Moderator: Why do many patients with liver disease often fail to understand their own laboratory sheets?
Li Yueqi: Liver disease is very complicated. There are many laboratory tests for liver disease. Different laboratory tests have different meanings, and many patients (especially new patients) are really not very clear about the tests.
Mao Yuanli: Laboratory examination of hepatitis B mainly includes two aspects: 1 and blood biochemical examination (liver function examination). 2. Detection of virus markers (five items of hepatitis B). The commonly used items of liver function examination mainly include total protein (TP), albumin (ALB) and globulin (GLO), which mainly reflect the synthetic function of the liver. Alanine aminotransferase and aspartate aminotransferase mainly reflect the damage of liver cells. Direct bilirubin and total bilirubin mainly reflect the metabolic function of hepatocytes.
Five tests of hepatitis B
Is there hepatitis B virus in HBsAg?
Is surface antibody (anti-HBs) protective?
Is е antigen (HBeAg) virus replicable and contagious?
Is the replication of е antibody (anti-HBe) virus inhibited?
Has the core antibody (anti-HBc) ever been infected with hepatitis B virus?
Mao Yuanli: With the development of technology, HBV-DNA detection can now reflect whether there is hepatitis B virus in the liver and whether it is replicating. This kind of test should be carried out in a big hospital, which can make the results more accurate.
Li Yueqi: Big Three Yang.
Surface antigen (HBsAg)+
е antigen (HBeAg)+
Core antibody (anti-HBc)+
This situation usually reflects that virus replication is active.
Xiaosanyang
Surface antigen (HBsAg)+
е antibody (anti-HBe)+
Core antibody (anti-HBc)+
Patients with small three-yang diseases should be tested for DNA. If it is positive, it reflects that virus replication is active. If it is negative, it reflects that the virus is suppressed and the virus replication is inactive.
Moderator: Many patients think that a plus sign indicates that they have hepatitis. Is this correct?
Mao Yuanli: This view is wrong. Etiological examination (two and a half examinations) only reflects whether the patient is infected with the virus and whether the virus replicates. As for the onset, it is necessary to determine whether he has liver disease, the severity of his illness and the damage of liver cells according to the results of liver function examination.
Moderator: What abnormal liver function tests suggest hepatitis?
Mao yuanli: for example, the increase of transaminase indicates that liver cells are damaged. It can be said that liver function is abnormal, that is, acute liver disease may be active as chronic liver disease. The increase of bilirubin (jaundice) indicates that the liver function is in a state of destruction.
Compere: The appearance of Big Three Yang or Small Three Yang indicates that there is a virus in the body. If there is no abnormality in liver function, will the virus affect the body?
Li Yueqi: The main mechanism of liver injury caused by hepatitis B virus infection is easy to cause immune disorder. The direct damage of hepatitis B virus itself to the liver is very weak. Many patients have this virus, and the virus replication is very active, but it has no damage to the liver. We call this kind of patient a virus carrier, which can last for a long time, even for life without getting sick. Some patients may cause liver damage after carrying the virus, so there is no need for more treatment in clinic for those who carry the virus but have no liver damage. Virus carriers, especially patients with big three-positive and DNA positive, are very active in virus replication and highly contagious, but the main route of transmission of hepatitis B virus is blood transmission, and the general contact infectivity is relatively low.
Moderator: What kind of situation appears on the hepatitis B test sheet, which means treatment?
Li Yueqi: The most important thing for patients with hepatitis B is that the liver has inflammation and damage, especially when the damage is serious (jaundice or other symptoms). The detection index is high transaminase or abnormal bilirubin. At this time, they need to go to the hospital for further examination and treatment.
Mao Yuanli: Etiological examination should be distinguished from liver function examination. Once the etiology is abnormal (big or small, three positive), you should go to the hospital for relevant examination, but don't be too nervous, because the virus is likely to be carried healthily for life, and only when the liver function is abnormal, you need active treatment.
Compere: How likely is it to eliminate hepatitis B virus?
