A comprehensive treatment plan should be used according to the patient’s specific situation, including reasonable rest and nutrition, psychological balance, improvement and restoration of liver function, regulation of body immunity, antiviral and anti-fibrotic treatment measures. At present, it is believed that the formation of chronic hepatitis is mainly due to persistent viral infection, therefore, antiviral treatment should be emphasized for chronic hepatitis.
I. General treatment
(a) Proper rest: bed rest should be emphasized for those with obvious symptoms or severe disease, and for those with mild disease, they should not feel tired after activity.
(2) Reasonable diet: appropriate high protein (animal and vegetable protein), high calorie, high vitamin and easy to digest food is beneficial to liver repair. Calories should be sufficient to maintain standard body weight, and there is no need to overemphasize high nutrition to prevent fatty liver. Do not eat too much sugar, so as not to induce diabetes.
(iii) Psychological balance: make the patient have a correct view of the disease, should have patience and confidence in the treatment of hepatitis, keep a happy spirit.
(iv) Avoid alcohol and drugs that damage the liver.
Second, to promote the liver detoxification drugs
(i) Reduced glutathione: 1.2g~1.8g per day in 10% glucose 250ml intravenously, once a day, generally 4 weeks as a course of treatment.
(ii) Thiopronine: 0.2g daily in 10 glucose 250ml intravenously once a day, usually 4 weeks as a course of treatment.
(iii) Glucuronide (Heptarea): 0.1g~0.2g orally 3 times a day; or 0.2g~0.4g intravenously once a day, usually 4 weeks as a course of treatment.
Three, to promote jaundice subsidence
(a) potassium magnesium menthylate 10% potassium magnesium menthylate injection 20ml ~ 40ml into 10% glucose 250ml slowly intravenous drip (30 drops / min), once a day, 2 weeks for a course of treatment.
(ii) Adenosylmethionine 500~1000mg daily intravenously, 2 weeks as a course of treatment.
(iii) Magnesium isoglycyrrhizate (Tianqing Ganmei) 0.1~0.2g daily with 5%~10% glucose 250ml intravenously, 4 weeks as a course of treatment.
(iv) Prostaglandin E1 (PGE1) injection: 100-200μg per day added to 5%-10% glucose 500ml slow intravenous drip, Kaishi for 10μg per day added to 0.9% sodium chloride or 5% glucose 10ml, slow intravenous push, 10-15 days for a course of treatment.
(v) Ursodeoxycholic acid (Eusebio): 100mg~250mg, orally, 2~3 times daily, usually for 2~4 weeks or longer.
(vi) Phenobarbital: 30mg-60mg orally 3 times a day for 50% reduction of jaundice, total course of treatment is 4-8 weeks. It is generally used for mild jaundice or intrahepatic cholestasis that is gradually improving, but difficult to subside.
(vii) Chinese medicinal preparations and extracts
1.Inchuan Huang 10～30ml daily with 10% glucose 250ml intravenously.
2. Bitter yellow 30～60ml daily add 10% glucose 250～500ml intravenously, 15 days a course.
3.Shuhenian Each time 10-20ml add 10% glucose 250-500ml, intravenous drip, once a day.
4.Bitteroside 0.2~0.3g per time, orally, three times a day; or 0.4~0.6g per time, intramuscularly, once a day; or glucose injection of bitteroside 100ml:0.6, intravenously, once a day.
5.Danshen injection 250 ml(16g) per day, intravenous injection, once a day.
6.Shengzhi injection 20-60ml daily with 10% glucose 250ml intravenously once a day.
7.Lampsin 5~10ml per time, intramuscular injection, twice daily; or 20~50mg per time added to 10% glucose 250ml, intravenous injection, once daily
IV. Enzyme-lowering treatment
(i) Glycine injection (capsule) is composed of glycyrrhetinic acid diamine. Add 30ml of injection solution to 250ml of 10% glucose intravenously, once a day, 14 days as a course of treatment. Glycine Capsules, 150mg, 3 times daily. Diammonium glycyrrhizinate enteric solvent (glypine), 150mg, 3 times daily.
(ii) Glycyrrhizin preparation Use 150mg, orally, three times daily; or 40-100ml, add 10% glucose 250ml intravenously, once a day, 14 days as a course of treatment.
(iii) Dicyclomine 25-50mg per dose, three times daily.
(iv) Hepatrim. Take 2 tablets orally 3 times a day for 3 months.
(v) Pentaerythritol capsule orally 2 capsules each time, 3 times daily.
(vi) Pendula. 7.0-10g per dose, 3 times daily, for a course of 1 to 2 months.
