1.What are the similarities and differences between chronic hepatitis B and hepatitis C?
(1) Both hepatitis B and hepatitis C are caused by viruses. The hepatitis B virus is a virus called deoxyribonucleic acid (DNA), while the hepatitis C virus is a ribonucleic acid (RNA) virus. These two viruses cause extremely similar pathological changes in the liver.
(2) The incubation periods of the two types of hepatitis are not the same. The incubation period before the onset of hepatitis B is 6 weeks to 6 months, with an average onset of 3 months; hepatitis C is 5-12 weeks, with a minimum of 2 weeks and a maximum of 30 weeks.
(3) The two types of hepatitis have similar transmission routes. Both are caused by blood transfusion, blood products and unclean injections, and close living contact can also be transmitted. Another route of transmission for hepatitis B is mother-to-child transmission. If a mother has a positive blood test for both hepatitis B virus surface antigen (HbsAg) and e antigen (HbeAg), 85%-95% of her babies who are not vaccinated against hepatitis B will become infected with hepatitis B virus later in life. The problem of mother-to-child transmission of hepatitis C is not conclusive, and the possibility exists, but it is much less serious than that of hepatitis B.
(4) Hepatitis B is widely distributed worldwide. According to the survey, 58% of people in China have been infected with hepatitis B virus, and it is projected that 600- 700 million people have been infected. Hepatitis C is not yet available, but it is known that hepatitis B accounts for 70%-80% of sporadic chronic hepatitis, and hepatitis C accounts for about 10%. Hepatitis C predominates in up to 60-90% of hepatitis acquired through blood transfusion.
(5) There are asymptomatic carriers of both hepatitis B and C viruses. It is known that about 10% of our population are carriers of hepatitis B virus (about 300 million in the world, but 120 million in China), and about 1/4 of these people will develop chronic hepatitis, cirrhosis or liver cancer in the future.
(6) Hepatitis B and hepatitis C symptoms are similar, most of them start insidiously, the gastrointestinal symptoms are not obvious, most of them are not jaundiced, the symptoms are not typical, and some patients are found only during physical examination. Some of them have acute onset with gastrointestinal symptoms and jaundice.
(7) Both types of hepatitis can detect the corresponding antigens and antibodies by laboratory tests, which can be used as the basis for pathogenic diagnosis. Anti-hepatitis C virus antibodies (anti-HCV) and antigens (HCV-RNA) can be detected in hepatitis C. The corresponding antigens and antibodies for hepatitis B are more complex, and the most common test for hepatitis B is the “two-and-a-half” test, a pair of hepatitis B virus surface antigen (HBsAg) and antibodies (anti-HBs); a pair of hepatitis B virus e antigen (HbeAg) and antibodies (anti-Hbe); and hepatitis B virus core antibody (anti-HBc).
(8) Hepatitis caused by both viruses is prone to a chronic process, with about 20% eventually developing cirrhosis and some evolving into liver cancer. The rate of hepatitis C turning into chronic hepatitis, cirrhosis and cancer is higher than that of hepatitis B.
(9) about prevention, hepatitis B infection has a reliable vaccine, there are blood-borne vaccines and genetically engineered vaccines have been widely used; in addition there is hepatitis B immunoglobulin. The transmission of hepatitis B, mother-to-child transmission is one of the main transmission routes, the current use of hepatitis B vaccination, to interrupt mother-to-child transmission plays an important role, newborns according to the provisions of the vaccination, can make more than 90% of infants from hepatitis B virus infection, this protection can last 8-9 years; and hepatitis C is not yet a vaccine.
(10) At present, there is little difference in the treatment of the two types of hepatitis, are using antiviral therapy. Most scholars at home and abroad believe that the choice of interferon treatment, the efficacy of hepatitis C than hepatitis B, but the course of treatment is long, expensive drugs, should be used at your discretion.
2, the hepatitis patient’s diet to pay attention to what problems?
It is often said that the disease “three points of treatment, seven points of nourishment”. The “seven points of nourishment” includes reasonable nutrition allocation. Especially for patients with hepatitis or cirrhosis, a good diet can promote the recovery of liver disease.
Acute hepatitis patients in the early stages of the disease, liver cell swelling, necrosis, deterioration of liver function, jaundice, liver breakdown, synthesis and detoxification functions can have varying degrees of impact. At this time, patients feel nausea, aversion to oil, abdominal distension, fatigue and weakness, yellow urine like tea. It is very important to reasonably regulate dietary nutrition to ensure that the patient has all the nutrients he needs.
First of all, 1.0-1.5 grams of high-quality protein per kilogram of body weight per day (insufficient supply, the liver to break down the body’s protein), such as eggs, fish, milk, lean meat, etc., so that the body effectively synthesize clear (albumin) protein, repair necrotic liver cells. However, protein food should not be too much, so as not to increase the burden on the liver, followed by an appropriate supply of fat, 50-70 grams per day, carbohydrate intake is appropriately limited.
