Chronic second liver is newest knowledge

Poison of second liver disease-resistant has been become at present of second liver advocate make treatment, the guideline of second liver prevention and cure of each country already all was become actually " guideline of disease-resistant poison prevention and cure " , about how undertaking disease-resistant poison is treated, broad patient should go to a little new knowledge learn and understanding. 1. Before when the doctor the consideration gives patient disease-resistant poisonous treatment, be evaluated in the round and be being communicated adequately is must. This are very important really, before the patient has treatment, the doctor wants pair of patients go to already circumstance, use medical history, familial history, economic atmosphere understands seriously, undertake with the patient one subaltern time communicates, the goal that achieves the intent that shows treatment, possibly, period of treatment and the note that use drug. Must win sufficient understanding of the patient and support, 10 thousand cannot rude behavior, arrogate to oneself makes a stand. I recieved patient of 8 second liver continuously in outpatient service recently, stop drug because of proper motion, bring about the illness accentuates repeatedly, this explains comply with sex of the patient is poorer, and the doctor's entrust and management do not reach the designated position. Using drug is a project, how to lay the foundations, how to design blue print, how to put into effect to have exquisite. It is very important to arouse and be communicated before the patient is treated. 2. Normal to result of infection of second liver virus, liver or ALT level is slight and elevatory (the patient of 1-2 × ULN) is divided have clear liver fiber is changed or liver is sclerotic, suggest to be able to be not treated commonly, but need every 3-6 the month is followed visit the mark content that reachs pair of liver cancer to undertake monitoring. Additional, before chronic second liver is being treated, ascendant patient of ALT of companion of bounce of disease of ill to having poisonous blood or ALT is normal upper limit (hepatic biopsy should undertake before age of patient of 0.5~1 × ULN) exceeds 40 years old of cure. HBeAg electropositive patient, ALT>2 × ULN and the patient of chronic second liver of 104 IU/ml(105 Copies/ml) of HBV DNA>2.0 × and HBeAg negative and ALT>2 × ULN or the patient of chronic second liver of 103 IU/ml(104 Copies/ml) of HBV DNA>2.0 × should fight virus to treat, before and disease-resistant poison cure should be in producing liver to break acting countervail as far as possible inchoate have treatment, should accept 3-6 month otherwise along with visit observation. 3. On the choice of disease-resistant bane content, can choose common interferon 5-10MU 3 second / week; gets together glycol interferon α - 2a, favour of; of 90-180 Mg/ week replaces day; of 10 Mg/ of A Defu Wei of; of day of Ka Wei 0.5 Mg/ decide; of 600 Mg/ day than the husband or rummy husband decides 100 Mg/ day. Also can apply day of 1(of thymus peptide α to amount to celestial being) : 1.6 Mg, 2 / . The countervail that miss generation period the patient should choose rummy husband to decide, OK also applying for be decided than the husband or favour treat for Ka Wei. To the patient of HBeAg positive, the period of treatment of common interferon should last 4-6 the patient with lunar electronegative to HBeAg; , the period of treatment of common interferon answer at least 1 year. Electropositive to HBeAg patient gets together glycol interferon α - the period of treatment of 2a should the patient with electronegative to HBeAg; of at least 6 months, get together glycol interferon α - the period of treatment of 2a should at least 12 months. No matter HBeAg is electropositive or the patient of HBeAg negative, day of 1(of thymus peptide α amounts to celestial being) period of treatment should be 6 months. Common IFN, PegIFN α - 2a, favour replaces calorie of Wei He to replace the nucleotide that waits to appear on the market in last few years surely than the husband (acerbity) in analogue any all be a gleam of one kind to treat medicaments. 