At present, there is no specific treatment for all types of hepatitis, and the improvement of liver function should start from a comprehensive treatment to reduce the inflammatory response in liver tissue and promote the regeneration of hepatocytes, which is manifested in the decrease of transaminases and bilirubin, and the increase of prothrombin activity and albumin. For patients with chronic hepatitis B and C, effective antiviral therapy is the most important hepatoprotective measure, which is described in detail in another section, and this article only describes the other commonly used hepatoprotective treatments as follows.
1, general treatment.
The general treatment of hepatitis includes 3 main aspects: rest, diet and avoidance of alcohol. Of course, the psychological adjustment of patients with hepatitis is also gaining attention. For the acute phase of acute hepatitis and chronic hepatitis patients with obvious symptoms, bed rest should be the main focus, while when the condition is significantly better, then you can appropriate activities. With regard to diet, it should be determined by the specific situation of the patient. Generally, it is best to have a light diet when hepatitis patients have obvious digestive symptoms or have deep jaundice, fatty foods can aggravate nausea in such patients and even lead to vomiting, at which time the patient should be given static points of sufficient glucose and appropriate amount of vitamins to replenish the calories and raw materials needed for liver cell repair, while when the jaundice obviously subsides, light and tasty foods can be entered . Whether acute or chronic hepatitis patients should absolutely avoid drinking alcohol, a large number of clinical trials have confirmed that chronic hepatitis combined with a large number of long-term alcohol consumption will aggravate the necrosis of liver cells and accelerate the progress of cirrhosis.
2.Drug treatment.
2.1 Certain herbal extracts or analogues.
2.1.1 Wu Wei Zi type preparations.
These drugs have obvious enzyme-lowering effects, and animal experiments have proved that they have the effect of reducing liver tissue damage, the mechanism is unknown. Bifenthix as its extract is a fast and effective enzyme-lowering drug, which can effectively reduce the level of serum ALT, but it is easy to rebound after stopping the drug; the effect on AST is not obvious, and some patients with chronic liver disease will still have an increase in AST after taking it. The long-term efficacy is poor. Indicated for patients with migratory hepatitis and single ALT elevation. Dosage: 15mg, 3 times daily. The dosage should be gradually reduced after ALT has returned to normal. Dicyclomine is a newly marketed chemical compound with significant enzyme-lowering effects. The results of a randomized double-blind trial showed that 269 patients with chronic hepatitis B treated with dicyclomine showed greater improvement in clinical symptoms, and the rates of normalization of ALT and AST were 53.5% and 48.7%, respectively, and 40.2% and 48.7%, respectively, after 1 2w of drug discontinuation. Compared with the bifenthrin group (61.6% and 44.2%; 45.7% and 5 0.0%), P > 0.0 5. The serum HBeAg negative rates were 2 0.8% and 2 9.0% in the bicyclomine group at the end of treatment and 1 2wk after discontinuation, respectively, and the HBeAg/anti-HBe seroconversion rates were 1 5 .6% and 2 0 .8%, respectively, and the HBV DNA negative rates were 3 9.0 and 45.7%, respectively.
2.1.2 Licorice sweetener preparations.
As the active ingredient extracted from licorice, glycyrrhizin can competitively bind to the liver enzyme that metabolizes adrenocorticotropic hormone and increase the level of adrenocorticotropic hormone in the body. Therefore, it has the effects of anti-inflammatory, choleretic, protecting liver cells, lowering transaminases, promoting jaundice subsidence and regulating the immune function of the body. Other active ingredients include glycyrrhetinic acid and glycyrrhetinic ammonium secondary acid. Its side effects include easy to cause water and sodium retention, increased blood pressure and hypokalemia, so it should be used with caution in patients with severe high sodium, low potassium and hypertension.
2.1.3 Silymarin.
Silymarin can improve liver function and has the effect of protecting and enhancing hepatocyte membrane function. It is suitable for the treatment of acute and chronic hepatitis and toxic liver injury. Its preparations include: Yiheling, compound Yiheling tablets, Hepatoprotein capsule, etc.
2.1.4 Picrasin.
Picrasin is an oxidized bitter ginseng base purified from bitter bean seeds, and animal and clinical experiments have confirmed its obvious effects on improving liver function, antiviral effects and anti-liver fibrosis. Wang Yongyi et al. summarized 38 units with a total of 1950 patients with chronic hepatitis B. The average ALT reversion rate was 85.44% after simple injection of oxymatrine 400mg, 1 time/day for 3 months; another 1767 HBVDNA-positive patients had an average HBVDNA negative rate of 44.93% after the same treatment; the average HBeAg negative rate was about 42.27%. The current recommended dose is 600 mg, administered either quietly or orally, for 3 months. Adverse reactions are about 6% to 8%, mainly upper gastrointestinal symptoms, rash and bitterness in the mouth, and caution in liver failure. Also extracted from Sophora japonica, it has good enzyme-lowering effect.
