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Abstract: A 48-year-old middle-aged male patient had hepatitis B since childhood and did not feel unwell and therefore did not undergo treatment. However, in the past 2 months, the patient came to the clinic feeling weak, bloated, deepening urine color, and poor diet. After admission, the patient was immediately given hepatoprotective, enzyme-lowering, anti-yellowness, and antiviral treatment. Both transaminases and bilirubin continued to decrease after treatment, and the hepatitis B virus DNA test was negative after 3 months of retesting, with good results of antiviral treatment.
Basic information】Male, 48 years old
Disease Type】Chronic viral hepatitis B, hepatitis cirrhosis, splenomegaly
Hospital】The Second Hospital of Harbin Medical University
Date of Consultation】March 2022
Treatment plan】Intravenous injection (reduced glutathione for injection, diammonium glycyrrhizate injection, adenosylmethionine butadisulfate for injection) + oral medication (entecavir tablets, Fuzheng Huayu capsule)
Treatment period】16 days of hospitalization and regular review
Treatment effect] Viral load decreased, liver function normalized
I. Initial consultation
This is a 48-year-old middle-aged male patient who was seen for the first time. The patient indicated that hepatitis B had been found for decades and his mother also had hepatitis B and cirrhosis. The patient had been a smoker but not an alcoholic. He had been feeling unwell for more than 2 months, but did not go to the hospital in time because he did not feel too serious, often felt bloated, did not like to eat, had to go out for a walk when he ate a little bit more, and felt weak and lack of energy.
After a careful examination of the patient, he had a slightly dark complexion, a dark skin tone, and was thin overall. After the initial examination, the patient was found to be a hepatitis B major triple-positive with a hepatitis B viral DNA load of 4.78×10^7 cps/ml, liver function showed high transaminases and bilirubin, and liver ultrasound showed cirrhosis and splenomegaly. The patient was clearly diagnosed with hepatitis cirrhosis, chronic viral hepatitis B and splenomegaly.
II. Treatment history
When the patient was admitted to the hospital, he had obvious abdominal distension, nausea and poor appetite, and after learning that he had developed cirrhosis, he was unable to eat even more. I told the patient that although he had developed cirrhosis, there were no serious complications yet, and the results would be good if treated actively, and that adequate physical strength and nutrition were needed for the recovery of his current condition.
The patient was then immediately given injectable reduced glutathione, diammonium glycyrrhizinate injection, and adenosylmethionine butanedisulfonate for injection for liver protection, enzyme lowering, and anti-yellowing treatment; the patient was also given an antiviral regimen, and the current first-line hepatitis B antiviral regimen is mainly entecavir tablets or tenofovir dipivoxil fumarate tablets, and the patient chose entecavir tablets for antiviral treatment. Explain to the patient that hepatitis B cannot be absolutely cured at present, and antiviral drugs need to be taken for a long time for life. At the same time, the patient is advised to take anti-cirrhosis treatment, and the drugs for soft liver can be used in the form of Fu Zheng Hua Yu Capsules, which have a long course of treatment. Soft liver drugs can only delay the progress of liver disease, and are generally not able to reverse cirrhosis.
III. Treatment effect
After the first week of hospitalization, the patient’s symptoms were obviously relieved, and the liver function was rechecked, and transaminases and bilirubin both continued to decrease. On the 16th day of hospitalization, the liver function was rechecked: glutamic aminotransferase 56U/L, glutamic aminotransferase 50U/L, and total bilirubin 28umol/L. The patient was advised to be discharged to continue treatment. The patient was also instructed not to stop the medication without permission and to monitor the hepatitis B viral load afterwards. The patient was rechecked 3 months after discharge, and the hepatitis B virus DNA test was negative and below the lower line of detection, and this antiviral treatment was effective.
IV. Precautions
I was very happy that the patient recovered some strength and her symptoms were relieved when she was discharged from the hospital, and told the patient that this was only the first step of treatment. After being discharged home, we should pay attention to hepatitis B disease and pay attention to the following points.
1, antiviral drugs need to be taken for a long time, must not stop without permission, once they stop, hepatitis B virus replication will increase again, and there is a risk of drug resistance.
2, usually need to quit drinking in life, avoid drugs that damage the liver, moderate physical exercise.
3, pay attention to regular review, review items are blood routine, liver function, hepatitis B DNA quantification, methemoglobin, liver ultrasound or CT.
4. Pay attention to the physical condition, once there is weakness, abdominal distension, yellow urine, leg swelling and other manifestations, indicating that liver function may be a problem, return to the hospital as soon as possible for consultation.
V. Personal insight
Liver cirrhosis is a relatively common chronic liver disease, and hepatitis B virus infection is a common causative factor. As in the case of this patient, he was diagnosed with hepatitis B in the past, but has not been formally treated in a standardized manner, so his condition has gradually worsened. Because the liver is so compensatory, cirrhosis can take years or even a dozen years to develop, during which time it can be asymptomatic. Once decompensation occurs, the patient will only have symptoms of weakness, bloating, nausea and anorexia, and then go for a review of the disease has missed the best time for treatment. Fortunately, the patient was seen in time at a later stage and no serious phenomena occurred. If the disease continues unchecked, further development can lead to nodular cirrhosis and even liver cancer.
Therefore, patients with cirrhosis or hepatitis B infection must be seen early to control the progression of the disease, and in addition, they need to be reviewed regularly, usually every 3-6 months, for methotrexate and liver imaging to avoid the occurrence of liver cancer.