We are all familiar with Li Lanjuan, an academician of the Chinese Academy of Engineering.
During the COVID-19 epidemic last year, a large number of Chinese medical elites, including academicians Li Lanjuan and Zhong Nanshan, were calm and forgot all about food and sleep to race against the epidemic, which can be called the “magic needle in the sea” in the fight against the epidemic, and made outstanding contributions to the great victory in the fight against the epidemic.
Academician Li Lanjuan specializes in the prevention and treatment of emerging infectious diseases and has unique insights into various types of hepatitis.
Academician Li pointed out that antiviral treatment for hepatitis B patients should be more active, do our best to improve the condition and prolong the life of patients.
In clinical practice, we often encounter a few patients with second liver, do not know what is antiviral treatment, antiviral treatment should how to do, what to notice.
By this topic, the doctor and everyone say.
In general, the development of hepatitis B virus in the human body needs to go through four stages:
(1) Immune tolerance period.
This stage is mainly reflected in the infant period, although the virus settled down in the body, but the infant’s immune system is still in the early stage of development, very imperfect, so between the immune system and the virus “well water does not break the river”, peaceful.
There is a lot of virus in the baby, but because the virus and the immune system “coexist peacefully”, it is reflected in the liver function is all right.
At this stage, it is not appropriate to carry out antiviral treatment, if the treatment is not necessary, the effect is likely to be counterproductive, not only the drug effect is not good, there may be resistance and complications, the gain outweighs the loss, the risk is greater.
(2) Immune clearance period.
With the powerful, the body’s immune system development of hepatitis b virus was sensitive, and hepatitis b virus fantasy of “long-term coexistence” gone, the body’s immune system to the hepatitis b virus attack, main land within the liver, both sides you come to me to, it inevitably in the liver of liver cell damage, reflected in liver meritorious service is the number of hepatitis b virus is very high, liver meritorious service is not normal again, this time can antiviral treatment.
(3) Immune control period.
As the immune system is bolstered by antiviral treatment, and as scientific treatments are adhered to, both quantity and quality of the virus are falling.
Antiviral therapy achieved stage success.
The virus is dormant for a while, and the fight between the immune system and the virus enters a truce.
During the truce, the virus’s own metabolism is replaced, part of the virus is gradually “destroyed and swallowed” by the immune system and antiviral drugs, and the virus population is slowly reduced.
This period of time is variable, but relatively long, the power of immune control, mainly derived from drugs, or rely on the body’s immune system.
(4) Immune reactivation period.
Hepatitis b virus (HBV) if by chance the opportunity to grow again, once the immune system, the two sides met again lit “war”, this time the virus is likely to be changed, change, or “weapons” may upgrade, can’t adapt to the body’s immune system, namely before using drug control also of no help, this leads to resistance, can only change medicine, or use the more advanced drugs.
During the immune reactivation period, some patients may not take the initiative to make diagnosis and treatment, or appear drug resistance on the basis of the original treatment. No matter how the situation changes, antiviral treatment is necessary at this stage.
At present, there are mainly long-acting interferon and first-line nucleoside drugs for antiviral treatment, which have both advantages and disadvantages. However, considering the safety degree of medication, maintenance of work and life order, the number of patients, and the affordability range, we choose first-line nucleoside drugs for antiviral treatment, which is better.
According to the above four stages, the route selection of antiviral therapy is predicted as follows:
1, if the patient belongs to the “big three Yang”, the number of viruses is high, B ultrasound examination is normal, no family history of liver cancer, no need for antiviral treatment, but it is best to do an examination every 3 to 6 months.
2, if the patient is “big 3 this world”, the virus number is high, the test result is normal, but the lineal within three generations have cancer, especially cancer of the liver, or have a family history of cancer of the liver, it suggested that antiviral treatment, efficacy and choice for strong first-line nucleoside drugs, such as entecavir and tenofovir, TAF, reduce the risk of drug resistance.
3, if the patient belongs to the “small three Yang”, abnormal liver function examination, abnormal elevation of transaminase, and determined to be caused by hepatitis B virus, belongs to the state of the disease attack, immediate antiviral treatment, the earlier the better, with first-line nucleoside drugs.
- If the patient belongs to the “minor three Yang”, there are 5 different situations, only 1 of which does not need antiviral treatment, and the other 4 should be treated quickly.
(1) the patient “small three Yang”, virus detection negative, liver function is normal, without liver fibrosis phenomenon, this is the carrier of second liver virus, do not need treatment.
(2) The patient underwent liver puncture examination and was diagnosed as grade 2 inflammation. The liver fibrosis reached stage 2 or above, and the patient received immediate antiviral treatment.
(3) the patient “small 3 this world”, check virus 2 times continuously is greater than equal to 5 power, although transaminase is normal, or rise value is less, also want antiviral treatment, because be “small 3 this world” hepatitis broke out.
(4) Male patients with “minor three Yang” status, age over 40 years old, two consecutive tests for the virus greater than or equal to the fourth power, need antiviral treatment.
(5) Patients with transaminase values above 60 for 3 consecutive months, tested positive for virus for 3 consecutive times, need antiviral treatment.
Doctors suggest that: for antiviral treatment, patients should first make clear which stage they belong to, which kind of situation, save the diagnosis data of previous examinations, for doctors to make judgment and develop treatment plan.
Secondly, it is recommended to use first-line nucleoside drug therapy, which is not only to prevent drug resistance, but also the most worrisome choice in long-term treatment.
Again, pay attention to regular examination, standard medication, timely detection of physical improvement or abnormal conditions, to ensure that the antiviral treatment continues to be effective.