4. Hepatitis
Poisoning by poisons, toxins and other substances is called toxic hepatitis; Bacterial hepatitis is caused by bacteria; People who cause viruses are called viral hepatitis. Therefore, the word hepatitis is a general term for liver inflammation caused by various reasons. But at present, hepatitis is the endorsement of viral hepatitis in a narrow sense.
5, viral hepatitis
At present, viral hepatitis is divided into seven types: A, B, C, D, E, G and transfusion-transmitted virus, namely hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), hepatitis E virus (HEV), hepatitis G virus (HGV) and transfusion-transmitted virus (TTV).
6. Clinical classification of viral hepatitis
According to the clinical manifestations of seven kinds of viral hepatitis, the clinical types commonly used for diagnosis are:
(1) Acute icteric hepatitis (a few can be transformed into chronic severe hepatitis).
(2) Acute jaundice-free hepatitis (some of which can persist or recur, and can turn into chronic hepatitis, and hepatitis B, hepatitis C, hepatitis D and hepatitis G are more common.
(3) Chronic persistent hepatitis and chronic active hepatitis.
(4) Cholestasis hepatitis.
(5) Severe hepatitis (acute severe, subacute severe and chronic severe).
7, seven kinds of viral hepatitis infection rate
According to the second national hepatitis survey of 1996, the average positive rate of hepatitis A infection rate is 80.9%, which is the total infection rate of hepatitis A in China (but 80.9% of people are not all sick, but only infected by hepatitis A virus). The infection rate of hepatitis B was 57.6%. The infection rate of hepatitis C was 3.2%; The infection rate of hepatitis D virus was1.15%; The infection rate of hepatitis E was18.1%; The infection rate of hepatitis G virus was 8%. The transfusion-transmitted virus has not been successfully isolated so far, and the infection rate has not been reported.
(1) Why is family emotional support important for the recovery of liver disease?
Family is the basic element of society and the destination of everyone's mind and emotion. When a family member is ill, he should inform other family members first. Especially for patients with liver diseases, he or she may be alienated from colleagues and friends because of infectious diseases. At this time, all emotions will be pinned on family members, and the attitude of family members towards patients will directly affect the emotions of patients, and even the words and deeds of a family member will make patients sensitive. If the family members do not grasp their emotions well at this time, they will be pessimistic, desperate and crying after knowing the patient's condition, which will make the patient lose confidence in the treatment and affect the recovery of the disease. Others don't like and alienate the family members of hepatitis patients without knowing anything about disinfection and isolation, which not only affects the treatment of patients, but also makes patients pessimistic, give up on themselves and aggravate their illness. The above situation is not conducive to the recovery of the patient's condition. What should be correct is: sincerely care for patients, support each other emotionally, and let them feel the warmth of their families; Let patients understand their important position in the family and help patients establish confidence in overcoming the disease; Through body language such as language communication, eye contact and skin contact, patients feel that they have not been abandoned by their families and society, and their hearts are nourished by love, and they maintain an optimistic attitude, so as to actively cooperate with treatment and strive for an early recovery.
(2) How do patients with non-liver diseases get along with patients with liver diseases?
Patients without liver disease should avoid two extremes when dealing with patients with liver disease. One extreme is fear of infecting oneself, alienating isolated patients, making patients feel inferior, which is not conducive to patients' recovery. The other extreme is to show that you are close to the patient and don't dislike it. You completely abandoned the disinfection and isolation system, and in principle, you did not have close contact with patients, so that you were infected with hepatitis. The correct way is:
(1) Emotionally support patients, close the distance with patients, care more about patients, encourage patients to talk about their unhappiness, help patients to eliminate fear, inferiority and despair, and establish a cheerful and optimistic attitude towards life in the treatment and conditioning of diseases, so that patients feel that they are not isolated, and their relatives and friends are connected with their hearts.
(2) Non-liver disease patients and patients with liver disease have a * * understanding of the disease, and have a better understanding of the transmission route, disinfection and isolation measures and treatment methods of liver disease. And take corresponding disinfection and isolation measures on the premise that patients understand. In fact, patients are unwilling to transmit liver disease to relatives and friends, and some even take the initiative to avoid relatives and friends. At this time, relatives and friends should take the initiative to communicate with patients and make friendly contact on the premise of understanding medical knowledge.
(3) Pay attention to the section. Don't let some trivial things hurt the patient, such as shaking hands, hugging, taking what the patient just took, etc. , will not be infected with hepatitis. At this time, patients with non-liver diseases should not be too careful, so as not to hurt the self-esteem of patients with liver diseases.
