But this way is not very assured, you can call and ask Hangzhou five boat (Hangzhou five boat phone: 400--150--8089), they have a partnership with India Apollo Hospitals, Hangzhou five boat to get the patient's case directly and Apollo Hospitals remote consultation to help patients assess the condition of the suitable medication will be directly mailed directly to the patient's home, there is a need to ask them.
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|Hepatitis C is caused by the hepatitis C virus (HCV), which is transmitted by transfusion or blood products, hemodialysis, single plasma collection also transfusion of blood globules, kidney transplantation, intravenous drug use, sexual transmission, and mother-to-child transmission. Hepatitis C is more widely distributed and is more likely to evolve into chronic, cirrhosis and liver cancer. In the measures to prevent hepatitis C, screening blood donors is an important part, where the blood anti-HCV positive or HCVRNA positive can not be used as blood donors.
Clinical manifestations: acute hepatitis C gastrointestinal symptoms are mild, the proportion of jaundice is low, and ALT and serum bilirubin levels are significantly lower than those of acute hepatitis B. The symptoms of acute hepatitis C are mild, and the proportion of jaundice is low.
Examination: Hepatitis C virus indicators include anti-HCV and HCVRNA.
Treatment: Although some patients with acute hepatitis C can recover spontaneously, all patients with acute hepatitis C should be given active treatment because of the efficacy of the acute phase. Its treatment can be based on the patient's specific situation for appropriate rest, lowering enzymes, liver protection, antiviral and other symptomatic treatment, of which the most important treatment is antiviral therapy.
The treatment of chronic hepatitis C, currently recognized as effective at home and abroad only interferon, should also be early treatment. Clinical tendency to use a combination of drugs. For example, interferon plus thymidine or interferon plus viral azole tablets. Disease description Viral hepatitis is a group of systemic infectious diseases caused by a variety of hepatitis viruses to liver damage. According to the etiological classification, currently identified as hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, through the experimental diagnosis to exclude the above types of hepatitis called non-A - E hepatitis. Whether the recently discovered hepatitis Hepatitis G virus and blood transfusion virus cause hepatitis has not been conclusively determined. Clinical manifestations of hepatitis A and E are similar, with fatigue, loss of appetite, anorexia, hepatomegaly, abnormal liver function, and jaundice in some cases. Type A and type E are mostly characterized by acute infection; type B, type C and type D are mostly characterized by chronic infection, and a few cases may develop into cirrhosis or hepatocellular carcinoma. Currently, there is no specific treatment for viral. Types A and B can be prevented by vaccine, but there is no vaccine for types C and D. Disease etiology The transmission pathway is similar to that of hepatitis B. However, due to the lower content of HCV in body fluids and the fact that it is an RNA virus with lower external resistance, its mode of transmission is more limited than that of hepatitis B, and its infectiousness is weaker than that of hepatitis B virus. It is mainly transmitted through the extraintestinal route.?
(1) Blood transfusion and blood product transmission: used to be the most important transmission route, in the late 1980s to the mid-1990s, post-transfusion hepatitis more than 70% of hepatitis C. The blood transfusion of hepatitis C is the most common route of transmission. With the improvement of screening methods, this mode of transmission has been significantly controlled, but anti-HCV-negative HCV-carrying blood donors can not yet be screened out, and blood transfusion still has the potential to transmit hepatitis C, especially those who are repeatedly transfused with blood and blood products.
(2) Transmission by injection, needlestick, organ transplantation, hemodialysis: more than 80% of intravenous drug addicts are reported to be anti-HCV positive in China. Hemodialysis patients and bone marrow transplant recipients are also high-risk groups.?
(3) Close contact transmission: About 40% of HCV infected patients have no obvious history of blood transfusion, blood products, or injections, which is called community-acquired, and most of them are transmitted by close contact.
(4) Sexual transmission: HCV exists in semen and saliva, and sexual contact transmission should not be ignored. Multiple sexual partners and homosexuals are high-risk groups.
(5) Mother-to-child transmission: infants whose mothers are HCV-infected have about a 10% chance of contracting HCV. [edit]Treatment options Viral hepatitis currently lacks a reliable and effective treatment. Treatment should be differentiated according to different pathogens, different clinical types and histologic damage. The principle of treatment for all types of hepatitis is based on adequate rest and nutrition, supplemented by appropriate medication, avoiding alcohol, overwork and liver-damaging drugs.
(1) Acute hepatitis is generally self-limiting and can be completely recovered. The general treatment of symptomatic supportive therapy, the acute period should be isolated, obvious symptoms and jaundice should be bed rest, the recovery period can gradually increase the amount of activity, but to avoid overwork. After 1-3 months of normal liver function, the patient can return to work. Give light and easily digestible food, supplement vitamins appropriately, and strive for protein intake of 1-1.5g/kg per day, and intravenous glucose supplementation should be given to those with insufficient calories. Supplemented with drugs to symptomatic and restore liver **** cold, drugs should not be too much, so as not to aggravate the burden on the liver. Antiviral therapy is generally not used, polar hepatitis C is the exception, because acute hepatitis C is easy to turn into chronic, early application of antiviral drugs can reduce the rate of slow turn. Dry interferon or long-acting interferon can be used for a 24-week course of treatment, and ribavirin can be added at the same time.?