Acute hepatitis is usually hospitalized, and the diet during this period should be deployed depending on the course of the disease. In the first 10 days of the disease, especially in patients with high jaundice, the appetite is very poor, so on the basis of ensuring the supply of nutrients, a light diet should be given, avoiding greasy. As a result, liver cells are destroyed and the secretion of bile is reduced, which is not conducive to the digestion and absorption of fat. It is advisable to drink milk, steamed egg custard and eat some fresh vegetables to promote appetite.
Eat more fresh fruit, especially watermelon, to replenish vitamins, do not eat canned fruit, because canned is autoclaved, most of the vitamins have been destroyed, and added with preservatives. At this time, dishes should be boiled or steamed, and eat as little fried food as possible, because fried food is greasy and not easy to digest. Patients should eat to the extent that they do not feel hungry, especially dinner should not be too much, so as not to cause abdominal distension due to indigestion.
After about 2 weeks, jaundice gradually subsides, nausea improves, oil aversion is reduced, some patients still have yellow sclera, but appetite increases greatly, and some still need to add meals at night. At this time, food containing high protein and fat should be increased appropriately to make up for the lack of intake in the early stage of the disease, but should not be too full, in order to prevent increasing the burden on the liver, which is not conducive to recovery. When the disease will be healed, patients often report that they cannot eat, which is due to the long hospitalization, monotonous diet, long-term inactivity and reduced consumption. At this time, the patient is asked to take a walk and increase the variety of food to promote appetite. Acute hepatitis patient’s diet rule from do not want to eat to want to eat, from eat less to eat more, gradually return to normal, is very important for the recovery of the disease.
Chronic hepatitis diet allocation, and acute hepatitis and cirrhosis have many similarities. The diet of chronic hepatitis is normal during the stable period, with an appropriate increase in protein and vitamin-rich fruits and vegetables. If chronic hepatitis is active, nausea, aversion to oil, yellow urine, and significant changes in liver function, the diet should be adjusted according to acute hepatitis patients. In heavy chronic hepatitis patients, the dietary requirements should be adjusted with reference to patients with cirrhosis, with an appropriate increase in high-quality protein to ensure that the liver has sufficient raw materials to produce serum (albumin).
3, chronic hepatitis follow-up review what are the contents?
Chronic hepatitis can be transformed into healing, or it can develop into cirrhosis or cancer. Therefore, it is necessary to follow up chronic hepatitis patients regularly. The first thing is to observe the change of symptoms, whether there is any aggravation of gastrointestinal symptoms, yellow urine, nosebleed, enlarged liver and spleen, swelling of lower limbs, ascites and bleeding. In addition, the most important follow-up visit is to do relevant laboratory tests for.
①White blood cell and platelet counts, whether the total number is decreased.
②Liver function test, whether transaminase is elevated.
③Serum albumin test for decreasing trend, if it is lower than 34g/l, it indicates the tendency of cirrhosis.
④Hepatitis virology examination, such as detection of HBV-M, HBV-DNA and HCV-RNA.
⑤ Whether or not the alpha-fetoprotein is elevated and whether or not it gradually decreases along with the improvement of liver function.
(6) Ultrasound examination should be done to see the ultrasound changes of the liver, the size of the liver, whether the portal vein is widened and the degree of splenomegaly, and whether there is cancer. If it is difficult to make a conclusion by ultrasound, CT examination can be done.
Finally, fiberoptic endoscopy should be done regularly to understand the changes in the esophagus and stomach. Because the liver fibrosis of chronic hepatitis patients makes the portal vein pressure rise, leading to gastric mucosa stasis and hypoxia, coupled with liver dysfunction, the toxic substances in the body can not be completely cleared by the liver; at the same time, coupled with endocrine disorders and bile reflux, etc., can lead to gastric mucosa damage.
There are mainly: superficial gastritis, erosive gastritis, atrophic gastritis, bulbar ulcer and inflammation, etc. Through fiberoptic gastroscopy, we can observe whether there are varices in esophageal veins and their degree, and understand the changes of the stomach. There is no fixed requirement for the interval of follow-up for chronic hepatitis, but generally 3-4 months is appropriate. If the condition improves, the follow-up time can be extended; if the condition deteriorates, you should visit the hospital at any time in order to detect the change of condition at an early stage and deal with it in time.
4.What does the evolution of major triplet and minor triplet indicate?
After young children are infected with hepatitis B virus, the virus replicates and multiplies in liver cells, and various antigenic antibodies related to hepatitis B virus infection can be detected in the serum, routinely detectable as
①Surface antigen (HbsAg), ②Surface antibody (HbsAg)
②Surface antibody (HbsAb), and
(3) e antigen (HbeAg), and
④e antibody (HbeAb), ⑤ anti-nuclear antibody (HbeAb)
⑤Anti-nuclear antibodies (HbeAb).