(3) Can hepatitis patients get married?
In our clinic, many patients and their families often ask: Can hepatitis patients get married? Hepatitis, especially chronic hepatitis, lasts for a long time and recurs. Some people think that marriage can cure diseases. Some people are eager to get married, and they get married before they get well. In fact, this practice is wrong.
As we all know, hepatitis is an infectious disease. There are a large number of hepatitis viruses in patients, which can be transmitted to their spouses through close contact such as eating, kissing and sexual life. Therefore, patients with hepatitis should not get married until they are fully recovered. Therefore, unmarried hepatitis patients should actively cooperate with doctors for proper rest and treatment. When the symptoms and signs improve and the liver function returns to normal, after a period of consolidation, you can consider getting married with the permission of the doctor. However, after marriage, we should be careful not to be overworked, and our sexual life should be controlled, otherwise it will easily recur.
As for hepatitis B virus carriers, their unmarried wives should be vaccinated against infection before marriage. If a woman is a carrier of hepatitis B virus, the newborn should be vaccinated with hepatitis B vaccine in time after delivery to prevent it from getting hepatitis B.
What are the benefits of eating more fruits and vegetables?
Fresh vegetables and fruits are rich in glucose, fructose and vitamins. These sugars can improve the detoxification ability of the liver and are also the source of energy for the human body. Vitamins can enhance the ability of liver to repair, renew, detoxify and stop bleeding. At the same time, it can reduce fatigue. Especially vitamin C, a water-soluble vitamin, can inhibit viruses. A large dose of vitamin C can improve human immunity, promote antibody formation, increase phagocytosis of white blood cells and enhance disease resistance. Vitamin C is involved in the formation of bile acids in the liver. The metabolism of norepinephrine and tryptophan also needs vitamin C. Experiments show that vitamin C can reduce fatty degeneration of liver cells, promote the repair and regeneration of liver cells, and has the functions of removing excessive bilirubin from blood and benefiting gallbladder. It also has the ability to bind bacterial endotoxin and reduce the damage of endotoxin to the liver. In addition, vegetables and fruits contain inorganic salts that are indispensable for human growth.
In short, eating more fruits and vegetables is beneficial to protect the liver.
(5) Which health products are suitable for patients with liver diseases?
The following health care products are more suitable for patients with liver disease:
(1) Jujube: Jujube can protect the liver, promote the regeneration of hepatocytes and inhibit the growth of cancer cells. Sleeping here, patients with liver disease can often eat red dates. Eating red dates should not be excessive, otherwise it will damage the digestive function and cause bloating and constipation.
(2) Edible fungi: Edible fungi contain 7 kinds of 8 kinds of amino acids necessary for human body (including 8 kinds of flat shavings and grass shavings), and the quantity and proportion of amino acids contained are very in line with the daily needs of human body; The digestibility of protein contained in edible fungi in human body can reach 80%; Edible fungi are rich in vitamins and minerals, which basically meet the needs of human body; The fat content in edible fungi is only 2%, and the unsaturated fatty acids contained in it have the function of reducing blood fat; Carbohydrates (polysaccharides) in edible fungi have a special role in promoting and improving human immune function.
(3) Cordyceps sinensis: Cordyceps sinensis has the functions of regulating immune function, antitoxin, anti-fibrosis, adjusting albumin/globulin ratio and reducing transaminase to a certain extent.
(4) Honey: Honey is fragrant and flat. It has the functions of invigorating qi, nourishing spleen and stomach, moistening dryness and detoxicating, and has certain therapeutic effect on patients with chronic liver disease.
(5) bee milk and royal jelly: bee milk contains albumin-like substances, various amino acids, various enzymes, vitamins, fatty acids, gonadotropins, antibiotics and various hydroxy acids; Royal jelly acid is an effective component for lowering cholesterol. Bee milk and royal jelly have the functions of nourishing yang, stimulating hematopoiesis, resisting bacteria, cancer, relieving pain, resisting ulcer, promoting regeneration and repair of damaged tissues and lowering blood sugar.
(6) Pollen: Pollen contains various amino acids, vitamins and trace elements; Pollen has the functions of promoting metabolism, improving physiological function, restoring health and physical strength.
(7) Placenta: Placenta, also known as Placenta Hominis, has the functions of invigorating vitality, nourishing essence and blood, and nourishing heart and kidney. Placenta is rich in trace elements such as protein, vitamins, iron, calcium and phosphorus, and estrogen, which can be used to treat various diseases such as fatigue injury, insufficient blood and essence.