(2) chronic hepatitis according to the patient's specific situation using a comprehensive treatment program, including reasonable rest and nutrition, psychological balance, improve and restore liver function, regulate the body's immune system, antiviral, anti-fibrotic and other treatments.?
1, general treatment (1) appropriate rest: obvious symptoms or severe condition should emphasize bed rest, bed can increase liver flow, help recovery. For those with mild disease, the degree is that they do not feel wholesome after activities. (2) Reasonable diet: appropriate high-protein, high-calorie, high-vitamin digestible food is beneficial to liver repair, without over-emphasizing high nutrition to prevent fatty liver and avoid drinking alcohol. (3) Psychological balance: make the patients have the correct view of the disease, and should have patience and confidence in the treatment of hepatitis. Do not seek medical advice indiscriminately to avoid delaying treatment.
2, drug treatment The only effective hepatitis C is antiviral therapy, namely interferon combined with ribavirin: the purpose is to inhibit viral replication to reduce infectiousness; improve liver function; reduce hepatic tissue lesions; improve the quality of life; reduce or delay the occurrence of cirrhosis and HCC. Meet the adaptive needle salesman for antiviral treatment.
1) common interferon alpha (IFNα) combined with ribavirin: in 1992, the U.S. FDA approved the common interferon alpha-2b combined with ribavirin for the treatment of acute or chronic hepatitis C, the cure rate of 41-47%, i.e., to obtain the SVR after more than five years of follow-up is still serum within the hepatitis C virus negative.
2) Polyethylene glycol interferon alpha (PEG IFNα) in combination with ribavirin: The standard treatment regimen for both acute and chronic hepatitis C is polyethylene glycol interferon (alfa-2a or alfa-2b) in combination with ribavirin. PEG IFN alpha in combination with ribavirin is currently the most effective treatment for hepatitis C. It has increased the cure rate for hepatitis C by nearly 20 percentage points. Polyethylene glycol interferon alfa is also known as a long-acting interferon due to the fact that it is administered once a week, which greatly reduces the number of times it is administered and makes it convenient for the patient to take the medication, as opposed to regular interferon, which is administered three times a week or once every other day. Direct comparative clinical trials of two long-acting interferons in combination with ribavirin have shown that the relapse rate of 12KD polyethylene glycol interferon alfa-2b is significantly lower than that of 40KD polyethylene glycol interferon alfa-2a, the reason for which may be related to the antiviral activity and the distribution of the drug due to molecular size. It is generally believed that the larger the molecular weight of polyethylene glycol, the lower the antiviral activity, and the activity of 12KD polyethylene glycol interferon alfa-2b is significantly higher than that of 40KD long-acting interferon; moreover, 12KD long-acting interferon can be distributed throughout the body, and not only clear the main viruses in the liver, but also clear the extra-hepatic viruses in the lymph nodes, kidneys, spleen, adrenal glands, salivary glands and other viruses, so that the recurrence rate after stopping the drug is lower. The 40KD macromolecule polyethylene glycol interferon is limited to vascular and intrahepatic distribution due to its large molecular size, which is unfavorable to extrahepatic virus clearance. It not only aggravates the burden of liver and slow excretion, but also difficult to withdraw the drug when adverse reaction occurs because it is not excreted through kidney. It is generally believed that 12KD polyethylene glycol interferon alfa-2b should be the preferred drug for the treatment of hepatitis C due to the publication of the results of the head-to-head comparative IDEAL trial.
IFN-α is contraindicated in people with one of the following conditions: a, serum bilirubin > 2 times the upper limit of normal; b, decompensated cirrhosis; c, autoimmune disease; d, vital organ disease (severe cardiac and renal disorders, diabetes mellitus, hyper- or hypo-thyroidism, as well as neuropsychiatric abnormalities, etc.). Treatment regimen (adult): 3MU-5MU each time, the recommended dose is 5MU each time, 3 times a week, subcutaneous or intramuscular injection, the course of treatment is 4-6 months, which can be extended to 1 year according to the condition. Induction therapy can also be used, i.e., once a day for the first 15 days-3 months of treatment, and then 3 times a week until the end of the course.
Adverse effects of IFN-α: a. Influenza-like syndrome, usually occurs 2-4h after injection, symptomatic treatment such as antipyretic and analgesic can be given without stopping the drug. b. Bone marrow suppression, manifested as a decrease in the number of granulocytes and platelet counts, which can be recovered on its own after the drug is stopped. When the white blood cell count <3.0×109/L or neutrophil <1.5×109/L, or platelet <40×109/L, the drug should be stopped. Treatment can be resumed after the blood picture recovers, but close observation is required. c. Neuropsychiatric symptoms, such as anxiety, depression, excitement, irritability, and psychosis. The drug should be discontinued when depression and psychiatric symptoms occur. d. Insomnia, mild rash, alopecia, depending on the situation. Rare reactions such as epilepsy, nephrotic syndrome, interstitial pneumonitis and tardive dyskinesia should be discontinued for observation. e. Induced autoimmune diseases such as thyroiditis, thrombocytopenic purpura, hemolytic anemia, rheumatoid arthritis, and type I diabetes mellitus should be discontinued. Dietary precautions
1, avoid spicy spicy food easy to cause the digestive tract to generate moisture and heat, moisture and heat mixed, the liver and gallbladder qi imbalance, digestive function is weakened. Therefore, you should avoid eating spicy products.