(vii) Hepatitis Spirit, 2~4ml each time, intramuscular injection, 1~2 times daily, 2~3 months as a course of treatment.
V. Immunomodulatory drugs
(i) Thymidine (peptide) usage: Thymidine 40～160mg per day, intravenous injection, once a day, 3 months as a course; Thymidine (peptide) α1 1.6mg per time, subcutaneous injection, twice a week, 6 months as a course; Thymopentin 1mg per time, subcutaneous injection, every other day.
(ii) Others Specific immune RNA, specific transfer factor and therapeutic vaccine, etc.
VI. Antiviral therapy The objectives are to inhibit viral replication and reduce infectivity; improve liver function; reduce liver tissue lesions; improve quality of life; and reduce or delay the occurrence of cirrhosis and hepatocellular carcinoma. Patients must sign an informed consent form for the use of antiviral therapy.
(A) General indications for antiviral therapy
1, HBV DNA quantification ≥ 1×105 copies/ml (≥ 1×104 copies/ml for HBeAg-negative).
2, ALT level ≥ 2 × ULN; such as treatment with interferon, ALT should be ≤ 10 × ULN, blood TBil < 2 × ULN,.
3, ALT < 2 × ULN, but liver histology shows Knodell Histological Activity Index (HAI) ≥ 4, or ≥ G2
4, HBV DNA positive but less than 1×105 copies/ml, after monitoring the disease for 3 months, HBV DNA still has not turned negative, and ALT abnormal.
(II) Plain interferon Alpha interferon (IFNα)
1. Treatment targets Patients with chronic hepatitis B who meet the following two conditions are suitable for alpha interferon therapy.
① HBV replication HBeAg positivity and HBV DNA positivity.
② Abnormal serum ALT.
2. Those who meet the above conditions but have one of the following conditions should not be treated with alpha interferon.
① Elevated serum bilirubin > 2 times the upper limit of normal value.
(ii) decompensated cirrhosis.
(iii) autoimmune diseases.
(4) important organ disease (serious heart, kidney disease, diabetes, hyper- or hypothyroidism, neuropsychiatric abnormalities, etc.).
3. Dose and course Dose 3MU~5MU/dose, the recommended dose is 5MU/dose; Usage 3 times a week, subcutaneous or intramuscular injection, the course of treatment for 6 months, can be extended to 1 year according to the condition. HBeAg(-) CHB course of treatment for at least 1 year.
(iii) Long-acting interferon PEGylated interferon (piroxin) PEGylated IFNα 135 ug～180ug (1.5ug/kg) once intramuscularly can maintain the blood concentration for one week, it is a long-acting IFNα preparation, PEGylated IFNα once a week can maintain a more stable blood treatment level compared with ordinary IFNα three times a week, thus exerting a stable inhibitory effect pressure.
(iv) Nucleoside (acid) analogues
1. Lamivudine (LAM) is 100mg orally once daily. It can be used for patients who are close to hepatic decompensation or have clear signs of decompensation.
2. Adefovir Dipivoxil (ADV): 10mg orally once daily. It is effective against lamivudine-induced YMDD variant with reversible nephrotoxicity.
3.Entecavir (ETV): 0.5mg orally once daily; increase the dose to 1mg daily for YMDD mutation with LAM.
4.Tebivudine (LdT): 600mg orally once a day.
5.Tenofovir disoproxil fumarate (TDF) 300mg orally once daily.
6.Clavudine (CLV; L-FMAU), trade name Levovir, 30mg orally once a day.
7.Course of treatment is recommended For HBeAg(+) patients, the drug can be discontinued if the HBeAg seroconversion and HBV DNA are undetectable in two tests more than 6 months apart; for HBeAg(C) patients, the drug can be considered to be discontinued if the HBV DNA is undetectable in three tests more than 6 months apart.
VII. Prevention of liver fibrosis If the pathological diagnosis suggests obvious liver fibrosis (≥S2), or five abnormalities of liver fibrosis, anti-liver fibrosis treatment can be considered.
(i) Compound turtle shell soft liver tablets 4 tablets each time, 3 times daily, 3-6 months as a course of treatment.
(2) Anluo Huafu Wan (安洛化纤维丸) 6g once orally, 2-3 times a day, for a course of treatment in three months.
(iii) Rhubarb and Worm Pill: 3g~6g per dose, 2 times a day, 3 months as a course of treatment.
(iv) Compound bovine fetal liver extract tablets orally, 1-2 tablets once, 3 times a day, 15-30 days as a course of treatment.