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Abstract: A 32-year-old patient with chronic hepatitis B, who reported to have contracted hepatitis B from mother-to-child transmission, had stable test results in previous follow-up examinations. However, elevated transaminases were found on this review and he was admitted to the hospital. After hepatoprotective and antiviral treatment, liver function was gradually stabilized, and discharge was granted. Before discharge, the patient was instructed that anti-hepatitis B virus treatment should be long-term and standardized, and should not be discontinued without authorization.
Basic information】Male, 32 years old
Disease Type】Chronic hepatitis B
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】November 2021
Treatment plan】Liver protection and enzyme reduction (injectable reduced glutathione, diammonium glycyrrhizate capsules) + antiviral therapy (entecavir tablets)
Treatment period】9 days of hospitalization and 2 months of follow-up
Treatment effect】Liver function returned to normal, virus decreased to normal level
I. Initial interview
The patient with chronic hepatitis B in this case, Mr. Wang, has been regularly reviewed for 5-6 years. In previous reviews, he has always had a major triplet hepatitis B, with hepatitis B viral DNA load fluctuating between 7 and 8 times, and no significant abnormalities in liver function and liver ultrasound. However, when he came to the hospital this time, the patient reported that he had recently been under stress at work, had not been resting well, had a poor appetite, and was feeling somewhat tired. The results of the retest also showed that the patient’s liver function was abnormal: glutamic aminotransferase: 241 U/L, glutamic oxalacetic aminotransferase: 120 U/L, alkaline phosphatase: 159 U/L, and hepatitis B virus nucleic acid: 7.57×10 ^7 copies/ml. In the process of detailed understanding of the patient’s condition, we learned that the patient had not taken any special medication recently and had no drinking habits. The elevated transaminases were considered to be caused by the activity of hepatitis B virus, and the patient was recommended to be hospitalized for liver-protective and enzyme-lowering treatment, and an antiviral treatment plan was also formulated.
II. Treatment process
The patient was first admitted to the hospital, and was instructed to rest in bed, avoid stress and exertion, not to drink alcohol, and to eat a light and digestible diet. After fully communicating with the patient, the patient was given routine hepatoprotective, enzyme-lowering and antiviral treatment. The liver-protective drugs include injectable reduced glutathione and diammonium glycyrrhizate capsules to improve liver metabolism, protect liver cell membranes and lower transaminases. At the same time, an antiviral regimen was developed and the nucleoside analogue antiviral drug entecavir tablets were used for treatment. Patients were informed that this drug needs to be taken regularly and for a long period of time and should not be stopped without permission. During hospitalization, liver function was rechecked every 5-7 days, and after liver function was normal and symptoms were relieved, the patient could be discharged home to continue antiviral treatment.
III. Treatment effect
The patient’s symptoms improved significantly in the first few days of hospitalization, and the symptoms of weakness and anorexia were relieved. When the liver function was rechecked for the first time, both glutamic acid and glutamic oxalacetic transaminase decreased to less than 100 U/L. On the 9th day, the liver function indicators were normalized, and the patient was recommended to be discharged to continue antiviral treatment. When the patient was discharged, he had many doubts about the need for long-term oral medication and was psychologically burdened by the fact that he could not stop the antiviral drugs. After understanding this, the patient adhered to the antiviral treatment. At the 3rd month follow-up, the hepatitis B virus DNA quantification was below quadratic and negative. The patient was very satisfied with the control of his disease.
IV. Precautions
The patient was truly pleased as a doctor that his condition was under stable control after the treatment. In daily life, in addition to taking medication and review as prescribed by the doctor, patients should develop good living habits, avoid staying up late and exercise in moderation to help their body recover. In terms of diet, pay attention to a balanced diet and eat foods rich in vitamins and dietary fiber in moderation, such as winter squash and cauliflower. In addition, alcohol should be avoided to avoid aggravating the discomfort of the organism.
V. Personal insight
The most important thing for chronic hepatitis B is to review regularly and choose the right time for antiviral, to inhibit the replication of the virus before it progresses and causes irreversible liver damage, while once cirrhosis and complications appear and then go to antiviral, then the damage caused is irreversible. Therefore, during the immune tolerance period, the patient can be temporarily observed, and once the transaminases rise, liver hardness increases, or signs of cirrhosis appear, an antiviral regimen needs to be developed and individualized as soon as possible.