Second liver is treated first " precaution is able to bear or endure medicine " just be the best thing to do

Second liver is able to bear or endure medicine, perplexing countless doctors and patient all the time. Held recently liver of harbor Shanghai international is ill 2008 on the conference, global head " cure of poison of disease-resistant of chronic second liver is able to bear or endure medical management " result of Asian area findings report shows, of 99% suffer in visitting a doctor to be treated in poison of second liver disease-resistant, ever was faced with be able to bear or endure medical problem. And be able to bear or endure in patient happening in the remedial fee that extra burden needs after medicine, only expert outpatient service, hospitalization, be able to bear or endure medicine detects wait for charge, can make each patients are in be able to bear or endure the first year after medical happening, increase the premium of about 4000 yuan of RMBs. The expert points out, should avoid by be able to bear or endure the serious and clinical consequence that medicine brings and cost of additional economy and time, when initiative cure, the doctor should choose the most powerful effect, lowest as far as possible to be able to bear or endure for the patient medicine (have namely be able to bear or endure high medical gene protective screen) disease-resistant bane content. Be able to bear or endure medicine makes treat cost to increase 　 to occupy the introduction considerably, " cure of poison of disease-resistant of chronic second liver is able to bear or endure medical management " the expert group of research came in January 2008 in May, to coming from area of chinese mainland, Taiwan, Korea and Thailand nearly 600 are in the liver disease with seasoned respect of second liver cure or infected family doctor to undertake survey, have 99% as a result suffer visit a doctor to express, ever was faced with in cure of poison of second liver disease-resistant be able to bear or endure medical problem. According to introducing, according to the guideline of second liver prevention and cure of many countries and area, the first goal that refuses ill poisonous treatment is utmost, chronically restrain second liver virus to duplicate, achieve ultimate goal of cure thereby. But be able to bear or endure medical problem became influence second liver to treat a success for a long time however crucial factor, this is the challenge that the global clinician place that includes China inside faces. The expert points out, once second liver patient happens be able to bear or endure medicine, will bring about existing disease-resistant poison to treat invalidation, virus rebounds, transaminase of ALT(cereal third) a series of serious and clinical consequence such as recrudesce of elevatory, hepatitis. The disease-resistant poison that right now the doctor needs to consider a change to have treats plan (change medicine or add medical) , medicine is able to bear or endure for management in the meantime, the patient needs to increase outpatient service to visit inspect, the frequency that the lab checks. Study the estimation of the report according to this: Be able to bear or endure in patient happening in the remedial fee that extra burden needs after medicine, only expert outpatient service, hospitalization, be able to bear or endure medicine detects wait for charge, can be able to bear or endure the first year after medical happening in each patients, increase the premium of about 4000 yuan of RMBs, and cost of the traffic expenses of go to a doctor of the charge that these had not included to treat medicaments itself, patient, delay one's work. On the other hand, from be able to bear or endure in light of the time cost that medicine causes, be able to bear or endure oneself after medical happening, the patient needs to increase original outpatient service to visit inspect the frequency that checks with the lab, this gives be able to bear or endure medical patient raised additional time cost. "Precaution is able to bear or endure medicine " just be 　 of 　 of the best thing to do " cure of poison of disease-resistant of chronic second liver is able to bear or endure medical management " glad teachs Zhang Xin of director of lab of vice director of division of infection of hospital of Ruijin of one of investigator of findings report collaboration, Shanghai, clinical virus point out, at present the clinician is able to bear or endure to second liver medical administration occurs commonly 3 kinds of strategy: Namely " precaution is able to bear or endure medicine " , " forecast be able to bear or endure medicine " and " rescue cure " . Zhang Xin glad introduces, at present hospital of Chinese great majority was not able to bear or endure professionally medicine detects equipment, because this is used in the patient,be able to bear or endure after the disease-resistant bane content with medical higher occurence rate has treatment, the means that the clinician uses HBV DNA to detect mostly (basically detect whether does virus exist duplicate to be measured with virus) will monitor a patient to whether happen be able to bear or endure medical; and the sensitivity presence that homebred DNA detects is larger difference, because this doctor cannot be in well and truly,the patient comes through monitoring when inchoate cure " forecast " whether does the patient happen be able to bear or endure medicine, missed a patient thereby optimal save remedial time. Accordingly, "Forecast be able to bear or endure medicine " strategy is in China often because cannot be