Li Yueqi: At present, it is very difficult to completely eliminate hepatitis B virus, and the complete clearance rate is only about 10%. At present, there are many drugs for treating hepatitis B. We advocate that patients must use drugs under the guidance of doctors and never use drugs according to advertisements. This will not only lead to poor therapeutic effect, but also cause liver inflammation and aggravate the damage to the liver.
Moderator: When is the best time for treatment?
Li Yueqi: The best time for antiviral treatment is when the liver has inflammation (high transaminase), which reflects that the body's immunity has a certain effect on the virus. At this time, it will be very effective to use some antiviral drugs. If the liver is in a very stable state, the effect of antiviral drugs is really not ideal. In short, when patients need treatment, they should go to a specialized hospital for examination and then take medicine under the guidance of a doctor. For those virus carriers who do not need medication, the most important thing is to carry out regular monitoring, liver function monitoring for 3-6 months, and B-ultrasound once a year to monitor whether there is liver damage, and once it appears, it must be treated.
Compere: Will carrying HBV for a long time develop into cirrhosis or liver cancer? What preventive measures are there?
Mao Yuanli: HBV carriers may turn into chronic hepatitis and eventually develop into cirrhosis. It is very important to check the preventive methods regularly.
Li Yueqi: Only 20% or even less than 20% of patients with chronic hepatitis will develop cirrhosis. The incidence of liver cancer in patients with liver cirrhosis does not exceed 20%.
Moderator: Ms. Hu, a native of Shanxi, is 35 years old. My liver function is normal, but my bilirubin is on the high side. What's going on here?
Mao Yuanli: The premise of liver function examination is to carry out under the condition of virus infection. High bilirubin does not mean that you must have hepatitis B. Others, such as autoimmune liver disease, will cause obstacles to bilirubin metabolism. Therefore, the simple increase of bilirubin should also check other reasons to see how it is caused and then carry out symptomatic treatment.
Moderator: Mr. Zheng from Tianjin, 25 years old. I am a big three-yang patient. My wife just got pregnant. She went to the hospital to check that HbsAg and HBc were positive. Does it affect the fetus?
Li Yueqi: My wife is positive for HBsAg and HBc. If there is no vaccine before, 100% children will be infected. Now we have highly effective immunoglobulin and hepatitis B vaccine. When the child is born, we should first inject high-efficiency immunoglobulin, and then we should inject hepatitis B vaccine. Usually 80%-90% of hepatitis B virus can be blocked without being infected with hepatitis B, with 10.
Moderator: Ms. Zhang, 38, from Shanxi, my husband checked five items of hepatitis B, and two, four and five items were all positive. Is this hepatitis B? Do you need treatment?
Mao Yuanli: Two, four and five positives, that is, what we call triple antibody positives, do not need treatment, because two positives (surface antibody positives) indicate that they have the ability to resist infection, and four or five positives indicate that they have been infected with hepatitis B, but now their condition is recovering. Patients should insist on regular examination, check whether the liver function is abnormal at any time, and pay attention to protecting the liver at ordinary times.
Li Yueqi: First, we should check for viruses. I suggest the patient have his DNA checked. In a few cases, if all three antibodies are positive, it means there is still a virus, but the probability is very small. In addition, it is necessary to judge whether the liver is damaged.
Moderator: Ms. Liu, from Chongqing, is 35 years old. My brother is a chronic hepatitis B patient. The latest transaminase test actually reached more than 200. The family is very worried. Is the higher the transaminase, the more serious the condition?
Mao Yuanli: You can say that. Because transaminase itself exists in liver cells, the higher the transaminase, the more serious the damage to liver cells.
Li Yueqi: The high transaminase only reflects the serious inflammation of liver cells, but not the serious damage of liver function.
The focus of this issue
1, hepatitis B detection includes liver function test and virus detection.
2. Having hepatitis B virus does not mean having liver damage.
3. Whether the liver function is normal determines the necessity of treatment.
4. Don't use drugs blindly.