(8) Ants: The protein content of ants is above 50%, and there are amino acids, vitamins and trace elements necessary for human body. Ants have the functions of diminishing inflammation, relieving pain, relieving asthma, regulating human immune function and protecting the liver.
(9) American ginseng: American ginseng is cool and bitter. It has the functions of nourishing kidney and yin, clearing away lung-heat, moistening dryness, invigorating middle warmer, invigorating qi, nourishing blood and softening liver, invigorating spleen and regulating stomach, and has certain tonifying and strengthening body resistance. Patients with liver disease with spleen and stomach weakness can take American ginseng, but it is not suitable for acute and active chronic liver disease.
(6) Which drugs are easy to cause liver injury?
The following commonly used drugs are easy to cause liver damage:
Antibiotics include anti-tuberculosis drugs such as rifampicin and isoniazid, macrolides such as erythromycin and spiramycin, tetracyclines such as tetracycline and oxytetracycline, and antifungal drugs such as amphotericin B and ketoconazole. Penicillin, sulfonamides and cephalosporins can eliminate allergic reactions and do relatively little damage to the liver.
Antipyretic and analgesic drugs: aspirin, phenylbutazone.
Antipsychotics: chlorpromazine, perphenazine, trifluoperazine; Antidepressant amitriptyline; Epilepsy drug sodium valproate; Sedate phenobarbital; Narcotic drugs halothane, chloroform, etc.
Antihyperthyroidism drugs: propylthiouracil, tabazole and hyperthyroidism.
Antitumor drugs: cyclophosphamide, carbamazepine, gentamicin, mitomycin.
Hypoglycemic drugs: Youtang, sugar equality.
Cardiovascular drugs: aprotinin, α-methyldopa, procainamide, verapamil.
Antiviral drugs: arsenic compounds, antimonides and drugs for treating protozoa.
(7) How does alcohol damage the liver?
After alcohol is absorbed into the blood, about 90% is metabolized in the liver, and only 10% is excreted from the kidneys or lungs in its original form. Its metabolism in the liver needs the participation of many enzymes, and it is finally oxidized into carbon dioxide and water after several reactions. Any obstacle (such as lack of enzyme) in the process of this generation can lead to metabolic stagnation, in which the accumulation of intermediate metabolites can have toxic effects on the liver, and ethanol itself has obvious toxic effects on liver cells, such as changing the structure and function of mitochondria and microtubules of liver cells, inhibiting the synthesis, secretion and transportation of protein, and inhibiting glucose synthesis and gluconeogenesis. When ethanol exists in mitochondria, the oxidative metabolism of fatty acids is blocked, and the synthesis of blood lipids in liver increases, which leads to fatty liver. Because alcohol can repeatedly damage the liver for a long time, it will lead to liver fibrosis. If you still don't give up drinking and don't actively treat it, you will eventually develop cirrhosis.
(8) How to treat patients with fatty liver?
The principles of diet therapy for fatty liver patients are: controlling calorie intake, limiting fat intake, rationally distributing various nutrients, increasing vitamin intake and changing bad living habits. Specific measures are:
(1) Control calorie intake: Because excessive calories will increase the synthesis and storage of fat and induce fatty liver, reasonable calorie control is the first principle to treat fatty liver. Take light physical or mental workers as an example. The standard weight is required to be 65,438+020 kilojoules (30 kilocalories) per kilogram of body weight every day, and it should be appropriately reduced to 80-65,438+000 kilojoules (20-25 kilocalories) for overweight people and 65,438+040 kilojoules (35 kilocalories) for thin people, which can be increased with the increase of workload.
(2) Limit fat intake: The daily intake of fat should be controlled below 30% of the total calories, and pay attention to the quality of fat, mainly plant fat, and avoid the intake of animal fat as much as possible, and mainly consume oils containing unsaturated fatty acids (such as sesame oil and rapeseed oil), because unsaturated fatty acids have antithrombotic and cholesterol-lowering effects.
(3) Rational distribution of various nutrients is based on the principle of high protein, low fat and moderate sugar. The proportion of three nutrients is about 20% in protein, 30% in fat and 50% in sugar.
(4) Increase the intake of fiber and vitamins: fiber can delay gastric emptying and intestinal sugar absorption, which is beneficial to reduce postprandial blood sugar increase and blood lipid in patients with fatty liver. Vitamin b and vitamin e participate in liver fat metabolism and protect liver cells; Vitamin a and carotene prevent liver fibrosis. Therefore, the daily dietary fiber can be increased to 40-60 grams.
