1.Q: I heard that one out of ten people has the hepatitis B virus, so I am afraid every time I come into contact with others, please ask how infectious hepatitis B is? (Ms. Liuzhou, Guangxi Peng) = A: China is a high incidence of hepatitis B, hepatitis B virus infection rate of more than 60%, the carrier rate of about 10%, as estimated, there are about 130 million people in China are carriers of hepatitis B virus, so your above “1 / 10” statement is not too much, but in normal social places there is no need to be too nervous. Although the hepatitis B virus exists in body fluids, but it is mainly transmitted through the blood, saliva, semen, vaginal secretions in the amount of hepatitis B virus is very small, such as not a large number of long-term contact, generally will not be infected. 2, Q: Hepatitis B is a disease that can be transmitted through body fluids, but I live in a room with a hepatitis B virus carrier, so every time I was bitten by mosquitoes I was very afraid, please ask whether mosquito bites can spread hepatitis B? A: Scientists have been in the bite of the hepatitis B patient mosquitoes detected hepatitis B virus antigen, so presumably, mosquito bites spread hepatitis B is possible, but do not be overly nervous, because from the actual clinical situation, in many infectious disease hospitals on duty doctors and nurses do not have good mosquito avoidance measures, after years of investigation, have not been infected. Experts believe that the saliva of mosquitoes may have inactivated the hepatitis B virus, so that it lost the infectious; or because the content of the virus is too small to reach the infectious dose and not be infected. This issue needs to be further studied. 3, Q: A friend of mine recently often feel fatigue, nausea, yellow urine, I heard that people may have hepatitis B. What is the manifestation of hepatitis B and how to go to the hospital? (Miss Li, Haikou, Hainan) A: Hepatitis B clinical fatigue, nausea, loss of appetite, liver discomfort, liver enlargement, liver function abnormalities as the main manifestations, some cases can appear jaundice (eye sclera and skin yellowing, yellow urine). Your friend’s disease needs to be examined at the hospital immediately. In order to rule out hepatitis B, the first thing to do is a full set of hepatitis B tests (commonly known as “two-and-a-half”) and liver function (including transaminases, bilirubin and protein), and if possible, qualitative or quantitative tests of the hepatitis B virus (often referred to as HBV-DNA tests). In addition, sometimes ultrasound and routine blood, urine and stool tests are also done if needed. Since most of the above tests require fasting, your friend should not eat and drink before going for the test. 4.Q: I heard that hepatitis patients should pay special attention to diet, my child is now in the acute stage of hepatitis, how should I arrange his diet? (Guangdong Zhongshan Ms. Cai) A: Acute hepatitis patients should not eat spicy, greasy products, found abdominal flatulence, should be suspended to eat milk and cane sugar. Some easy to gas things, such as potatoes, soy products, sweet potatoes, etc., easy to cause abdominal distension pressure on the liver, hepatitis B patients should not eat. To strictly limit salt, monosodium glutamate and spicy and salty sauces, etc. Do not eat dessert before meals, so as not to affect the appetite. If edema or kidney dysfunction occurs, salt should be limited to no more than 4 grams of salt per day, and the amount of water intake should be the amount of urine excreted the previous day, plus 100 ml. Do not eat cold and fatty things. Acute heavy hepatitis patients should reduce the protein in the diet as much as possible to control the source of ammonia in the intestine to avoid liver coma. Chronic hepatitis patients should not eat more stimulating food, such as onions, ginger, garlic and fried barbecue products; acidic and cold food should also be eaten less. 5.Q: I used to be a hepatitis B “big three yang” patients, after 2 years of treatment has been turned into “small three yang”, so whether the condition has improved? (Netizen blue sky) A: “Big three yang” and “small three yang” are both common names for two combinations of serum markers of hepatitis B virus infection. The key to major and minor triple-positive is to see if there is HBeAg positivity, if there is, it is called “major triple-positive”, if only HBsAg, HBeAb, HBcAb positive is called “minor triple-positive”. As HBeAg is an important sign of hepatitis B virus replication and infectiousness, it is also an early sign of acute hepatitis B virus infection. Therefore, HBeAg continues to be positive indicates that the hepatitis B virus continues to replicate in the body, and the prognosis is poor. In the past, it has been considered that the change from “major triple-positive” to “minor triple-positive” is a sign that the disease is in remission and under control. However, recent studies have found that the judgment of major and minor triple-positive is also based on the following conditions: remission of clinical symptoms; normal liver function; and no mutation of the virus (commonly the end mutation of the front C region). This is because the hepatitis B virus can escape the body’s immune surveillance after mutation and can continue to reproduce and cause serious consequences. Therefore, the judgment of the major and minor triplets can not be generalized. 