Professor Li Yun and the chief physician won the third prize for the achievements of scientific and technological progress in the army, published 50 academic papers in various magazines, and participated in the compilation of 9 academic monographs. (Left)
Dr. Liu Shijin, deputy chief physician, deputy chief physician of the 302 Hospital of the People's Liberation Army 16 ward, doctor of traditional Chinese medicine, graduated from Beijing University of Chinese Medicine, mainly engaged in the clinical diagnosis and treatment of various liver diseases, especially viral hepatitis, advocated and actively used the combination of traditional Chinese and western medicine to treat viral hepatitis and made important progress. He has published more than 80 academic papers on liver diseases and more than 300 popular science articles in national sci-tech journals. (right)
Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about hepatitis B. ..
Moderator: Are there similarities between the development of hepatitis B vaccine and SARS vaccine?
Liu Shijin: At present, the experiments of SARS vaccine in animals have achieved initial results, but it is estimated that it will take some time to succeed in human experiments. As for the hepatitis B vaccine, we discovered the hepatitis B virus in the late 1960s, and it was not until the early 1980s that the hepatitis B vaccine was successfully marketed, and other vaccines for more than 30 other infectious diseases were also marketed.
Moderator: First of all, let's look at a population distribution map of hepatitis B, which shows that there are 65.438+0.2 billion hepatitis B virus carriers, 20 million chronic persistent hepatitis carriers, 65.438+0.00 million active hepatitis patients, 5 million liver cirrhosis patients and 500,000 liver cancer patients in China. Why are there so many hepatitis B virus carriers in China?
Li Jun: As we all know, China is a big country with hepatitis. Some descriptions of hepatitis symptoms can be found in Huangdi Neijing thousands of years ago, and it has a long history. The number of HBV carriers in China is related to the historical situation, living environment and quality of life. One of the most important transmission routes of hepatitis B is blood transmission. There may have been some negligence in the management of blood in the past, so the transmission of blood source is an important way. The other is mother-to-child transmission, especially the so-called "big three-yang" mother with positive virus replication. The children born may carry the virus, and the children born may carry more.
Moderator: What is the situation of hepatitis B virus carriers in other countries?
Liu Shijin: Internationally, hepatitis B virus carriers are divided into three levels: high incidence, moderate incidence and low incidence. China, Southeast Asia and some countries in Africa all belong to high-incidence areas, and the number of hepatitis B virus carriers in high-incidence areas can account for more than 10% of the total population, and so does China. Russia and other regions are moderately developed regions, and the population carrying the virus accounts for about 5%-6% of the total population. Some countries in Europe and America belong to low-incidence areas, and the population carrying the virus accounts for about 1%-2% of the total population.
Moderator: What kind of virus is hepatitis B virus?
Liu Shijin: Hepatitis B virus is a DNA virus that eats the liver. It is very small, about 30-40 nanometers. We can only observe it by magnifying it by tens of thousands of times through a high-power electron microscope. As shown in the figure, the virus can be filamentous or spherical. The appearance structure of standard hepatitis B virus particles is like a sphere, which consists of an outer layer and a core. The outer layer is mainly coat protein, which has recognition ability. The core of a virus determines its characteristics, that is, its replication characteristics. Whether a virus is contagious depends mainly on its core, which consists of a double-stranded DNA chain. There are some coding regions on this long chain, which determine the surface antigen and core antigen that we often detect. The virus is very small and has the characteristics of eating liver. It takes human liver as its base camp and also invades pancreas, kidney and other tissues.
Moderator: Why do people have to make such great efforts in the process of dealing with hepatitis B virus?
Li Jun: Whether the human body carries hepatitis B virus depends largely on its immune status. People's immune state is varied, including normal immune function, low cellular immune function, hyperimmune function and so on. The reason why patients carry hepatitis B virus is that the immune function of patients is abnormal in many cases, and most of them show low cellular immune function. Once the hepatitis B virus enters the human body, because the human body itself cannot resist the virus, then the virus will be parasitic in the human body. Hepatitis B virus itself is not pathogenic. Its pathogenicity lies in parasitism in the nucleus of human stem cells and fusion with human stem cells, which in turn stimulates a series of immune responses in the body and eventually leads to liver damage.
Moderator: Let's listen to the narratives of several patients:
Patient A: I'm 199 1. I was diagnosed as anti-Australian positive in the factory physical examination, and I became ill last April.