2, avoid smoking cigarettes contain a variety of toxic substances, can damage liver function, inhibit liver cell regeneration and repair, so patients with liver disease must quit smoking.
3, avoid drinking alcohol 90% of the alcohol to be metabolized in the liver, alcohol can make the normal enzyme system of liver cells are disturbed by the destruction, so direct damage to liver cells, so that the liver cell necrosis. Patients suffering from acute or chronic active hepatitis, even if a small amount of alcohol, will make the condition repeated or change.
4, avoid eating processed food less canned or bottled drinks, food. This is due to canned, bottled drinks, food often add preservatives, more or less toxic to the liver.
5, avoid the abuse of hormones and antibiotics "is a drug three poisons", any drug on the liver and kidneys have damage, liver disease patients must be in the correct guidance of the doctor, reasonable use of drugs.
6, avoid indiscriminate use of supplements Dietary balance is the basic conditions to maintain good health, such as improper nourishment, visceral dysfunction, break the balance, will affect health.
7, avoid excessive consumption of protein diet For serious hepatitis patients, due to gastric mucosal edema, small intestinal villi become thicker and shorter, bile secretion disorders, etc., so that the digestive and absorption function is reduced. If you eat too much eggs, turtle, lean meat and other high-protein foods, it will cause indigestion and bloating and other diseases.
8, avoid high copper diet Liver insufficiency can not well regulate the balance of copper in the body, and copper is easy to accumulate in the liver. Studies have shown that the amount of copper stored in the liver of patients with liver disease is 5-10 times that of normal people, and the amount of copper in the liver of patients with biliary cirrhosis is 60-80 times higher than that of normal people. Medical experts point out that too much copper in liver memory can lead to necrosis of liver cells, meanwhile, too much copper in the body can cause renal insufficiency. Therefore, patients with liver disease should eat less jellyfish, squid, shrimp, snails and other food containing more copper.
9, avoid irregular life, "three points of treatment, seven points of maintenance", so enough sleep, reasonable nutrition, regular life, every day to adhere to the morning exercise, work and rest is very important.
10, avoid emotional upset Liver disease patients should avoid irritation, pessimism, anxiety, etc., because patients with liver disease is not cured, often anxiety, nonsense, easy to anger and anger hurt liver, liver gas is easy to become a cumulative addiction.
11, avoid fatigue, liver is the body's important metabolic organs, hepatitis patients function abnormally, nutritional disorders, so fatigue, need to rest, so more rest is the key to treatment.
12, avoid indiscriminate treatment Do not trust the charlatan, so as not to delay the correct treatment, so that the condition aggravated or even worsened.
Daily diet and life precautions advisable
1, acid From the perspective of traditional Chinese medicine, acidic food can lead medicine into the liver. Chinese medicine in the schizandra is acidic, it can lead medicine into the liver, lower transaminase. In the past, it was also popular to treat hepatitis with rice vinegar. In addition, acidic food can also increase appetite.
2, sweet sweet food can give patients with hepatitis to supplement a certain amount of heat, easy to absorb, favorable recovery of hepatitis, in the acute stage of hepatitis, appetite is reduced, into the sweet food is good.
3, bitter Chinese medicine believes that bitter food is cold, can clear heat and detoxification, the liver and gallbladder damp-heat type of liver disease patients eating bitter food is beneficial, but the exception is beer. [edit paragraph] Disease prevention (a) control of infectious agents Hepatitis patients and carriers of the virus is the infectious agent of the disease, acute patients should be isolated and treated until the disappearance of the virus. Chronic patients and carriers can be assessed for infectiousness based on viral replication indicators. Those with active replication should be given antiviral treatment as far as possible. Infected persons with antiretroviral symptoms should not be engaged in food processing, food service, child care and other jobs. Blood donors are strictly screened and those who are not qualified are not allowed to donate blood.
(2) Cut off the transmission pathway Strengthen the supervision and management of childcare units and other service industries, and strictly implement the sterilization of tableware and eating utensils. Hairdressing, beauty care, bathing and other utensils should be sterilized according to regulations. Develop good personal hygiene habits. Wash hands with soap and running water after contacting patients. Promote the use of disposable injection equipment, all kinds of medical equipment and utensils to implement a use a sterilization measures. Blood and body fluid contaminants should be strictly sterilized. Strengthen the management of blood products, every blood donor and every unit of blood should undergo the most sensitive testing of HBsAg and anti-HCV, and when possible, HBV DNA and HCV RNA should be tested at the same time. positive people are not allowed to donate blood, and positive blood is not allowed to be used. Adopt active and passive immunization to block mother-to-child transmission.
(3) Protection of susceptible groups Because there is no vaccine, there is a lack of specific immunoprophylaxis.
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