The above antigen and antibody tests are medically known as HBV-M tests (commonly known as two-and-a-half tests), which are the most important indicators to check whether there is hepatitis B virus infection. The ① ③ ⑤ positive items, commonly known as the big three yang; ① ④ ⑤ positive items, commonly known as the small three yang.
In the first few years to more than ten years of hepatitis B virus infection in young children, the virus and the body “coexist peacefully”, and the serum shows the major triplet, so the major triplet also reflects that the virus in the body is constantly replicating and multiplying, while the damage to the liver is usually light at that time, a significant number of infected people, especially women infected, the virus can be long-term or lifelong and A significant number of infected people, especially women, can live with the virus “peacefully” for a long time or for life. play the role of the source of infection.
More infected people are 13-23 years old, and due to the maturity of the body’s immune system, they are able to recognize the infected liver cells and have a reaction to clear these infected liver cells. This process of repeated clearance and destruction is the self-limiting healing process of the body.
After several years, the virus is basically cleared, the e antibody in the serum appears, and the e antigen disappears one after another, which means that the person changes from a major triplet to a minor triplet. Thus, the process of changing from major triplet to minor triplet is a symbol for most patients with hepatitis B (except for mutant strains of infection) that the virus is basically cleared, or basically self-healed, and there will be no more hepatitis activity in the future.
Unfortunately, there are still a considerable proportion (about 2/3) of infected people, their own clearance response, can not completely clear the latent virus in the liver, after a number of weeks, months, years, the virus replication, clearance, liver repair week after week, so the small triplet to large triplet, large triplet to small triplet, or even always strong and weak triplet and the virus has not been cleared, this part of the infected people’s In the future, the liver is fibrotic to varying degrees, and some patients have developed cirrhosis and even ascites or cancer at the age of about 40. At this time, even though they have turned into small triplets, it only means that the virus has been mostly cleared but the liver damage has been quite serious.
Some patients after cirrhosis hepatitis is still active, indicating that the clearance reaction is still going on, liver damage is still developing, the body’s own protective reaction to clear the virus, bringing more and more serious irreversible damage to its own liver tissue, and eventually can make life finally liver disease damage, really incredible and sad results.
It can be seen that if the conversion of major tri-positive to minor tri-positive is completed before the age of 25-30, the process of virus clearance is completed for the organism, and the damage to the liver is lighter; if major tri-positive is transferred to and fro, or continues to be major tri-positive, and the clearance reaction (hepatitis continues to be active, and transaminases are repeatedly elevated) continues, then around the age of 40, for most chronic hepatitis B patients, even if they are converted to minor tri-positive, they have different degree of liver fibrosis or cirrhosis.
If you continue to be a major triple-positive for life, without significant hepatitis activity (liver function is always normal), you may still be able to live until the age of 60-70. The conversion of major triplet to minor triplet is a sign that the body has cleared the virus, but the liver damage that comes with it should not be taken lightly. Therefore, it is better to turn or not to turn, and the above reasoning is understood. Our experience over the years is that as long as the liver function is normal, there is no need to enable interferon, and there is no need to choose those immature, no scientific basis for the treatment of conversion.
5, young people infected with hepatitis B virus why do not worry?
Most of the hepatitis B virus infection in the youth due to the body to clear the virus, liver cells by the body’s immune clearance and destruction, natural virus reduced, but the liver cells are damaged, so the serum glutathione aminotransferase (that is, GPT) or ALT will be significantly higher, so the young people brought trouble, first of all, the problem of further education, the school found that students with elevated ALT that he withdrew; work units to see the youth ALT elevated The workplace to see young people with elevated ALT is “respect and far away”, so many people are really sad, is this right?
This is an error in the understanding of ALT elevation, usually most people, including many medical personnel are ALT elevation and hepatitis infectious mixed together, that ALT elevation of people that are infectious, can not study together, work together, which is obviously incorrect from the point of view of today’s understanding. First of all, many causes can cause an elevated ALT in the serum, and even if the ALT is elevated due to chronic hepatitis B, the virus in the serum will decrease rather than increase, so it is obviously wrong to consider an elevated ALT as a sign of contagiousness.
We now know better that this response of the body to clear the virus can last for years, even decades, and is the process of the body clearing viral hepatitis to heal itself, should we stop school for decades? We think this is too unjust. Some people also think that chronic hepatitis B patients are contagious with major triplets, so they can’t study or work together, that is also incorrect. As we have already talked about, the hepatitis B virus is mainly transmitted through blood; most infections among adults are recessive, or a few manifest as acute infections, and do not become chronic. Therefore, there is no reason why young people should not be allowed to participate in study and work.