I. Clarify two concepts: chronic hepatitis B patients, hepatitis B virus carriers Chronic hepatitis B patients and carriers are two different concepts, people are often easy to confuse, to clarify them to help guide the development of treatment programs and to determine the prognosis. 1, chronic hepatitis B patients Viral hepatitis is divided into acute hepatitis, chronic hepatitis, severe hepatitis, biliary hepatitis and hepatitis cirrhosis and other categories. Among them, chronic hepatitis B patient refers to acute hepatitis B disease duration more than half a year; or the original history of hepatitis B or surface antigen (HBsAg) carrying history, but also due to hepatitis B virus infection again clinical symptoms, signs and liver function abnormalities. Generally speaking, if the patient has clinical symptoms, such as nausea, vomiting, abdominal distension, anorexia, fatigue, yellow urine, yellow eyes, etc., as well as repeated abnormalities of liver function, then it is easier to judge for hepatitis B patients. 2.Hepatitis B virus carriers The formation of carriers is related to factors such as race, gender, age, heredity and different ways of infection, but more importantly, it is related to the body’s immune response (the ability to resist diseases). In a normal person, the immune response is normal, and it can clear the hepatitis B virus from the blood circulation through an immune response. When a person’s immune response is low, the phenomenon of “immune tolerance” can sometimes occur, thus allowing the hepatitis B virus to settle in the body for a long time and wreak havoc on the liver without being properly punished. Different ways of infection, for example, mother-to-child transmission from infancy, as mentioned above, when the body of infants has not yet formed a sound and powerful resistance to disease, the hepatitis B virus can not be cleared after infection, so that the patient carries the hepatitis B virus for a long time from childhood to adulthood. HBsAg in asymptomatic carriers of HBsAg persists in the blood for years, decades, or even for life. Although there are no symptoms and signs, and liver function is mostly normal, liver tissue may have different degrees of damage. Therefore, the term so-called HBsAg healthy carriers is no longer used in clinical practice. Instead, it is regarded as a kind of hidden process of hepatitis B virus infection, which may reflect the actual situation more objectively. For asymptomatic HBsAg carriers who meet the three criteria: 1) persistent positive HBsAg in the serum for more than half a year; 2) basically normal liver function without clinical symptoms and signs; 3) slight inflammation or non-specific changes in the histological examination, as the carriers themselves and their doctors cannot be completely ignored, and should be treated every half a year to 1 year, and should be taken into account in the clinical examination. Completely ignored, every six months to 1 year regular review of hepatitis B two half, HBV DNA and liver function, at any time to understand the dynamic changes of various laboratory tests. In the past, we often used to call those who have normal liver function (mainly refer to transaminase) and HBsAg positive for more than 6 months in Hepatitis B “two-to-half” test as carriers of Hepatitis B virus or HBsAg carriers or healthy carriers, however, China’s “Guidelines for the Prevention and Control of Chronic Hepatitis B” in 2005 categorized carriers into chronic Hepatitis B virus carriers and chronic Hepatitis B virus carriers, and HBV DNA carriers. into two categories: chronic hepatitis B virus carriers and inactive HBsAg carriers. Why is it divided in this way? This is mainly because the laboratory indicators, prognosis and treatment methods of these two are different. Inactive HBsAg carriers with serum hepatitis B virus deoxyribonucleic acid (HBV DNA) negative or below the low limit of detection are generally stable, while chronic hepatitis B virus carriers with positive serum HBV DNA have a different progression of disease. In addition, a considerable portion of chronic hepatitis B virus carriers, despite normal transaminases, still have different degrees of pathological changes if liver biopsy is performed, and may turn into chronic hepatitis B, or even develop into cirrhosis and liver cancer. Therefore, it is necessary for these carriers to be closely observed and, if necessary, take antiviral treatment to avoid disease progression. In conclusion, HBsAg-positive patients with obvious