(5) Change bad habits: stop drinking, eat regularly, and don't overeat. It is used for patients with diabetes and hyperlipidemia. Proper control of primary disease is the main principle of their diet.
(9) What if the hepatitis B vaccine does not produce antibodies?
There are several cases in which hepatitis B vaccine does not produce antibodies, which can be dealt with separately:
(1) Some people produce antibodies late, which is called slow reaction. You can inject 1-2 needles, or re-inoculate, and increase the dose appropriately;
(2) 0, 1, 2, 12 months can be used as the immunization course;
(3) At the same time of hepatitis B vaccination, low-dose interleukin-2 was used;
(4) BCG or vaccinia can increase the immune response to hepatitis B vaccine and can be used in combination;
(5) 5% ~ 10% of the vaccinators did not produce hepatitis B antibody even after the whole vaccination, or only produced low titer antibody. For those who have no response or low response, they should be vaccinated several times until antibodies are produced;
(6) Some people are recessive infected. The virus is in a low level of replication, "half" test is normal, but HBV DNA is positive. Such people will not form surface antibodies after vaccination.
You have been injected with eight doses of hepatitis B vaccine, and there are still no antibodies. You'd better check the HBV DNA in your serum first, because if the "two-and-a-half" test is normal, but the HBV DNA is positive, it is a recessive infection. For example, in the sixth case mentioned above, no surface antibody will be formed after vaccination. If the HBV DNA test is negative, the following methods can be taken: a, appropriately increase the dose and re-inject 1-2 needles; B as mentioned above; (3)(4) Inoculation, on the premise of negative HBV DNA, all the above methods can produce antibodies, indicating that you are a person who produces antibodies late or reacts slowly. Need to remind you that before adopting these methods, you should know the advantages and disadvantages of these methods in detail. If you still can't produce antibodies by using the above three methods, you are likely to belong to different people who don't produce hepatitis B antibodies or only produce low titer antibodies.
(10) How to adopt levamisole triple therapy;
(1) The mechanism of levamisole liniment (coating agent LIIS-L);
It has been proved that levamisole mainly acts on T lymphocytes, induces interferon, enhances chemotaxis and phagocytosis of monocytes, activates macrophages and regulates antibody production of B cells. Although levamisole is an ancient drug, it was also recommended by the American Medical Association when discussing the strategy of chronic HBV infection in the next century in May 2000. The purpose of skin administration of levamisole is to avoid many side effects of oral administration, increase dosage, prolong administration time, and thus increase. In the triple therapy, the main functions of levamisole liniment (coating agent) are as follows:
When stimulated by 1) antigen, levamisole liniment can increase antibody formation by 8- 1.28 times;
2) it is helpful to enhance the specific cellular immune response against HBV;
3) Enhance the phagocytic function of phagocytes, thus enhancing the ability to clear HBV.
(2) The mechanism of dipyridamole:
In clinical application, it is further found that dipyridamole not only acts on cardiovascular system; But also affect the uptake and metabolism of adenosine, interfere with the expression of hepatitis B virus receptor on the surface of cell membrane, thus affecting the adhesion or release of virus.
1) Dipyridamole can stimulate the body's immune function, stimulate the body to produce higher doses of interferon, and increase the body's antiviral ability;
2) It can improve the blood circulation in liver cells and increase the nutritional supply of liver.
(3) Mechanism of action of hepatitis B vaccine: Hepatitis B vaccine plays an important role in breaking the immune tolerance of the body to hepatitis B virus in triple therapy.
1) Hepatitis B vaccine is a specific immunostimulant, which can stimulate B cells in the immune response system and then produce -HBS antibodies;
2) It can activate CD4+ and CD8+T cells, and then induce specific cellular immune response against HBV.
(4) Possible synergistic effects of the three drug combinations:
Adjuvant combination can enhance the immune response induced by hepatitis B vaccine, thus improving the immune response ability of patients and enhancing the immune effect. Professor Wang believes that the combination of hepatitis B vaccine and adjuvant is more effective. Professor Wu Shanming reported that hepatitis B vaccine combined with adjuvant can break the immune tolerance or low state, improve the curative effect and promote the negative conversion of HBeAg and HBeAg-DNA.
