Part I What does hepatitis B virus infection mean? First, the harm of hepatitis B virus infection 1, once the human body is infected with hepatitis B virus, and the formation of chronic infection, the virus is difficult to eliminate, will affect the whole life. Shandong provincial hospital infectious disease department main Yu Hua 2, hepatitis B virus infection is a global problem. 3, 15% -25% of the hepatitis B virus infection. 3, 15-25% of hepatitis B virus infected people will eventually die of cirrhosis and liver cancer related to hepatitis B virus, and the natural end is very serious. 4. Every year, our country suffers great economic losses due to chronic hepatitis B (including cirrhosis and liver cancer), and the burden is even heavier for individuals and families. Hepatitis B virus can be transmitted through the following ways: mother-to-child transmission, blood transfusion, etc. Tattooing, sharing syringes, etc. Close contact (e.g. sex) The following ways will not transmit hepatitis B virus: sharing computers in the office, eating together, embracing, shaking hands, etc. Hepatitis B is not a hereditary disease, but a contagious disease. A large-scale survey found that: 80.8% of non-specialists regard hepatitis B as a hereditary disease; more than half (53.5%) of non-specialists regard hepatitis B as a hereditary disease. A large survey found that: 80.8% of non-specialized doctors regarded hepatitis B as a genetic disease; more than half (53.5%) of the non-specialized doctors could not answer the question of how hepatitis B is transmitted. Even doctors think that hepatitis B is a hereditary disease, and the general public can be imagined. We should be clear that hepatitis B has family aggregation, but it is not a genetic disease, but an infectious disease. Hepatitis B virus infection is divided into acute infection and chronic infection 1, acute infection: hepatitis B virus infection will be cleared within 6 months. 2, chronic infection: hepatitis B virus infection will be cleared within 6 months. 2, chronic infection: hepatitis B virus infection, 6 months later still not clear it. Proportion of the nature of infection after infection with hepatitis B virus at birth Acute 10% Chronic 90% Proportion of the nature of infection after infection with hepatitis B virus in infancy and childhood Acute 25-30% Chronic 70-75% Proportion of the nature of infection after infection with hepatitis B virus in adulthood Acute 90% Chronic 10% Age at the time of infection is the most important reason for chronicity, and the strength of the immune system is the key reason. Cirrhosis and hepatocellular carcinoma are grim outcomes of chronic infection. Every infected person should try to prevent or delay the coming of this end. V. Hepatitis B virus carriers are not hepatitis B patients or healthy people in the full sense of the word 1. Although hepatitis B virus carriers are not hepatitis B patients, they are not healthy people in the full sense of the word, and should be followed up. 2. 2. In the long run, hepatitis B virus carriers and chronic hepatitis B patients are at high risk of cirrhosis and liver cancer. Part II When treatment is needed I. “Major triple sun” and “Minor triple sun” are not scientific 1. “is unscientific common name. At present in order to take care of ordinary people’s comprehension, and still retain this name, but academic articles have abandoned this name. 2, clinical formal classification for e antigen positive chronic hepatitis B and e antigen negative chronic hepatitis B. 3, with e antigen positive chronic hepatitis B and e antigen negative chronic hepatitis B. 3, with e antigen positive chronic hepatitis B and e antigen negative chronic hepatitis B name can reduce some misunderstandings of the infected, such as thinking that “triple positive” into “small triple positive” will rest easy, and so on. On the “big three yang” “small three yang” positive and wrong views Error 1, “big three yang” condition is serious, “small three yang The “small triple sun” is a light condition. 2, “small triple positive” is not contagious. 3, I feel very good, it is not possible from “small triple sun” to “big triple sun”. 4, as long as the “big triple sun”, the “big triple sun”. 4, as long as the “triple positive” should be antiviral treatment. Correct 1, ALT and liver puncture test is an important indicator to determine the severity of the disease, not serum markers. 2, HBV-DNA is the most important indicator to determine the severity of the disease, not serum markers. 2, HBV-DNA is a parameter of hepatitis B infectious, “small triple positive” if the HBV-DNA is abnormal, but also infectious. 3, “triple positive” and self-perception is often not too much correlation. 