; provides sulfhydryl group to activate superoxide dismutase, accelerates the degradation of ethanol and acetaldehyde, prevents triglyceride accumulation; protects liver mitochondrial structure and improves liver function; through amidase hydrolysis, generates glycine, with a carbon unit involved in purine synthesis, promotes hepatocyte regeneration; sulfhydryl group reversibly combines with free radicals to form disulfide to scavenge it; against Heavy metals and drugs by providing sulfhydryl groups to enhance detoxification; sulfhydryl groups protect tissue cells to reduce the toxic effects of radiotherapy; treatment of senile cataracts and histamine exudative dermatitis, eczema, urticaria.
V. Liver-protective and enzyme-lowering drugs: these drugs should not be stopped suddenly, and should be gradually reduced to prevent the rebound of liver enzymes.
1.Biphenyldiphenhydramine: the active ingredient of Wu Wei Zi synthesis, strong enzyme-lowering effect, the mechanism is through the reversible inhibition of ALT in liver cells to achieve rapid enzyme-lowering effect. Advantages: rapid and effective. Disadvantages: the main lowering ALT, not obvious for AST lowering, the effect is not good for those who are seriously ill; the enzyme-lowering effect is not consistent with the recovery of liver function, still resting treatment after ALT normalization; not combined with antiviral drugs.
2.Silybin (Ligaron, Yihealing): flavonoids, protect and stabilize hepatocyte membrane, promote normal hepatocyte division and growth, improve hepatocyte synthesis of RNA and protein, improve mononuclear macrophage function, promote liver metabolism and detoxification function.
3.Hepatitis Ling: made from the extract of the roots of the plant, reduce enzymes, reduce liver necrosis, promote hepatocyte regeneration, improve non-specific immunity; 4mg intramuscular injection, once a day, for 2-3 months.
4.Compound glycyrrhizic acid: Glycyrrhiza glabra root extract, metabolized to glycyrrhizic acid-glycyrrhetinic acid in vivo by glucomannanase, glycyrrhetinic acid has high affinity with steroid metabolizing enzymes, hinders inactivation of aldosterone and cortisol, has hormone-like enzyme-lowering effect without obvious hormone-like side effects. It has hormone-like enzyme-lowering effect without hormone-like side effects. Strongin is a first-generation product, Glycopyrrolate is a second-generation product, and Mennen or Compound Glycopyrrolate is a third-generation product. Exogenous phospholipase is prone to cause hepatocyte damage, and glycyrrhetinic acid inhibits phospholipase A2 (PLA2) and lowers the enzyme. Characteristics: Stronger anti-inflammatory, improve liver function, lowering enzyme effect is significant.
Sixth, anti-yellowing drugs: gardenia yellow injection, red bile anti-yellowing granules, potassium magnesium mentholate, simethicone, ursodeoxycholic acid, etc.
1, red gall bladder anti-yellowness granule: clear heat and dampness, dredge the liver and reduce yellow.
2, adenosylmethionine (Simethicone): compound of ATP and methionine, in vivo transmethylation and transsulfuration groups play a key role, the lack of hepatocyte membrane phospholipid methylation is reduced, sodium pump and membrane mobility is weakened, bile stasis. It is also a precursor of physiological sulfhydryl compounds (cysteine, taurocholic acid, GSH). Restriction of the action of transmercaptans and reduction of the above synthesis leads to accumulation of bile acids in hepatocytes, detoxification is also weakened and damages hepatocytes. The drug helps hepatocytes to recover and promote the jaundice to subside.
3.Ursodeoxycholic acid: Ursine fluoride is an imported product. It is the 7β isomer of goose deoxycholic acid, which increases the secretion of bile acid and biliary effects; inhibits cholesterol synthesis, significantly reduces the amount of cholesterol and cholesterol esters in bile and the saturation index of cholesterol, litholytic effects; relaxes the sphincter of Oddi and strengthens biliary benefits; increases the activity of peroxidase in the liver, has a high detoxification and anti-toxic capacity, reduces blood triglycerides; inhibits the secretion of digestive enzymes and digestive juices, has immunomodulatory effects, and reduces HLA-I class antigen expression, reduce the number of activated T cells.
4.Cholestat: the active ingredient is anisotriazole: promote bile acid bile pigment and cholesterol secretion; enhance GSH level, enhance glutamylcysteine synthetase, GSH reductase activity; promote saliva secretion, promote gastrointestinal peristalsis and intestinal gas discharge; decompose cholesterol and detoxification, detoxification of alcohol.
5.Butylene glycol (bile-protecting and healthful): bile detoxification, promote the rapid and strong secretion of bile, cholesterol bilirubin phospholipids are increased, bile acid increased; reduce biliary edema and bile reflux, anti-inflammatory and biliary; relax the sphincter of Oddi does not contract the gallbladder, antispasmodic effect; hepatoprotective effect, reduce alcoholism.
Seven, anti-liver fibrosis: Xiao Chai Hu Tang, compound 861, compound turtle nail soft liver tablets, compound Danshen, bitter ginseng astragalus, Khan Fangji methosodium, Cordyceps sinensis, American ginseng, etc. If the hepatitis B virus is highly replicated, antiviral therapy has a definite anti-fibrotic effect.
VIII. Nutritional support therapy: compound amino acid preparation: maintain positive nitrogen balance and promote protein synthesis. Human albumin, fresh blood plasma, fat milk, energy combination, etc. all have better liver protection effect and are conducive to liver function recovery.
Nine, immunotherapy: chronic liver disease often appears immune dysfunction, immunomodulatory therapy can be given, but the immune function is very complex, there is no exact detection method, the mechanism of immunomodulators and the regulation of human immunity is not very clear, the efficacy is not sure.
1.Thymidine α1 (Ritalin): 28 aa composition, promote T cell maturation, Th produce IL-2 and receptor, induce CTL (antigen specific, MHC) activity, CD3, CD4, CD4/CD8 increase, act on the central link of cellular immunity and humoral immunity, amplify antiviral effect. 1.6mgih2 times/week×6M.
2, other agents: such as porcine polysaccharide, BCG vaccine.
X. Antiviral therapy: If HBV-DNA is highly replicated, ALT is increased or liver puncture suggests inflammatory cell infiltration in liver lobules, or the lesion has progressed to the stage of cirrhosis, antiviral therapy is recommended. The preparations are interferon, lamivudine, adefovir, entecavir, and telbivudine.