Reasonable make a diagnosis and give treatment is chronic hepatitis B

In practice of make a diagnosis and give treatment of chronic hepatitis B, follow the principle of primary make a diagnosis and give treatment that the guideline recommends, according to the specific illness of every patient and its apiration, every doctor should accomplish make plan of sound diagnosis and treatment hard. Be aimed at the clinical cure of hepatitis B, be opposite now " guideline of make a diagnosis and give treatment of chronic hepatitis B " (abbreviation guideline) the point that treats a share undertakes be unscramblinged simply. 1. Be aimed at chronic hepatitis B, refusing ill poisonous treatment is crucial: In recent years, the research that concerns medical history of nature of chronic hepatitis B domestic and internationally explains adequately, the virus inside system of patient of chronic hepatitis B holds an amount (or level of goldbrick poisonous bear, virus) it is a decision clinical disease progress and patient's long-term and prognostic main factor. A lot of clinical research also make clear, disease-resistant poison treats the long-dated prognosis of ameliorable patient, include to reduce liver cirrhosis to lose the occurence rate of acting countervail and cancer of cell of the former liver that send a gender, raise survival rate. Accordingly, the overall target that this guideline raises chronic hepatitis B to treat is: Show off of て of Yao of magpie of pull up of sheng of white the She nationality is planted BV of 鼿 of Ping Si  , relieve liver cell inflammation the necrotic fiber that reach liver is changed, defer and prevent a disease to make progress, decrease and prevent liver to break the happening of cancer of cell of cirrhosis of acting countervail, liver, liver and its complication, improve the life thereby quality and lengthen live time " . 2. Cure of poison of disease-resistant of what patient need and it when begin to refuse ill poisonous treatment is advisable to when begin to refuse ill poisonous treatment: The clinical progress of patient of chronic hepatitis B and long-term prognosis basically depend on level of its serum HBV DNA. Accordingly, come up from theory the patient that says positive of any serum HBV DNA all needs to undertake disease-resistant poison is treated. But about HBV nature history considers to make clear, virus level is in 104 copies of 1 × / Ml or 105 copies of 1 × / the patient under Ml, the occurence rate of liver cirrhosis and liver cancer all remarkable under those prep above the patient of this virus level. Because of this guideline also HBeAg positive 105 copies of ≥ of HBV DNA of hepatitis B patient / Ml is surely " need " the bounds; of disease-resistant poison at the same time, because HBeAg is electronegative person HBV DNA level is relatively inferior, its are reason surely 104 copies of ≥ / Ml should undertake disease-resistant poison is treated. A large number of clinical trials make clear, it is interferon no matter kind still be nucleotide (acerbity) analogue kind fight HBV medicaments, it is better to all have apparently elevatory patient curative effect to serum transaminase, HBeAg serum changeover is led or last especially HBV DNA is restrained rate. Accordingly, the guideline also sets to patient of chronic hepatitis B speech at the same time, be in only ALT ≥ normal upper limit of 2 × ULN() when just begin therapy. Can not mirror hepatic inflammation completely because of serum transaminase again necrotic circumstance, this guideline does not show reason especially, if ULN of ALT Lt;2 × , but liver histology shows ≥ of Knodell HAI 4, or ≥ G2 inflammation is necrotic also can begin therapy. Because at present medicaments lasts to serum transaminase,normal immunity is able to bear or endure suffer period patient (the person that chronic HBV is carried) curative effect is very poor, reason does not recommend treatment commonly, unless have histology evidence,make clear liver to have apparent inflammation necrotic. To serum HBV DNA is not the person that mobile sex HBsAg is carried electronegatively, because do not have method to keep clear of the virus of its minim at present, reason does not need disease-resistant poison to treat. According to the actual condition of our country, the guideline is special put forward to should notice to eliminate to be lifted by the ALT of medicaments, alcohol and other factor be caused by, because apply,also should eliminate to fall provisionality of the ALT after enzymatic medicaments is normal. Liver cirrhosis is like in a few special case, acerbity transaminase of ammonia of its day winter (AST) level but prep above ALT, can consult to this kind of patient AST level. 3. Choose why to plant it is advisable that medicaments undertakes disease-resistant poison treats: Fight medicaments of hepatitis B virus acceptedly domestic and internationally to basically have interferon at present kind mix kind of nucleotide (acerbity) analogue two kinds big, already obtained medicines and chemical reagents of our country food to supervise what management board approves to have common interferon among them α , get together glycol interferon α - husband of 2a, rummy is decided, ester, favour replaces Adefuwei Ka Wei, still have α of peptide of thymus of immune reaction conditioning agent additionally 1. In clinical and real work, the doctor should be mixed according to his professional knowledge clinical experience, in integrated consideration patient condition of specific illness, economy reachs the foundation of its individual apiration to go up, affirmatory below the principle frame of the guideline individual the remedial plan that change. 