Patient B: I have chronic hepatitis B. I was diagnosed in February. 1995. At that time, I always felt sleepy, especially tired, and my urine was particularly yellow, a bit like strong tea, and there was some yellowing next to my eye mask. At that time, there were more than 500 transaminase and 86 jaundice.
Patient C: I have been infected with hepatitis B for more than 20 years, and this time it is more serious, with deep jaundice, high transaminase, general fatigue and a small amount of ascites.
Patient D: 1983 was diagnosed with hepatitis B, and only received treatment in 2002. In July 2002, I found that my stomach was big. After the examination, the doctor said that I had water in my stomach, and the next examination found that it was cirrhosis.
Li Jun: Due to various reasons and objective conditions, many of these hepatitis B virus carriers do not have regular physical examinations, so I also want to emphasize here that healthy people must have regular physical examinations. Many people don't know that they are infected with the virus because they don't have regular physical examinations, so their living conditions and environment have not been paid enough attention. This virus can subtly damage the liver in the body. Many patients wait until jaundice and transaminase are high before returning to the clinic. What's more, they won't come to the clinic until they feel ascites. Some patients even suddenly found gastrointestinal bleeding during childbirth, and found liver cancer after examination. So be sure to have a regular physical examination.
Liu Shijin: Hepatitis patients may have been carriers of the virus a long time ago, but they just didn't know it. They may not have any discomfort or special symptoms, and their appearance is no different from that of normal people. If they carry hepatitis B virus, their liver is actually damaged to some extent. If they don't pay attention to the details of daily life on this basis, such as drinking, irregular life, playing mahjong all night, overwork, poor diet, etc., they may make patients sick.
Li Jun: I think the most important thing to do first is to try to prevent virus infection. In addition to paying attention to proper rest and diet, our personal hygiene habits and blood source management are very important. Like AIDS, hepatitis B has some transmission routes, including blood transmission, body fluid transmission and mother-to-child transmission. In addition to cutting off the source of infection, there are also some hygiene habits, such as separate meals, which are not only effective in preventing SARS virus, but also very important in preventing hepatitis B virus.
Liu Shijin: Key points of prevention and control of hepatitis B virus
1, regular review and follow-up:
Liver dysfunction series and hepatitis B virus indicators are once every quarter, and B-ultrasound is once every six months.
Go to a regular specialized hospital and carry out prevention and treatment under the guidance of regular experts.
2, work and rest, optimistic:
Moderately participate in physical exercise and leisure activities, avoid overwork and live a regular life.
Adjust your mentality and be open-minded.
3, advocate a healthy and civilized lifestyle:
Quit smoking and drinking, eat properly, pay attention to personal hygiene, and put an end to uncivilized lifestyle.
4, timely injection of effective infectious disease vaccine, to prevent overlapping infection:
Inject vaccines such as hepatitis A and influenza to prevent other infectious diseases from occurring on the basis of hepatitis B.
5, put an end to disorderly behavior:
You can't trust advertisements, and you can't easily use remedies and prescriptions.
Virus carriers are not suitable for using antibacterial drugs such as interferon and lamivudine. Usually, you need to explain your situation to your doctor and choose your medicine carefully.
6, conditional, liver biopsy, understand the actual situation of the liver, decide whether to treat:
The internal situation of the liver of the virus carrier is very complicated. If we want to find out the truth, we need a liver puncture.
7, usually can carry out some Chinese medicine diet:
Choose safe and effective Chinese medicines that can enhance immune function, such as Radix Astragali, Fructus Ligustri Lucidi and Coicis Semen. According to the dialectical characteristics of traditional Chinese medicine, suit the remedy to the case.
Moderator: Let's look at a patient's situation:
Jia Limin (Rehabilitation Patient): I will be discharged soon. At that time, my symptoms were pale and a little yellow.
Jiang (doctor of 302 Hospital of the People's Liberation Army): Because the patient had obvious jaundice, yellow body, yellow eyes, yellow urine, and obvious symptoms of fatigue, abdominal distension and stomach discomfort when he was admitted to the hospital, we first gave him treatment to protect his liver and relieve jaundice, and the second stage was simultaneous treatment with anti-virus and liver-protecting drugs, because liver-protecting drugs needed to continue to consolidate his liver function. The second stage will take about two weeks. The patient's liver function has completely recovered and transaminase has returned to normal. In the third stage, because the patient's liver function has completely recovered and the symptoms are good, the focus is on consolidating treatment. Due to the proper treatment of integrated traditional Chinese and western medicine, the condition recovered well. During hospitalization, the liver function was normal for three times, and there was no new liver function fluctuation. The test is also very good, protein and admission are inverted, and the activity is very low.