accomplished truly seasonable, accurate forecast, and be thought the feasibility in clinical practice is poorer. In investigation, the China that has more than 77% suffers visit a doctor to express, "Precaution is able to bear or endure medicine " just be to protect a patient to be far from be able to bear or endure the optimal strategy that medicine perplexes. Will tell to most clinician, "Precaution is able to bear or endure medicine " politic, not only clinical feasibility is bigger, and besides the remedial result that can assure to had been compared, because be able to bear or endure,patient of OK still and effective help avoids medicine and the additional economy that create and time cost. Accordingly " precaution is able to bear or endure medicine " it is the weapon that takes the most powerful effect at the beginning from cure, take a consolidate step by step, way that takes strict precautions against keep a firm hand on of virus of general of defend to the last, it is the patient is defying second liver virus is able to bear or endure the; of the best thing to do that should adopt in medical war and " forecast be able to bear or endure medicine " it is a patient after choosing weaker weapon, takes make a move sees the passive strategy of one pace, it is; of the second best plan " rescue cure " it is the weaker weapon in patient hand not enemy of virus after counterattacking, what adopt remedy measure, it is to be able to bear or endure a bad plan in medical management. Second liver is treated to answer first first selection is low be able to bear or endure medical medicaments 　 however, "Precaution is able to bear or endure medicine " strategy is in clinical on application rises to have certain difficulty however. Expert attending the meeting expresses, these difficulty basically come from at the patient do not understand. Zhang Xin glad says: "At present the guideline of second liver prevention and cure of many countries, area all is recommended, in second liver when initiative cure, should choose the most powerful effect, lowest as far as possible to be able to bear or endure disease-resistant bane content of medicine. " however, these efficient medicaments also mean high price. As we have learned, 4 kinds of nucleotide that obtain approval to be used at chronic second liver to treat at present in China kind in medicaments, rummy husband decides Wei of kind of He Ade blessing kind medicaments 5 years be able to bear or endure medical occurence rate is respectively 70% replace what decide kind of medicaments to be used at patient of negative of E antigen electropositive patient and E antigen two years than the husband to be able to bear or endure with 29%; medical occurence rate parts, its 5 years be able to bear or endure medical occurence rate is only 1.2% . Nevertheless, favour for Ka Wei kind medicaments is in curative effect is powerful, be able to bear or endure while medical occurence rate is low, the price is more expensive than other remedy also about the same 50% . Accordingly, if the doctor is using this kind of remedy to the patient at the beginning, the patient often can complain: "How to try with cheap medicine to me first, be no good just use ' expensive drug ' ? " 　 is right this, zhang Xin glad thinks, more and more research hint, inchoate virus learns respondent case is to forecast be able to bear or endure the main index of medical occurence rate. Treating inchoate restrain virus lowlier, appear be able to bear or endure medical possibility is less. And, in eye of this kind of patient " expensive drug " from sheet piece charge looks, the price compares other drug object height really, but from long-term in light of, the patient is able to bear or endure medical occurence rate is reduced, can save next expert outpatient service, hospitalization instead, be able to bear or endure medicine detects wait for charge. Accordingly, these curative effect are powerful, be able to bear or endure the medicaments with low medicine already was recommended to be patient of chronic second liver by guideline of prevention and cure of many second liver initiative cure a gleam of uses the first choice in medicine. "We suggest, if economic condition is permitted, the patient should be in as far as possible the first time the medicaments with virus strong inhibition chooses when cure. " 　 noun explanation: Precaution is able to bear or endure medicine: Point to in second liver patient when initiative cure, the choice falls virus capability is strong, be able to bear or endure the disease-resistant bane content with medical low occurence rate, active and active reduce be able to bear or endure medical risk, utmost ground avoids to be able to bear or endure medical happening, its are strategy of a kind of precaution constitutionally. Forecast be able to bear or endure medicine: Point to use in the patient be able to bear or endure medical occurence rate is higher (have namely low be able to bear or endure medical gene protective screen) after disease-resistant bane content has treatment, according to the patient the respondent circumstance of inchoate cure is adjusted in time, the change has remedial strategy, be able to bear or endure with defer or be being reduced relatively medical risk, its are one kind is followed constitutionally visit observation strategy. Rescue cure: Point to be able to bear or endure in patient happening after medicine, the disease-resistant poison with ability existing change treats plan (add medicine to perhaps change medical) , its are one kind remedies strategy constitutionally. (the exercitation edits: Plum apricot)