Introduction
Chronic hepatitis B(referred to as hepatitis B) refers to hepatitis B virus detection is positive, the course of disease for more than half a year or the date of onset is not clear and clinical manifestations of chronic hepatitis. The clinical manifestations are fatigue, fear of eating, nausea, bloating, pain in the liver area and other symptoms. The liver is large, the texture is medium hardness, and there is tender tenderness. Patients with severe illness may be accompanied by chronic liver disease, spider mites, liver palm, splenomegaly, abnormal liver function or persistent abnormalities. According to clinical manifestations, it is divided into mild, moderate and severe. Chronic hepatitis B is a positive test for hepatitis B virus, no chronic hepatitis symptoms, no abnormalities in serum ALT and AST after 3 consecutive follow-ups within 1 year, and normal liver histology.
Cause
Chronic hepatitis B is caused by infection with hepatitis B virus (HBV). Hepatitis B patients and HBV carriers are the main source of infection. HBV can pass through maternal and child, blood and blood products, damaged skin mucosa and sex. Contact spread. After infection with HBV, due to viral factors, host factors, environmental factors, etc., different outcomes and clinical types may occur, leading to the development of chronic hepatitis B:
Family spread
The main cause of high incidence of hepatitis B in China is familial transmission, in which mother-to-child transmission is the main cause. If the mother is positive for hepatitis B E antigen, the children born are not injected with hepatitis B vaccine, and most of them become carriers of hepatitis B virus. Hepatitis B virus can be detected in semen and can therefore be transmitted sexually. This is the main reason for the family aggregation characteristics of hepatitis B in China.
2. Infant and child infection
The age of initial infection with hepatitis B is closely related to chronic hepatitis B. When the fetus and newborn are infected with hepatitis B virus, about 90% to 95% become carriers of chronic viruses; children infected with hepatitis B virus, about 20% become chronic hepatitis B virus carriers; adults infected with hepatitis B virus, only 3% to 6% develop Carrying status for chronic hepatitis B virus.
3. Lack of awareness
Hepatitis B vaccine is a measure to block the vertical transmission of hepatitis B. Due to economic constraints and lack of awareness of prevention, the vaccination of hepatitis B vaccine is not ideal, making the prevention of hepatitis B difficult to implement, and more and more chronic cases.
4. Missed diagnosis
In the acute phase, the jaundice-free hepatitis is more likely to develop chronic than the acute jaundice hepatitis. This is related to the fact that no jaundice-type hepatitis is easily misdiagnosed or missed, and it is not treated promptly.
5. Immune dysfunction is infected with virus
Kidney transplantation, tumor, leukemia, AIDS, hemodialysis patients with hepatitis B easily evolve into chronic hepatitis. In the acute phase of hepatitis B, the use of immunoprecipitate drugs such as adrenal glucocorticoids can destroy the immune balance in patients and easily turn acute hepatitis into chronic.
6. Other people with previous history of liver disease infected with virus
The original hepatitis (alcoholic hepatitis, fatty liver, alcoholic liver fibrosis, etc.), schistosomiasis, malaria, tuberculosis, etc., after re-infection with hepatitis B virus, not only becomes chronic hepatitis, but also has a poor prognosis.
symptom
The incubation period of this disease is 6 weeks to 6 months, usually 3 months. This period is called the incubation period from the invasion of the hepatitis virus to the initial clinical symptoms. The incubation period varies with the type, quantity, virulence, and immune status of the pathogen.
Whole body performance
Patients often feel weak, prone to fatigue, and may have mild fever. Insomnia, dreams, etc. may be related to this.
2. Digestive tract performance
In hepatitis, liver function is abnormal, bile secretion is reduced, and there is often loss of appetite, nausea, oiliness, upper abdominal discomfort, and abdominal distension.
3. Huang Wei
When the condition is severe, liver function is impaired, bilirubin intake, binding, secretion, excretion and other obstacles, blood bilirubin concentration increases. The bilirubin is discharged from the urine, and the color of the urine turns yellow, which is the earliest manifestation of jaundice. The concentration of bilirubin in the blood continues to increase, causing yellowing of the eyes and skin. Due to the discharge of bile acids, the concentration of bile acids in the blood is increased, and excessive bile acids are deposited on the skin, stimulating the peripheral nerves, which can cause itching.
4. Liver pain
Chronic hepatitis B generally does not have severe pain. Some patients may have upper right abdomen, right quarter rib discomfort, dull pain, tenderness or slap pain. If the liver area is severely painful, pay attention to the possibility of biliary disease, liver cancer, and gastrointestinal disease to avoid misdiagnosis.
5. Liver and spleen
Patients often have large liver due to inflammation, congestion, edema, and cholestasis. In the late stage, a large number of liver cells are destroyed, fibrous tissue is contracted, and the liver can be shrunk. In the early stage of acute hepatitis or chronic hepatitis, the spleen has no obvious swelling. When the portal vein is high, the spleen is congested and can cause splenomegaly.
6. Extrahepatic manifestations
Chronic hepatitis B, especially in patients with cirrhosis, looks dull and dark, called liver disease. The palm of the hand and the small fish are obviously congested and called the liver palm. A cluster of radially expanding, capillary-like capillaries on the skin is called spider mites, and other parts can also appear. Males may have erectile dysfunction, symmetric or asymmetrical breast hyperplasia, swelling and breast development, and may be misdiagnosed as breast cancer; women may have menstrual disorders, amenorrhea, loss of libido and so on. This may be related to decreased liver function, decreased estrogen inactivation, and increased estrogen in the body.
7. Liver fibrosis
Chronic hepatitis B inflammation has long-term unhealed, repeated attacks, intrahepatic fibrous connective tissue hyperplasia, and its degradation activity is relatively or absolutely insufficient, a large number of extracellular matrix deposition to form liver fibrosis. If liver fibrosis is accompanied by destruction of the hepatic lobular structure (liver regeneration nodules), it is called cirrhosis. It is difficult to separate the two clinically. The chronic liver disease is a continuous development process from liver fibrosis to cirrhosis.
complication
Chronic hepatitis B can occur in various systems of the body, such as: liver-induced diabetes, fatty liver, hyperbilirubinemia after hepatitis, cirrhosis.
treatment
1. Principle of treatment
Treatment of chronic hepatitis B: three-point treatment, seven-point conditioning; need to have the confidence and will to overcome the disease, happy spirit, regular life, reasonable diet, not excessive nutrition caused by obesity; in addition to jaundice or transaminase significantly increased need to stay in bed, Should be appropriate activities, dynamic and static.
2. Principle of medication
(1) Do not overdo it. Many drugs are detoxified by the liver. Excessive use of drugs increases the burden on the liver and is unfavorable to liver disease.
(2) According to the specific conditions of patients with chronic hepatitis B, the anti-viral drugs for patients with obvious hepatitis B virus replication; the drugs with immune function disorder; the drugs for protecting liver cells with liver cells An active microcirculatory drug with liver microcirculatory disorders. Traditional Chinese medicine has a long history in China, and its essence lies in dialectical treatment. Through dialectical treatment, it can improve the clinical symptoms of patients with chronic hepatitis B, improve their physical fitness, enhance disease resistance, promote the immune system to clear the virus, and promote disease recovery.
(3) Pay attention to rest, nutritional rest and nutrition during the medication is the main treatment for patients with liver disease. It is possible to play a drug role on the basis of rest and nutrition.
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