discomfort and abnormal liver function are easy to be recognized as hepatitis B patients. However, for HBsAg-positive people who do not have obvious discomfort and have normal liver function, it is not possible to arbitrarily assume that they must be hepatitis B virus carriers. A small number of people are diagnosed as chronic hepatitis B patients or even progress to cirrhosis after liver puncture and imaging tests. Therefore, serum HBV DNA test and liver puncture examination, if necessary, can help to confirm the diagnosis and further treatment. Second, hepatitis B clinically divided into which types Hepatitis B is an infectious disease that mainly invades the liver and causes liver damage. Clinically, hepatitis B can be divided into the following types: 1, acute hepatitis, including acute jaundice hepatitis and acute non-jaundice hepatitis. 2, chronic hepatitis, including acute jaundice hepatitis and acute jaundice hepatitis. 2.Chronic hepatitis According to the severity of the disease can be divided into three kinds of mild, moderate and severe hepatitis; according to the hepatitis B virus e antigen (HBeAg) can also be divided into HBeAg positive and HBeAg negative chronic hepatitis B. 3.Severe hepatitis can be divided into three types: acute severe, subacute severe and chronic severe hepatitis. 4.Silent hepatitis. 5.Hepatitis cirrhosis can be divided into compensated and decompensated cirrhosis according to the liver pathological changes and clinical manifestations. It can also be divided into active and quiescent cirrhosis according to the inflammation of the liver. What is hepatitis B virus carrier and what should be paid attention to in normal times China’s “Guidelines for the Prevention and Control of Chronic Hepatitis B” categorizes carriers into chronic hepatitis B virus (HBV) carriers and inactive HBsAg carriers. Chronic HBV carriers are defined as serum HBsAg positive, with more than 3 consecutive follow-up visits in a year, serum alanine aminotransferase (ALT) are in the normal range, e antigen (HBeAg) positive or negative, and HBV DNA positive. A portion of the population is not stable and even develops cirrhosis. Therefore, for this part of the population, they should be actively mobilized to do liver histology examination. If the liver histologic examination shows Knodell hepatitis activity index ≥4 or G2 inflammatory necrosis, antiviral treatment is needed. Inactive HBsAg carriers are defined as serum HBsAg-positive, HBeAg-negative, e-antibody (anti-HBe)-positive, HBV DNA-negative or below the low limit of detection, and with serum ALT in the normal range for more than 3 consecutive follow-up visits in a year. Liver histology shows a Knodell Hepatitis Activity Index of <4 or other semi-quantitative scoring system with minimal lesions. Treatment is generally not required in this population. For carriers, the problems that should be paid attention to are: 1. Maintain optimism and eliminate pessimism. 2, Regularly go to the hospital for examination and laboratory tests, and antiviral treatment can be carried out if necessary: Liver function, "two pairs of half", HBV DNA, alpha-fetoprotein and ultrasound and other imaging tests should be carried out every 3-6 months, once there is an ALT more than two times the upper limit of the normal value, and at the same time, HBV DNA is positive, it is possible to use the following options under the direction of the doctor Interferon-alpha or nucleoside analogs such as lamivudine and adefovir can be used for antiviral treatment under the guidance of doctors. 3, to develop regular habits, as little as possible to drink alcohol or do not drink alcohol, careful treatment of drugs that have damage to the liver. Fourth, what factors can make acute hepatitis B into chronic hepatitis B After a person is infected with hepatitis B virus (HBV), the virus lasts for six months and is still not cleared, known as chronic HBV infection. Some survey data show that 60% to 90% of acute hepatitis B can be completely recovered, 10% to 40% into chronic hepatitis B or virus carrier. There are many factors affecting the chronicity of HBV infection, specifically the following aspects: 1, age Age at the time of infection is the most important factor affecting the transformation of acute hepatitis B into chronic hepatitis B. Among those who are infected with HBV in perinatal period and infancy, 90% and 25%-30% will develop chronic infection respectively. In adolescents and adults infected with HBV, only 5% to 10% will develop into chronic infection. Generally speaking, the chronicity rate of male patients is higher than that of female patients. Clinical type It is reported that the chronicization rate of acute non-jaundiced hepatitis patients is higher than that of acute jaundiced hepatitis patients. 