Li Jun: Chinese medicine has a long history of treating hepatitis and has a good clinical effect. Practice has also proved that Chinese medicine treatment is unique. The combination of Chinese and western medicine is not a simple combination of Chinese and western medicine, but an organic combination of two different theoretical systems of traditional medicine and modern medicine. For the treatment of chronic hepatitis B patients with integrated traditional Chinese and western medicine, we often follow the idea of reducing jaundice first, then reducing enzyme and finally adjusting protein.
Liu Shijin: Chinese medicine has a characteristic in treating hepatitis, and different patients have targeted individualized treatment programs.
Moderator: Ms. Liu from Guangxi, 29 years old. My family has a family history of hepatitis. I was vaccinated against hepatitis, but I was recently found to be anti-Australian. Is there any way to become a full member?
Li Jun: There are many cases in clinic. After the Australian anti-positive hepatitis B vaccine, it is not clear whether the patient has checked the hepatitis B virus markers (two and a half grades). ) Before getting the hepatitis B vaccine. Usually, hepatitis B virus markers must be checked before vaccination to see if they have been infected with hepatitis B virus. Whether the patient can turn negative depends on whether the patient's immune function is normal. If the immune function is normal, it can be removed. If the immune function is abnormal, it may be in a carrying state. If the immune function is abnormal, hepatitis may occur. At present, 654.38+200 million HBV carriers are not all healthy carriers. Through clinical examination, we found that more than 70% hepatitis B virus carriers have liver inflammation. If the carrier has normal clinical liver function and no clinical manifestations, it is really necessary to do liver biopsy to find out whether there is inflammation in the liver. If there is inflammation and virus replication is active, antiviral treatment is still needed. If there is fibrous tissue hyperplasia, anti-fibrosis treatment should be carried out. In order to prevent further development, further development may develop into cirrhosis or even worse, liver cancer.
Moderator: Ms. Li from Yunnan, 56 years old. I took interferon during my stay in hospital and relapsed soon after my discharge. They asked me to take the exam again this time. Is it harmful for doctors to take too much interferon?
Liu Shijin: Interferon is an effective drug for treating chronic hepatitis B, but it has clear indications. Generally speaking, the transaminase of chronic hepatitis B is increased by 2-5 times, the virus replication index is positive, and there is no cirrhosis and compensatory period. In this case, interferon can often achieve good results, and about 40% people will have negative virus replication index and normal liver function. However, because interferon can't completely kill the virus, it inhibits the virus, which may be short-lived. For patients with no family history, interferon is still useful if the virus turns positive again.
Moderator: Mr. Liu from Beijing, 25 years old. I haven't had antibodies since I got the hepatitis B vaccine. What's going on here?
Li Jun: This may be related to the function of plasma cells in patients' humoral immune parietal cells. Some people may not produce antibodies after playing several times. We can't ignore such patients. Don't think that they may not be infected with hepatitis B virus. It is suggested to check the DNA of hepatitis B virus and make further examination if necessary.
Moderator: Ms. Xu from Beijing, 32 years old. My child is 3 years old. She has just been vaccinated against hepatitis B. Her father and I are both chronic hepatitis B. Is it too late to fight now?
Liu Shijin: Both parents are hepatitis B, and the child is not vaccinated within 24 hours after birth, so the risk will increase with the child's age. It's definitely too late to get a vaccine at the age of three. Children must go to the hospital to check the indicators of hepatitis B virus. If there is no antibody, it is not too late to fight now. If the surface antigen is positive now, it is useless to fight again, because it is already in a virus-carrying state.
Moderator: Mr. Bai from Shanxi is 53 years old. He went to your hospital to treat chronic hepatitis B. How much does it cost to cure him?
Li Jun: It varies from person to person. The specific situation of each patient is different, and the treatment plan given is different. Generally speaking, ordinary patients with chronic hepatitis, if the treatment effect is good, patients discharged in about 3 weeks, the cost is about several thousand yuan.
Moderator: The clinic hours are Li Jun Tuesday morning, Liu Shijin Wednesday afternoon and Friday morning; Hospital telephone number (010) 6381601669332 10/0.