Second liver is clinical cure ≠ thoroughly

Recently first " first countrywide second liver patient pick off second liver cap " the report causes a society to pay close attention to extensively. The report says, fight virus to treat through growing effect interferon, home already had patients of 103 chronic second liver to obtain exterior antigen changeover, pick off of second liver " cap " . Once media is announced,report, posed the doubt of the attention of expert of numerous second liver and patient instantly. For this, the relevant problem that the reporter treats around second liver interviewed China to combine traditional Chinese and Western medicine committee member of committee of institutional liver ill major, liberation army 302 hospitals combine traditional Chinese and Western medicine doctor of director of liver ill division, chairman Dr. Liu Shijing. Dr. Liu expresses, clinical cure 103 people to do not have substantial meaning, clinical cure and curing second liver thoroughly is different two concepts; additional, immunity rebuilds is a complex systematic project, sheet relies on 9 kinds of medicaments to come true hard. Well-known, treat chronic second liver to still do not have specific content at present, but second liver illness is to be able to get pilot. The remedial process of second liver is destined is a prolonged " marathon campaign " . The patient of chronic second liver that state-owned half controls in transmits infection through Mu Ying. The development of function of the immunity when the baby is born have not perfect, it is mistake of second liver virus easily the one part of oneself, consequently immune system cannot identify virus of liver of cleared second... 　 second liver is clinical cure ≠ to cure 　 Liu Shijing to think thoroughly, unusual to liver function, second liver is duplicate index is electropositive, have the second liver patient of clinical symptom, the curative effect of more objective science decides the standard can divide kind: One kind is real cause -- clinical cure, another kind is good cause -- virus is cleared. The medical level with current according to, it is very difficult to cure chronic second liver thoroughly, patient of only and few number passes proper treatment, can achieve cure thoroughly. According to our country " clinical disease diagnostic basis cures improving standard " , remedial second liver is obtained clinical cured level comes true more easily, its standard is: Main symptom disappears; hepatomegaly disappears, liver area does not have apparent tenderness or knock at painful; liver function to return to normal. But it is very difficult however to should reach cured level. Accordingly, ten million of second liver patient cannot clinical cure with cure confuse sth with sth else thoroughly. What is the standard that second liver cures? (1) is cured thoroughly. Pass proper treatment, index of series of work of liver of examination of patient exsanguinate assay is completely normal, antigen of surface of virus of liver of DNA of virus of liver of occurrence second of index of series of second liver virus, second, E antigen turns shade, liver puncture organizes immune group to change antigen of core of virus of examination second liver, surface antigen to disappear, such result holds time of two years of above. (2) is cured basically. Pass proper treatment, index of series of work of liver of examination of patient exsanguinate assay is completely normal, antigen of DNA of virus of liver of occurrence second of index of series of second liver virus, E turns shade appears the serological changeover of E antigen and E antibody (second liver " big 3 this world " turn for " small 3 this world " ) , liver puncture organizes immune group to change antigen of core of virus of examination second liver to disappear, such result holds time of two years of above. Dr. Liu points out, at present 8% the following patients can be achieved cure thoroughly, the patient that 30% is control can be achieved cure basically. Virus of this part patient is duplicate index turns shade, liver meritorious service is regular, antigen of core of the virus in liver organization already also disappeared, slight or inflammation of organization of pathology examination liver is dormant, infectivity is done not have almost, illness progress is basic block is broken, the probability that produces liver cirrhosis or liver cancer reduces the patient of;70% above to be able to pass active and proper treatment greatly, speed of progress of slow down illness, win clinical improvement. How is ability achieved cure a standard? Grasp good treatment opportunity. Check acid of occurrence third ammonia to transfer enzymatic heighten when assay of second liver patient, had better be the 2 times above of normal upper limit, but 10 times the following when, second liver virus is duplicate index (antigen of E of virus of liver of DNA of second liver virus, second) for masculine gender, liver function is in acting countervail phase, patient of; of correct and reasonable use medicaments must carry out the; of optimal treatment opportunity that is second liver right now seriously remedial program, ten million do sth without authorization stops drug or cannot stop treatment, cannot change often medicaments. Dr. Liu says, current, the overall objective that treats second liver