4, Immune function state People with low immune function, such as AIDS, chronic nephritis, renal insufficiency, tumor, lymphoma, leukemia, etc., or applying immunosuppressants such as adrenocorticotropic hormone to suffer from acute hepatitis are prone to turn into chronic hepatitis. 5.Combination of other diseases If acute hepatitis is combined with parasitic diseases such as schistosoma and Schistosoma, as well as hyperthyroidism, diabetes mellitus, tuberculosis and other diseases, it is generally easier to turn into chronic hepatitis. 6.Viral factors If HBV gene mutation occurs, the immune cells can not be recognized, so as to escape from immune surveillance. At this time, the patient is often difficult to spontaneous remission, resulting in repeated fluctuations in the condition, the development of chronic hepatitis patients. 7.Other If acute hepatitis B patients are overworked, long-term alcoholism, taking drugs that damage the liver, surgery, trauma infection, malnutrition, exposure to chemical substances are easy to turn into chronic hepatitis. V. What factors are related to the prognosis of chronic hepatitis B? Hepatitis B virus (HBV) infection can be manifested as acute or fulminant hepatitis, but also can be manifested as a variety of chronic infections, such as viral carriers, chronic hepatitis, cirrhosis, hepatocellular carcinoma. In chronic hepatitis B patients, the prognosis of patients with milder disease is better, generally do not evolve into cirrhosis, only for a long period of time, or become a viral carrier, or even may be cured. Some studies show that the estimated annual incidence of chronic hepatitis B patients developing cirrhosis is 2.1%, and the annual incidence of cirrhosis decompensation in chronic hepatitis B patients is about 3%. In addition to the patient's physical fitness and immune response status, the following factors play an important role in the prognosis and regression of chronic hepatitis B: 1. Genotype of the virus According to the differences in HBV gene sequences, it is currently divided into 8 genotypes from A to H. In China, B and C types are the most common. China is dominated by B and C genotypes, with C genotype dominating in the northern region and B genotype dominating in the southern region. More studies have confirmed that HBV genotype is an important factor in determining the clinical prognosis of chronic HBV-infected patients. It has been reported that the C genotype is more likely than the B genotype to cause fibroplasia in the liver tissue of HBV-infected patients, and it is more likely to lead to more severe liver disease. In addition, the response rate to interferon therapy is lower in the C genotype than in the B genotype, and the former is more likely to produce HBeAg seroconversion. 2, the level of the virus Taiwan scholars have 3851 cases of hepatitis B surface antigen-positive people for a period of 13 years of follow-up, research on the level of the virus on behalf of high and low indicators - HBV DNA level and prognosis of the relationship between the final conclusion that "high serum HBV DNA level is an independent risk factor for liver cancer". Finally, it was concluded that "high serum HBV DNA level is an independent risk factor for hepatocellular carcinoma". Therefore, it is now recommended that chronic hepatitis B patients receive antiviral treatment to suppress viral replication and reduce viral levels, ultimately for the benefit of the patients. The level of transaminase, bilirubin, cholinesterase and serum protein also has influence on the prognosis of hepatitis B. Among them, high or fluctuating level of transaminase is the high-risk factor of cirrhosis. 4.Combination of other viral infections If combined with hepatitis C, hepatitis D or AIDS, patients with chronic hepatitis B tend to develop cirrhosis more easily. In addition, these are also high-risk factors for cirrhosis patients to develop hepatocellular carcinoma. 5, alcohol consumption Research data show that alcoholism obviously affects the prognosis of hepatitis B patients, which can make hepatitis B easy to become severe and chronic, and the incidence of liver cancer will also increase. Alcoholism and hepatitis B virus infection have synergistic effect on liver damage.