Clinical efficacy of combined application of three drugs;
According to the clinical research results of the General Hospital of Beijing Military Region and the Fifth People's Hospital of Shangqiu City, 80 cases of hepatitis B virus carriers were treated with two groups of "triple therapy", the children group 12 and the adults group 68. The observation period is 6-65,438+08 months. At the end of treatment, the observation results showed that the negative conversion rate of HBeAg and HBV-DNA in children group was 50% after 6 months of treatment. After treatment 12 months, the cumulative negative conversion rates of HBeAg and HBV-DNA in children group were 83.33% and 83.33%, while those in adults group were 47.06% and 60-29%, respectively. After treatment 18 months, the cumulative negative conversion rates of HBeAg and HBV-DNA in children group were 108, respectively.
Advantages of levamisole liniment triple therapy;
The cost of each drug is less than 100 yuan, with few side effects and high curative effect.
Usage of levamisole liniment triple therapy;
(1) Usage of levamisole liniment: twice a week, each time 1 tablet (500mg), applied to the inner skin of both legs. /kloc-the dose of children under 0/0 is halved or calculated at 10 mg/kg, and half a year is a course of treatment.
Side effects: allergic skin rash is occasionally seen, so you can use Piyanping locally, or clean the applied part 24 hours after application.
(2) How to use Persephone; /kloc-over 0/6 years old, 75 mg (three tablets)/day, taken orally (before going to bed or three times a day),/kloc-over 0/5 years old, 50m g-25mg/ day, the course of treatment is half a year.
Side effects: Disabled for patients with hematological diseases. A few people may have headache, dizziness, nausea, diarrhea and other symptoms during use, and some patients may blush for a short time after taking the medicine, which can be relieved by themselves. If the symptoms are unbearable, you should stop taking medicine.
(3) the use of hepatitis B vaccine; Hepatitis B vaccine (genetic engineering) 30 mg/ day, intramuscular injection or subcutaneous injection of deltoid muscle for half a year.
How to choose lamivudine to treat hepatitis B;
In recent years, lamivudine, a clinical anti-hepatitis B virus drug, has a remarkable effect, and many patients with chronic hepatitis B have benefited from it. If abused, it will inevitably lose its original effect. At present, the most important issue is to strictly control the indications of lamivudine. The unanimous opinion of experts is that patients with chronic hepatitis B have clear HBV replication indicators, such as: the content of DNA virus is above 10×5 copy /ml, the range of transaminase increase is between 2- 10, they are jaundice-free, their age is above 12, and their weight is above 35 kg, which is a "golden indicator" and is the application of lamivudine.
The following conditions are not the best indications for lamivudine.
(1) Chronic asymptomatic hepatitis B virus carriers, with normal transaminase and no symptoms, should not take lamivudine regardless of whether there are virus replication indicators (no matter "big three yang" or "small three yang"). However, it is understood that people who take this medicine are very common at present, which wastes both medicine and money. At present, there is no particularly effective drug to solve the treatment problem of hepatitis B virus carriers. The main reason why lamivudine can't be used to treat hepatitis B carriers is that it is ineffective. After taking the drug, the DNA may drop below 10×3 copy /ml, and once the drug is stopped, it will rebound immediately. The clinic found that some people took it for more than one and a half years, and HBV-DNA turned negative, and it rebounded less than one month after stopping taking it. Moreover, HBeAg can not turn negative at all, so this drug can no longer be used to treat hepatitis B carriers unless liver biopsy confirms the pathological changes of chronic hepatitis.
(2) Acute severe hepatitis or acute liver failure, the condition is critical and dangerous. At this time, the main contradiction of patients is not virus replication, and some patients even have no virus replication index. What threatens the patient's life is liver failure. According to the principle of "slow cure, urgent cure", this is the most important support therapy, such as fresh plasma albumin infusion and artificial support therapy.
(3) In the acute attack of chronic hepatitis B, if the transaminase exceeds the upper limit of normal value 10 times, there is obvious jaundice or serum bilirubin is greater than 85.5 mmol/L, it is not appropriate to take antiviral drugs such as lamivudine for the time being. However, the treatment is mainly to protect liver, reduce jaundice and decrease enzyme, and lamivudine can be given when the condition is relieved. Although lamivudine does not have a strong effect on immune function like interferon, it is not the best strategy to prevent immune damage during acute attack of hepatitis.
(4) Chronic hepatitis B pregnancy or post-pregnancy hepatitis B infection, lamivudine should not be used for the time being, mainly because the effect of lamivudine on the fetus is not clear. Although there are application reports abroad, which are relatively safe, domestic experts have not reached a consensus. To be prudent, it is a wise choice not to apply them for the time being.
(5) Lamivudine was used in 3- 12-year-old children with hepatitis B, and some patients had the effect of completely controlling the virus.