2.1.5 Others.
Such as pendant herb punch, Yinjianhuang, Salvia preparations have certain enzyme-lowering and anti-yellowing effects, which can be applied according to the specific conditions of patients, and injections should pay attention to the allergic reactions they may cause.
2.2 Hepatocyte growth factor.
Hepatocyte growth promoter is a small molecular weight peptide active substance extracted from the liver of suckling pigs. It can stimulate the synthesis of normal hepatocyte DNA, promote hepatocyte regeneration, have a protective effect on damaged hepatocytes, and promote the recovery of liver function. Clinically used for the treatment of heavy hepatitis, chronic active hepatitis and liver cirrhosis. Dosage: 80-120mg/day in 250ml of solution in an IV drip. The results of a multicenter clinical study (41 hospitals and 347 patients participated) showed that the total effective rate of hepatocyte growth promoter added to the combination therapy for severe hepatitis was 78.4%, with a reduced morbidity and mortality rate and significant improvement in symptoms, signs and biochemical indices. The authors suggested that it may be related to the ability of hepatocyte growth factor to promote the regeneration of hepatocytes, reduce the level of tumor necrosis factor and have a certain repair effect on hepatocyte membrane. The total efficiency of hepatocyte growth factor in the treatment of severe hepatitis in phase II clinical trials was also 77.1%. It is generally believed that hepatocyte growth stimulants are more effective in early and mid-stage severe hepatitis than in late stage severe hepatitis. Therefore, early application of hepatocyte growth promoter should be emphasized for the treatment of severe hepatitis in order to improve the efficiency of treatment.
2.3 Sodium fructose diphosphate (fructose-1,6-bisphosphate trisodium salt).
Sodium fructose diphosphate is a cellular metabolite present in human body, which can regulate the activity of various enzyme systems in glucose metabolism, improve the state of cellular hypoxia and ischemia, and facilitate the recovery of damaged hepatocytes. It has a certain effect on yellowing in patients with severe jaundice. Liu Huimin et al. treated 30 cases of chronic heavy hepatitis with sodium fructose diphosphate combined with glutathione, and the efficiency reached 70%. Dosage: 5-10g, 1-2 times daily, slow intravenous drip, too fast sedation may have local pain, panic, sweating and other side effects.
2.4 Prostaglandin E1.
Prostaglandin E1 has a variety of pharmacological effects: (1) on the liver injury caused by hypoxia prostaglandin E1 has a stabilizing effect on lysosomes and strengthen the stability of the cell membrane system; (2) can dilate blood vessels, improve liver blood circulation, inhibit platelet aggregation; (3) can bind to specific receptors on the hepatocyte membrane, activating adenylate cyclase leading to increased CAMP content in hepatocytes, can inhibit phospholipase activity, but also (4) It can inhibit the immune damage provoked by hepatitis virus infection and has immunomodulatory effect. It has been reported that prostaglandin E1 can significantly reduce the level of TNF, which is one of the important mechanisms for the treatment of heavy hepatitis. The national “seventh five-year plan” and “eighth five-year plan” for the treatment of heavy hepatitis, prostaglandin E1 has a certain effect of reducing mortality.
2.5 Potassium magnesium menthylate.
Potassium magnesium menthylate plays an important role in the tricarboxylic acid cycle, has obvious effect on acute and chronic hepatitis, can be conducive to the jaundice of hepatitis, reduce blood ammonia, and promote hepatic encephalopathy patients to wake up.
2.6 Adenosylmethionine.
Adenosylmethionine is a physiologically active molecule present in all tissues and body fluids in the body and is involved in important biochemical reactions in the body. It can reduce the cholesterol/phospholipid ratio, improve the fluidity of hepatocyte membranes, overcome the barriers to the transsulfhydryl reaction and promote the synthesis of sulfhydryl groups in the endogenous detoxification process, which helps to reduce bile depression in acute and chronic liver diseases and alleviate the symptoms of itchy skin and fatigue in patients. It is used for the treatment of intrahepatic biliary depression before and after cirrhosis and intrahepatic biliary depression during pregnancy. Dosage: Initial treatment: 500-1000mg daily, intramuscular or intravenous injection for 2 weeks; Maintenance treatment: 1000-2000mg/day, orally. Chongqing Institute of Viral Hepatitis treated 110 patients with intrahepatic cholestatic jaundice with adenosylmethionine, and the results showed that the rates of ALT, AST, total bilirubin and direct bilirubin normalization were 66.67%, 69.23%, 40% and 46.67%, respectively, and the efficacy was significantly higher than that of the potassium magnesium menadione group. And it is believed that in addition to the above mechanism, it may also be related to the inhibition of TNF expression and reduction of serum TNF level.
2.7 Drugs to help reduce yellowing by promoting bile excretion.
2.7.1 Ursodeoxycholic acid.
Ursodeoxycholic acid can promote the secretion of bile, slow down the conversion of acetate into cholesterol in the liver, significantly reduce the amount of cholesterol and cholesterol esters in human bile and the saturation index of cholesterol, prevent the formation of gallstones, and thus have a beneficial biliary effect. It can be used for the treatment of gallstone disease and jaundice, especially for jaundice caused by autoimmune liver disease. The duration of treatment is long, usually not less than 6 months. Adverse effects are rare, with occasional diarrhea, constipation, headache, stomach pain, itching, etc.
