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Abstract: The patient was admitted to the hospital with intermittent malaise, peripheral discomfort, and positive antibodies to hepatitis C. He was examined for chronic viral hepatitis C. In addition to hepatoprotective therapy, antiviral therapy was administered as the patient met the indications for antiviral therapy and there were no contraindications. The patient’s symptoms improved after treatment, and he was instructed to undergo regular follow-up examinations to understand the effect of treatment.
[Basic information] Male, 61 years old
Disease Type】Chronic viral hepatitis C (mild), type 2 diabetes mellitus, hypertension, fatty liver
Hospital】Liaoning Provincial People’s Hospital
Consultation time】August 2018
【Treatment plan】Liver protection and enzyme reduction (compound dichloroacetate diisopropylamine injection) + antiviral treatment (sofosbuvir-velpatasvir tablets)
Treatment period】Inpatient treatment for 8 days, outpatient follow-up after 1 month
Effectiveness of treatment】Improvement
I. Initial consultation
Elderly male, complaining of “intermittent weakness for 3 months”. The patient had intermittent weakness, malaise, yellow urine, and beer-like urine 3 months ago, and the above symptoms were obviously aggravated after exertion. The patient had been diabetic for 2 years and was taking metformin orally with fair glycemic control. He denied heart disease, previous history of hepatitis and blood transfusion. He was diagnosed with “chronic viral hepatitis C” and needed to improve the examination, evaluate his condition and further antiviral treatment.
II. Treatment history
On admission, examination: blood pressure 150/90 mm Hg. Specialized examination: clear and clear speech, chronic disease appearance, visible liver palm, no spider nevus. No abnormal signs were seen in the heart, lungs and abdomen, and there was no swelling in both lower limbs. Auxiliary examination: glutamic aminotransferase: 125.4 U/L, glutamic aminotransferase: 67 U/L, fasting glucose: 7.31 mmol/L, glycosylated hemoglobin 6.3%, hepatitis C virus RNA: 9.91 E6 IU/mL; ultrasound: fatty liver, enlarged gallbladder; HCV genotyping: HCV subtype 3b; normal electrocardiogram; diagnosed as ” chronic viral hepatitis C (mild), type 2 diabetes mellitus, hypertensive disease, fatty liver”. He was given a low-salt, low-fat diabetic diet, compound diisopropylamine dichloroacetate injection for sedation, and liver-protective and enzyme-lowering therapy. The patient had indications for antiviral therapy and no contraindications. Antiviral therapy was recommended, and the options were conventional PR therapy (interferon + ribavirin) and DAA drugs, and DAA drugs were preferred in terms of efficacy, safety, and duration of treatment. Depending on the genotype, sofosbuvir + daclatasvir or sofosbuvir-velpatasvir tablets could be chosen, both for 12 weeks, and the patient and his family were informed of the precautions for antiviral therapy. The patient himself chose to apply sofosbuvir-vipatasvir tablets for antiviral treatment.
III. Treatment effect
1. After 7 days of hepatoprotective and antiviral treatment, the effect was obvious, the patient’s symptoms improved, the liver function improved, glutamate transaminase: 86.1 U/L; glutamic oxalacetic transaminase: 43.8 U/L; and DAA treatment had been started without obvious adverse reactions, the patient requested to be discharged and agreed to be discharged, and continued hepatoprotective and antiviral treatment after discharge.
2. 1 month after the patient was discharged from the hospital, the rechecked hepatitis C virus quantification was lower than the minimum detection line (i.e., below 50 IU/ml). This indicates that the antiviral treatment is effective. Continue to take oral DAA antiviral drugs and complete the treatment course for 12 weeks.
IV. Notes
We are glad to see that the patient’s symptoms have improved after the treatment. In daily life, in addition to following medical advice for treatment, you should also pay attention to the details of life in general. It is recommended to eat light food, avoid intake of greasy, spicy and stimulating things, avoid smoking and drinking alcohol, as well as avoid abusing drugs and keep your mood relaxed to avoid causing discomfort. Once any physical discomfort occurs, you should go to the hospital as soon as possible to avoid delaying the disease.
V. Personal insight
The source of infection of this disease is acute and chronic hepatitis C patients and asymptomatic virus carriers. From the perspective of prevention, you should avoid sharing toothbrushes, razors and other items with such people, as well as avoiding sexual relations. Because hepatitis C virus infection is not easily detected, cases of spontaneous recovery are rare. Unless effective antiviral treatment is administered, spontaneous clearance of HCV RNA rarely occurs, so as long as the hepatitis C virus is replicating, antiviral treatment is needed, otherwise cirrhosis and liver cancer cannot be ruled out even after about 20 years of infection. Such patients need to be reviewed regularly, and doctors should clarify their living and eating status in addition to understanding the development of the patient’s disease, which contributes to their health.