6, Q: I have been suffering from chronic hepatitis B for more than 6 years, recently the liver function repeatedly abnormal, to the hospital, some physicians recommended that I use interferon, but some physicians said that the use of lamivudine good. I want to know the advantages and disadvantages of these two drugs? A: Interferon (IFN) and lamivudine (trade name: Herceptin) are both clinically used anti-hepatitis B virus drugs. Interferon is a peptide substance with broad-spectrum antiviral activity and immunomodulatory effects. IFN is still considered to be the best antiviral drug of choice to inhibit the replication of hepatitis B and C viruses. There are many types of interferons, including α-IFN, β-IFN, γ-IFN and so on, but the antiviral effect of α-IFN is the strongest, so the commonly used interferons in clinical practice, Seroquin and Andafungin, are derived from α-IFN. The advantages of interferon are that it has been in clinical use for a long time, doctors have a clear understanding of its indications, contraindications, dose and duration of treatment, and more importantly, no resistant strains of the virus have been found, and it also has good efficacy against hepatitis C virus; the disadvantages are that there must be clear indications for its use, there are side effects such as fever, low white blood cells and platelets, hair loss, and it is not suitable for patients with cirrhosis, especially in the decompensated stage. It is not suitable for patients with liver cirrhosis, especially in the decompensated stage (it will aggravate the disease), and the use of a longer period of time (more than six months) will produce antibodies to interferon. Lamivudine is a new generation of nucleoside analogues, which is effective in inhibiting hepatitis B virus replication, and its main mechanism is to interfere with the replication of the virus. The advantages of lamivudine are that it is easy to administer orally, has fewer side effects, can be used by patients with cirrhosis, and makes up for the shortcomings of interferon. Its disadvantage is that after a long period of time (more than half a year), some patients can produce drug-resistant mutations that make the drug basically ineffective, and at the same time, because it does not remove the super-helix type cccDNA of the virus in the liver cells, once the drug is discontinued, the virus may replicate again, so long-term medication is needed to achieve lasting results. 7.Q: I am a doctor in a primary hospital, we often encounter the problem of hepatitis B virus mutation in the treatment of chronic hepatitis B. Why is the hepatitis B virus prone to mutation and what trouble does it bring to treatment? (Hunan Wugang Dr. Liu) A: Hepatitis B is difficult to treat, an important reason is the mutation of the hepatitis B virus. There are two main reasons for the mutation of the hepatitis B virus. One is that the hepatitis B virus needs to change its face frequently in order to escape from the fight. The second is the lack of correction function of the polymorphic enzyme of the hepatitis B virus gene, the product of replication often differs from the original, and over time, the gene of the virus will undergo a large mutation. Hepatitis B virus gene mutation can bring many clinical disadvantages, for example, some people’s surface antigen (HBsAg) turns negative after treatment, but liver function is still abnormal, most likely because the hepatitis B virus S gene mutation can not be detected, seemingly cured, but in fact not cured. The P gene mutation can produce lamivudine resistant mutant strains, making lamivudine lose its therapeutic effect; the former C mutation may cause fulminant hepatitis or the deterioration of chronic hepatitis or liver transplantation failure, etc. 8.Q: My child is two months old, because I am hepatitis B surface antigen positive, the family is firmly opposed to my breastfeeding, please ask the mother with hepatitis B virus like I can breastfeed? (Shijiazhuang, Hebei, Ms. Guo) A: Can mothers with hepatitis B or hepatitis B surface antigen (HBsAg) positive breastfeed their children, there are two opinions, one believes that the content of the virus in the mother’s milk is far less than in the blood, plus the transmission of hepatitis B virus is mainly through the blood, so newborns can be breastfed after the first injection of hepatitis B vaccine after birth. Another view is that in order to reduce the chance of transmission, it is better for mothers with hepatitis B virus not to breastfeed their newborns. It is generally believed that the following situations are not suitable for breastfeeding: breast milk can detect hepatitis B virus, suggesting the presence of hepatitis B virus in breast milk, highly contagious; HBV-DNA positive or “major triple-positive ” mothers, especially those with abnormal liver function; infants with broken or ulcerated oral cavity, throat, esophagus, gastrointestinal mucosa, or mother’s nipple rupture should also temporarily stop breastfeeding; Infants with negative surface antibodies (HBsAb) should be vaccinated against hepatitis B in a timely manner and breastfed only after protective antibodies have been generated. E antibody (HBeAb), core antibody (HBcAb) positive patients, if the liver function is normal, you can generally breastfeed. 9.Q: I am a college student, I know that liver disease can not take drugs, but I do not know which drugs are not good, you can tell me? （A: According to statistics, there are at least 200 kinds of drugs that can cause different degrees of liver damage, the following are more common: antipyretic and antirheumatic drugs such as acetaminophen, pautazone, indomethacin, salicylic acid, allopurinol, etc.; narcotics such as halothane, chloroform, methoxyflurane, trifluoroethylene ether, etc.; anti-tuberculosis drugs such as isoniazid, rifampin, etc.; endocrine hormone drugs such as oral endocrine hormone drugs such as oral contraceptives, methyltestosterone and anabolic hormones, anti-thyroxine drugs, etc.; anti-tumor drugs such as 6-mercaptopurine, azathioprine, methotrexate, 5-fluorouracil, etc.; tranquilizers such as chlorpromazine, trifluoperazine, diazepam (Valium), etc.; certain herbal medicines such as neem (Neem), Guanmutong, Cang Er Zi, Juxiang San Qi, fish gall bladder, mugwort, Wu Bei Zi, pomegranate bark, centipede powder, etc.; certain compound preparations and Some compound preparations and certain herbal extracts such as Qing Dai Pills and Lei Gong Tang Polyglucoside Tablets have also been reported to have liver function damage. Generally speaking, drugs with liver damage are stated in their instructions, so patients should pay attention to reading them when taking them. For some hepatotoxic drugs that must be used, they should be used under the guidance of a doctor.