4, “triple positive” if ALT, HBV-DNA, liver puncture test are normal, just carriers, temporarily do not need antiviral treatment. Once hepatitis B surface antigen is found to be positive in physical examination, liver function test should be carried out immediately ALT normal people under 35 years old: check ALT, ultrasound and HBV-DNA every 6 months Above 35 years old: in addition to checking ALT, ultrasound and HBV-DNA every 3-6 months, check AFP, and if necessary, do liver puncture ALT abnormal people, please go to infectious disease or hepatology department to check HBV-DNA, or go to hepatology department to check HBV-DNA. If ALT is abnormal, please go to Infection Department or Hepatology Department to check HBV-DNA and other indexes, and consult the doctor whether antiviral treatment is needed. Older people who are positive for surface antigen of Hepatitis B virus should pay attention to ultrasound, alpha-fetoprotein and even liver puncture to find out the signs of complication at an early stage, and to grasp the time of antiviral treatment, instead of judging the condition completely by self-feeling. General indications for antiviral therapy 1, HBV-DNA ≥105cps/ml (≥104cps/ml for HBeAg-negative), ALT ≥2 times the upper limit of the normal value 2, HBV-DNA ≤105cps/ml (≤104cps/ml for HBeAg-negative), ALT ≤2 times the upper limit of the normal value, but the histology of liver shows that Knodell HAI ≥4, or ≥G2 inflammatory necrosis or ≥S2 fibrosis. For those who fail to meet the above treatment criteria, disease changes should be monitored, and antiviral therapy should also be considered if there is persistent HBV-DNA positivity with an abnormal ALT. In addition, older patients (>40 years old) with chronic hepatitis B should be followed more closely, and if necessary, liver biopsy should be performed to identify inflammation and fibrosis, and antiviral therapy should be given actively. Fourth, hepatitis B virus carriers blindly pursuing surface antigen conversion waste of money hepatitis B virus surface antigen positive annual natural conversion rate of about 2%, so a few patients in the service of a certain drug found that the antigen conversion is likely to be a natural conversion, rather than the role of drugs. Patients with chronic hepatitis B who are eligible for antiviral therapy also have a very low rate of hepatitis B surface antigen conversion after drug treatment. Therefore, both hepatitis B patients and hepatitis B virus carriers should not blindly pursue surface antigen conversion. Part III Marriage, family life and employment 1. People infected with hepatitis B virus can have normal marriage and love 1. When in love, if one of the parties is infected with hepatitis B virus and the other party is not, the other party should be injected with vaccine to increase the immunity against hepatitis B virus. 2. 2. After getting married, protect your family. 3, newborn babies should be injected with hepatitis B vaccine and hepatitis B immunoglobulin when they are born. 4 .Infected people also need to pay attention to their own health. Follow up and monitor their condition. Hepatitis B virus infected people: different age, different self-protection 1, schooling and employment stage: the vast majority of HBV infected people are in the immune-tolerant or inactive stage when they are young, with no self-conscious symptom, normal liver function and no need for antiviral treatment; in order to eliminate hepatitis B discrimination, the Ministry of Health has made it clear that no check of hepatitis B 5 is allowed in schooling and employment. 2, love marriage stage: the vaccine can make adults and newborns can get significant HBV blocking effect; China’s HBsAg positive rate of children under 5 years old has been controlled to less than 1%; if antiviral treatment is needed at this stage, attention should be paid to the timing of the medication and the choice of drugs. 3, people to middle age: more than 35 years old, from the history of HBV infection, mostly in the immune clearance period, to strengthen the monitoring of the disease; more than 40 years old HBV infected, in addition to every 6 months to check the liver function, but also every 6 months to check the ultrasound, in order to early detection of pathological changes. Third, the object of vaccination newborns; infants and young children; medical personnel frequent contact with blood frequent recipients of blood transfusions or blood products; the use of immunosuppressive drugs patients; prone to traumatic injuries; male homosexuals or heterosexuals who have multiple sexual partners and intravenous drug users; HBsAg-positive family members; four injection of the vaccine time, dosage; 1, adult Hepatitis B vaccine 20ug Children Hepatitis B Vaccine 10ug 0 1 6 Principles of injection 0 Injection of the first injection 1 month later injection of the second injection 6 months later injection of the third injection 2 , Hepatitis B vaccination requirements for newborns whose mothers are HBsAg-positive 1) Newborns should be injected with Hepatitis B vaccine and Hepatitis B immunoglobulin within 12 hours of birth. The two injections should not be given at the same site. 2) The 2nd and 3rd shots are given after 1 month and 6 months respectively. At present, the hepatitis B surface antigen carrier rate of children under 5 years old in China has been reduced to less than 1%, which confirms the effectiveness of the vaccine. V. Employment of hepatitis B virus-infected people The Ministry of Personnel, the Ministry of Labor and the Ministry of