2.7.2 Bovine health care agent.
The main ingredients are: dihydroxy dibutyl ether, ethyl p-hydroxyphenylpropionate and propyl p-hydroxyphenylpropionate. It can promote the rapid, strong and persistent secretion of bile; it can effectively reduce the inflammatory edema of small bile ducts and capillary bile ducts and the bile reflux caused by them, and thus has obvious biliary anti-inflammatory effects. Animal experiments show that the damage to liver tissues and cells in alcoholism is lower than that in the control group, showing its obvious hepatoprotective effect. It also has the effect of relaxing the sphincter of Oddi, which is conducive to the excretion of bile into the small intestine and promotes the elimination of jaundice. Dosage: 0.5-1g/dose, 3 times daily. Severe hepatic insufficiency, hepatic encephalopathy, complete biliary obstruction and gallbladder enlargement are contraindications. Use with caution in glaucoma and severe prostatic hypertrophy.
2.7.3 Toninapic acid.
Its active ingredients are p-methylbenzyl nicotinate and α-naphthalene acetic acid can promote hepatocyte production and secretion of physiological bile containing all popular substances, and have anti-inflammatory, anti-swelling, keep the biliary tract open and improve liver function. It mainly treats cholecystitis, intrahepatic cholestasis and jaundice. Dosage: 1-2 tablets/time, 3 times a day.
2.8 Scavenging free radicals and detoxification effects.
2.8.1 Reduced glutathione.
Reduced glutathione is a peptide naturally synthesized in human cytoplasm, which contains sulfhydryl group and has important physiological functions. Through the combination of sulfhydryl group and free radicals in the body, it can be converted into easily metabolizable acids, thus accelerating the excretion of free radicals, protecting the synthesis, detoxification and inactivation of hormones of the liver, and promoting the metabolism of bile acids, and facilitating the absorption of fats and fat-soluble vitamins in the digestive tract. It is suitable for patients with all types of acute and chronic hepatitis, cirrhosis and hepatocellular carcinoma. Various toxic liver diseases (alcohol, drugs, etc.) are also suitable for using this drug. Dosage: 300-600mg/dose, 1-2 times daily, intramuscularly or intravenously.
2.8.2 Thiopronine.
Thiopronine is a new type of glycine derivative containing free sulfhydryl group, which is experimentally confirmed to reduce the activity of liver mitochondrial ATPase, increase the content of ATP in mitochondria, improve hepatocyte structure and function, inhibit the formation of hepatocyte mitochondrial lipid peroxide, protect hepatocyte membrane, protect hepatocyte mitochondrial structure, promote hepatocyte regeneration and hepatocyte membrane repair, and participate in hepatocyte protein and sugar metabolism. Accelerate ethanol metabolism in the liver, etc. Domestic clinical data show that thiopronin has better efficacy in chronic hepatitis, and compared with hepatitis spirit injection, its effect of lowering ALT and AST is similar, but the effect of lowering GGT and raising albumin is better than hepatitis spirit group. Adverse reactions are only 4.6%, mainly include fever, rash, skin itching, etc. Thiopronin is suitable for fatty liver, early cirrhosis and various types of acute and chronic hepatitis, drug-related hepatitis, etc. Dosage: 100-200mg/dose, 3 times daily, orally after meals.
2.8.3 Zeljian.
The main specific active ingredient of Curegene is carnitine orotate, in addition to pyridoxine hydrochloride, vitamin B12, liver-derived anti-toxic components, adenine hydrochloride, etc. Carnitine orotate can restore liver injury caused by various reasons, promote protein synthesis in the liver, adjust the activity of metabolic enzymes, and also promote fat metabolism in the liver, which has anti-fatty liver effect; the anti-toxin component can remove toxins in the liver, promote the recovery of liver function and liver histology, and strengthen the detoxification function of liver cells. Clinically, it can be used to treat various kinds of hepatitis, cirrhosis, fatty liver, drug and alcoholic hepatitis. Dosage: 2 capsules/time, 2-3 times/day.
2.8.4 Hepatogain.
The active ingredients of Hepatogain are natural phosphatidylcholine diglycerides and excess unsaturated fatty acids. The pharmacological effects include: (1) essential phospholipids protect the hepatic sinusoidal endothelium and hepatocyte biofilm and promote membrane regeneration; (2) reduce hepatocyte fatty infiltration and inflammatory response; (3) promote hepatocyte regeneration by increasing the synthesis of ribonucleic acid, protein and glycogen; (4) reduce hepatic connective tissue proliferation by inhibiting the synthesis of collagen fibers and hydroxyproline in the liver. Its main components are easily absorbed by hepatocytes and maintain important functions necessary for the vital activities of the liver, especially the detoxification function of the liver. Dosage: Tablets 1-2 capsules/dose, 1-3 times daily with meals.