4. Chronic hepatitis B fights virus cure to answer standard: Poison treats normative disease-resistant to basically should include: An ancient type of banner hoisted on a featherdecked mast of Juan of grave of small car of Xing of  of ⒔ of beach of shoot a glance at of solid herd of delicacy of coal of take along sth to sb of ⒉ of Sha of ┪ of solid bursa of delicacy of ⒑ of buccal to fold of solid act of ≡ Yao delicacy retreats 　 of Di deceive? patient of chronic to HBeAg positive hepatitis B, at present domestic and international most scholar thinks remedial terminus is HBeAg serum changeover, namely HBV DNA turns shade (under 103 copies / Ml or under detect be restricted) , HBeAg disappears, fight - HBe appears. Research makes clear, once achieve this one goal, the clinical disease progress of major patient tends stable, long-dated prognosis is improved. The common interferon that recommends at present and get together glycol interferon period of treatment is 6~12 month, the inchoate virus with because lack is similar medium cure of virus of the liver that fight third learns respondent will forecast continuously virus learns respondent rule, use fixed period of treatment commonly. With nucleotide (acerbity) the case when analogue is treated is more complex, what recommend at present is the shortest period of treatment only. The data shows, the period of treatment that although achieve,provides at present and standard stopping drug, namely HBV DNA turns shade, HBeAg disappears, fight - HBe appears, after stopping drug 2 years, also have recrudesce of patient of quite a few. Accordingly, to most patient, the likelihood needs to use nucleotide for a long time (acerbity) analogue is maintained with obtaining respondent. Because still lack data of the effectiveness of long-term remedy, security, have not overcome completely especially clinical be able to bear or endure problem of property of a medicine, still cannot recommend the specific period of treatment that manages treatment for a long time and program at present. Patient of chronic to HBeAg negative hepatitis B, still do not have accepted remedial terminus at present. Although a lot of clinical trials use ALT answer to often reach HBV DNA to turn continuously,shade regards cure as terminus, but interferon kind or nucleotide (acerbity) the recrudesce after analogue cure stops drug is led normally all very tall. Want to period of treatment of this kind of patient longer, the period of treatment that guideline place recommends and alleged level stopping drug also is lowermost requirement only. Accordingly, in clinical on should choose as far as possible be able to bear or endure for a long time with medicine the medicaments with medical low rate will treat. On the contrary, should avoid first selection to be able to bear or endure as far as possible the medicaments with medical high rate is decided like rummy husband. The author thinks, be in what can foreknow to will come, will obtain through long-term remedy preserving respondent possibility is a kind of actual and helpless choice. To acting countervail period patient of cirrhosis of hepatitis B liver, its treat a cause is the happening that try to prevent or defers liver function to miss acting countervail and liver cell cancer, its cure points to impose the requirement that did not include transaminase level, treat namely point to ask for a ≥ of requirement HBV DNA 105 copies / Ml(HBeAg is electronegative person for HBV DNA ≥ 104 copies / Ml) . The doctor should need possibly to apply nucleotide for a long time to patient specification (acerbity) analogue, want the close curative effect that monitor and security, be able to bear or endure especially the happening that medicine mutates. Because of interferon kind the likelihood brings about hepatitis to break out and cause liver function to break acting countervail, reason should apply carefully. Acting to breaking countervail period patient of cirrhosis of hepatitis B liver, fight HBV cure to get used to card and acting countervail period liver cirrhosis is identical. Its treat a cause is through restraining virus duplicates, improve liver function, with defer or reducing the demand that liver transplants. The problem that must note has: Swiftly in all " leap up of Zhu of barren of riverside of bureau acute communicable diseases? of  of Hangzhou arm 〗 but itself is unalterable eventually the ② of; of final final result of evening liver cirrhosis cannot stop drug at will, otherwise interferon of ③ of sequential and serious; belongs to no-no card, because its can bring about ④ of liver exhaustion; to get used to medicine of card external use because of belonging to, the know the inside story that should obtain a patient agrees with a book. 5. Accept because of other disease change depressor of cure, immunity (especially adrenal candy is coriaceous hormone) HBsAg is electropositive person (although HBV DNA negative and ALT are normal) , a large number of HBV is OK duplicating that bring about serious hepatitis to break out thereby even liver fails. Before making clear cure about clinical research, begin to give namely refuse HBV treatment, after lifting than HBV DNA resumptive cure, the effect is better. Accordingly, the guideline is recommended begin to take rummy husband to decide in before this kind of cure 1 week, daily 100 Mg. After changing cure and immune depressor cure to stop, duplicate case of the HBeAg condition before answering to be treated according to the patient and HBV DNA will decide rummy husband stays medical time surely. In recent years, transplanting of our country liver is begun more and more general, among them major patient is patient of HBV relevant disease. If do not undertake effective precaution, the patient of the 80% above after liver transplants can produce HBV reinfection. Offer the experience with him our country according to foreign article, the guideline recommends the price relative to globulin of inferior small dose immunity flesh is noted and husband of rummy of profess to convinced combines long-term precaution plan surely. Follow to the patient it is very important to visit and be monitored, should regard clinical cure as the substantial of the plan. To monitor effect of disease progress, therapy and harmful response, the guideline is right before cure, after cure counteracts cure, and do not treat a patient along with visited viewing time interval and project to all be made define. To patient of cirrhosis of chronic hepatitis B, liver, especially patient of tall danger of liver cell cancer (Gt;40 year old, wine of the male, be addicted to, liver function not complete or already had) of heighten of armour embryo albumen, should every 3~6 the month detects armour embryo albumen and travel abdomen B exceed (make CT or MRI) when necessary, with inchoate discovery cancer of the liver. Sclerotic to liver patient still answers every 1~2 year undertake gastroscope is checked or go up radiography of enteron X line, have in order to observe reach its progress situation without the varicosity end esophagus stomach. (the exercitation edits: Plum apricot)