Health have jointly issued a notice specifying that hepatitis B examination shall not be mandatory in the physical examination for employment. Any positive hepatitis B surface antigen found in the physical examination cannot be used as a reason for not accepting or being dismissed. However, in order to protect others and reduce infection, the relevant laws also clearly state that people infected with hepatitis B virus should not be engaged in the following jobs: nursery work in child care institutions; medical work in contact with blood; military personnel; work in services with potential skin breakage such as hairdressing or pedicure; Part IV Adherence to Follow-up Monitoring of Condition A. Significance of Adherence to Follow-up 1, Hepatitis B virus infection is not constant. 2. 2. Early detection of pathological changes in the liver to prevent deterioration of the condition. 3. Finding the time for antiviral treatment. 3. Finding the time of anti-virus. 4, Regular follow-up, responsible for oneself! The content and frequency of follow-up 1. Hepatitis B five Follow-up frequency: Hepatitis B virus-infected patients only need to pay attention to the changes of e-series, do not emphasize the frequent monitoring. 2.Liver function test follow-up frequency. 2, Liver function test follow-up frequency: 3-6 months 3, HBV-DNA test HBV-DNA is a direct indicator of viral replication. Purpose of the test: to understand the infectiousness of hepatitis B. As an important indicator of the need for antiviral treatment. As an important indicator of whether antiviral treatment is needed. To estimate the prognosis of the disease. For patients on antiviral therapy, HBV-DNA testing can also determine the effectiveness of antiviral therapy and monitor whether drug resistance has occurred. Follow-up frequency: 3-6 months 4 .B ultrasound Ultrasound is done in patients infected with hepatitis B virus in order to understand the morphological changes of the liver, spleen and the width of the internal diameter of the portal vein and the presence or absence of hepatic fibrosis, cirrhosis, fatty liver, liver tumors, splenomegaly and so on, in order to decide on the treatment plan. Ultrasound is a non-invasive diagnostic tool that is performed with less fear and can detect more serious complications. Follow-up frequency: 3-6 months. 5, CT and MRI examination If found small nodules in the liver, in order to clarify the nature of cirrhosis nodules, or liver cancer nodules, should be electronic computerized tomography (CT) and magnetic resonance (MRI) examination. Characteristics of CT: it can reflect the pathological and morphological manifestations of the liver, such as the size, shape, location, number of lesions and the presence of intra-lesion hemorrhage and necrosis. Characteristics of MRI: It is better than CT examination in showing pseudo-envelope, internal structure of tumor, edge of hepatocellular carcinoma and invasion of blood vessels, as well as distinguishing hepatocellular carcinoma from cirrhotic regenerative nodules. 6. Liver puncture biopsy Liver puncture, also known as liver biopsy, is mainly applied to the diagnosis of chronic hepatitis. Doctors can directly understand the severity of liver lesions of patients, and also can detect the distribution of viruses in liver cells and fibrosis of liver tissue through histochemical methods, guide the use of medication, predict the effect of medication and determine the development trend of the disease. If mild jaundice of unknown cause occurs for a long period of time, or the transaminase is not normal, it is necessary to go through liver puncture examination to make a clear diagnosis. Infected patients over 40 years of age should undergo liver puncture biopsy if necessary for early detection of histologic lesions in the liver. Part V Liver health care Hepatitis B infected patients should pay attention to other causes of liver injury. Anti-tuberculosis drugs such as isoniazid, rifampicin, pyrazinamide and so on. Antibiotics: tetracycline, erythromycin, and so on. Antipyretic and analgesic drugs: anti-inflammatory pain, pau d’arco, paracetamol, salicylic acid and so on. Other drugs: antipsychotics, immunosuppressants, antithyroid drugs. The actual fact is that they are not the same as the other drugs, and they are not the same as the other drugs. In addition, pay attention to some components of the unspecified health products, which may have added some Western drugs. Easy to occur drug hepatitis crowd: older, family history, history of allergic reaction to other drugs, more varieties of joint use of drugs, alcoholism, obesity, the original liver disease, diabetes, renal function is not good, as well as AIDS infected people, liver transplantation. Second, Chinese herbal medicine Special attention should be paid to the fact that Chinese herbal medicine also harms the liver, and it is known that there are more than 60 kinds of Chinese herbal medicines with hepatotoxicity. Third, fatty liver Hepatitis B virus-infected patients should be alerted to the following cases of fatty liver: 1 transaminase abnormal HBsAg-positive patients, if the HBV DNA 2.