4. In fighting virus to treat a process, check to patient convention. ALT, HBeAg and (or) HBV DNA should at least 3 months detect 1 times. The patient that uses ester of A Defu Wei should monitor kidney result. The patient that uses interferon should observe harmful response. Rummy husband decides generation to be able to bear or endure medical patient, adding ester of Wei of blessing of the heart that use A is necessary; optional also choose is changed with favour for Ka Wei () of 1 Mg/ day. The patient that rummy husband treats first surely applies ester of A Defu Wei to appear be able to bear or endure medicine, can add use or change decide with rummy husband, for be decided than the husband or favour for Ka Wei. Application is replaced be able to bear or endure surely than the husband medical patient, adding ester of Wei of blessing of the heart that use A is necessary, change be being treated with interferon also is a kind of choice. After cure ends, should advanced 3 months detect every months the level of ALT and HBV DNA in order to discover inchoate recrudesce. HBeAg or the chronic patient with electropositive HBV DNA, should continue to survey at least 6 months (to having respondent) , every 3 months are followed visit. Without respondent patient, should detect further HBV mark content in order to discover defer is respondent, and regard as constitute the basis that treats a plan. Refuse the patient of positive of virus medicaments HBeAg to profess to convinced, when at least 6 months have interval twice HBeAg serum is changed and HBV DNA is not measured when going out, cure just can end. To the patient of HBeAg negative, still not be clear that cure should last at present how long. But when at least 6 months have interval 3 times HBV DNA is not measured when going out, cure can end. 5. To the female patient of Yo age, if not gravid, first choice interferon, and be in do not encourage gravid. The female is like when taking matter of bane of disease-resistant of profess to convinced gravid, can continue to take gravid B class to medication. Affect HIV but the patient that does not need treatment, can apply Adefuwei, for be decided than the husband or interferon (if CD4>500) treats second liver; to affect HIV and the patient that needs treatment, should choose the Fu Wei that replace Nuo or decide combination to undertake active disease-resistant poison is treated for Nuo blessing Wei and rummy husband. New guideline affects the patient of HCV or HDV to incorporating, cure depends on which kinds of virus is dominant, adopt remedy accordingly. New edition deleted the proposal that transplanting liver injury reachs time of choose period transplanting related pair of liver transplanting conditions and occurrence HBV infection. Newest medicaments is favour the Wei He that replace card is replaced decide two kinds of remedy than the husband, to the patient is being treated first for, before the prep above with the apparent ability that these two kinds of medicaments duplicate in transplanting virus nucleotide (acerbity) analogue rummy husband is decided with ester of A Defu Wei. And favour for the clinical research that the patient treats at the beginning of Ka Wei data shows 3 years to be able to bear or endure medical rate is 1% , and be able to bear or endure for what decide remedy 1 year than the husband medical rate is 7% , these results that study an aspect hint all excel rummy husband is decided. But be able to bear or endure surely to rummy husband medical patient, be able to bear or endure use after medicine favour the Wei Yuchu that replace card treats patient photograph to appear more easily tall proportional be able to bear or endure medical happening should grant to take seriously. 6. Before undertake immune depressor or changing cure, should determine patient HBsAg. If HBsAg is electropositive, thing of direct disease-resistant bane should use before cure, after and last apply to immune depressor or changing cure to end at least 12 weeks. Liver is brought about to fail because of HBV in those and await the patient that liver transplants, should choose nucleotide (acerbity) analogue cure, and detect HBV DNA. Rummy husband combines small dose HBIG(400-800 U surely, intramuscular injection, last 1 times everyday 1 week, later every months of 400-800 U applies for a long time) can safe the effective HBV reinfection that avoids transplanting liver. Choose plan as equipment, rummy husband adds ester of A Defu Wei to also can consider surely. To liver transplanting later period (at least 12 months after liver transplants) ester of A Defu Wei replaces patient applicable HBIG, such safety and economy. Right " low risk " patient, can consider to apply rummy husband to be replaced surely in later period. Fight to the patient is being treated to accept at the beginning of infection of virus of liver of liver transplanting second - HBc offers liver electropositively, answer to be treated for a long time, choice rummy husband is decided or HBIG prevents cure. (the exercitation edits: Plum apricot)