is not to ask to be cured thoroughly, utmost ground is restrained for a long time or eliminate second liver virus however, 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 cirrhosis of acting countervail, liver, liver cancer and its complication, improve the life thereby quality and extend surviving time. Still make antigen of surface of 　 of second liver virus turns trivially at present ideal medicaments 　 Dr. Liu of shade thinks, poison of second liver disease-resistant treats the core content that is second liver cure, 1992 ～ had content of bane of 5 kinds of disease-resistant to obtain approval to be used at second liver to treat in the world 2005. These 5 kinds of medicaments are respectively: Common interferon α - husband of 2b, rummy is decided, get together glycol interferon α - Wei Heen of 2a, A Defu replaces Ka Wei. Among them common interferon α - 2b use time is the longest, already exceeded 10 years, rummy husband is used surely already had 7 years, get together glycol interferon α - Wei uses 2a and A Defu to already had two years, favour be less than a year for Ka Wei. Current, favour the Wei that replace card and the new-style nucleotide analogue such as Adefuwei are used increasingly at clinical, because these two kinds of medicaments are used for a long time, produce virus not easily to mutate, curative effect is relatively lasting. Favour control rate of second liver virus for Ka Wei the fastest, inchoate and respondent rate is as high as 90% above, the patient majority that accepts treatment obtains shade of DNA of second liver virus to turn, use this medicine did not produce virus mutation phenomenon inside two years, the patient happening virus that there is 2% about after using 3 years mutates. From the inhibition of virus speed and effectiveness look, favour the Wei that replace card is most effective. But favour appear on the market formally for Ka Wei use time is shorter, confirm the long-term effect of this medicine still hard at present. The nether world that discovers DNA of second liver virus in the patient that has used turns rate is quite high, but produce antigen of E of second liver virus / the serological changeover of antibody is more difficult, this means need to take this drug long-term and abidingly. Come so, the charge nature of medicaments becomes an issue, bring about the expenses for medicine with a lot of patient exalted financial insolvency. Value of A Defu Wei is relatively inferior, but poisonous effectiveness of this medicine disease-resistant not as good as favour for Ka Wei, the first time use disease-resistant poison treats the patient that selects this drug, about 60% shade of DNA of second liver virus can appear to turn after treating half an year to arrive one year, but, if use this medicine to replace remedy,rummy husband treats unsuccessful case of illness surely, the effect should be differred a lot of. Additional, this medicine large dose or use the kidney function that causes a patient likely for a long time to damage. Sheet relies on interferon to treat second liver 　 to realize immunity to rebuild hard 　 Liu Shijing thinks, long-term since the research that medical home devotes oneself to second liver immunity to adjust works, try vaccine of thymus element, interferon, Bai Jiesu and liver of remedial sex second to be used at the cure of second liver early or late, send a hope to suffer at breaking the immunity of second liver to be able to bear or endure, rebuild system of immunity of second liver patient. But these attempts did not obtain satisfactory result. Because of the abidance of second liver infection still has a lot of foundation problems to have not make clear, for example wither of cell of factor of the cell in element of the immune heredity characteristic of the gene type of virus, virus, immunity, antigen identifying, liver dies etc. Rebuild system of human body immunity can be an ideal only at present just, the distance is vogue successfully early. Additional, after use interferon, the identifying that can increase cell of human body immunity ability, enhance T cell cleared ability, but the disease-resistant poisonous action of interferon be confined to is duplicate DNA of virus of sexual second liver, can not keep clear of the CccDNA of duplicate pattern plate of virus of liver of the second inside nucleolus of consist in liver, the virus after stopping drug is OK emersion is duplicate, cannot keep clear of to had been mixed the virus gene of host DNA conformity, the antigen of surface of second liver virus that makes its are conveyed hard disappears. Although all sorts of interferon treat second liver,adjust to a few immunity since the meeting action, but these adjustment action is very limited. Our country is newest those who promulgate " guideline of prevention and cure of chronic hepatitis B " point out, immune adjustment treats one of important steps that are cure of chronic hepatitis B, but still lack immunity of hepatitis B particularity to treat a method at present. Treat second liver through growing effect interferon merely, achieve the effect of system of immunity of person weight compose impossibly. More what is more,the rather that everybody can not use liver of interferon cure second, if use an opportunity undeserved, can bring about illness aggravation instead. (the exercitation edits: Plum apricot)