Xiao Li is 43 years old this year. When she was 16 years old (1995), her father died of liver cancer and , and the whole family went for a physical examination. My mother and younger brother are fine, he, his elder brother and sister are both chronic infections with hepatitis B.
My father used to be so strong was already thin before his death, with a swollen belly and golden eyes. His father gasped and held his hand and told him: "In the past year, I always felt bitter and bitter in my mouth. I had yellow urine, couldn't eat it, and I was exhausted. Now I have a stomach full of ascites. My disease cannot be cured! I am dead. You are the eldest son. You must take good care of your mother, younger brother and sister, and carry this family..." After saying this, my father fell into a coma and never woke up again.
cirrhosis ascites
After his father passed away, 16-year-old Xiao Li dropped out of school and started working, and worked with his mother to support his younger brother and sister to study. Xiao Li has a low level of education, but he is diligent and studious. He starts from a worker and becomes the vice president of the company step by step.
Because he witnessed his father's death from liver cancer, Xiao Li attached great importance to hepatitis B, especially after having a certain economic foundation. He began to seek medical treatment everywhere, and had taken traditional Chinese medicine, herbs, various health products, and liver protection drugs... Xiao Li is from Guangfeng and took herbal medicine intermittently for more than two years. It turned out that the liver function was normal, and the aminotransferase began to gradually increase, fluctuating between 40 and 90. Symptoms such as bitter mouth, fatigue, anorexia, and yellow urine showed signs of symptoms, which made Xiao Li particularly frightened. Aren’t these all the symptoms my father said before he died?
Xiao Li decided to go to Shanghai's large hospital to treat hepatitis B. Shanghai experts recommend injecting interferon for treatment. After one year of interferon treatment, the amount of virus is still as high as eighth power copies. Experts recommend oral lamivudine combined with adefovir treatment. Due to economic reasons, Xiao Li chose oral adefovir singly monotherapy treatment. After taking adefovir ester for 2 years, the amount of virus still fluctuates around the third power. I have been replaced with entecavir single agent for treatment until now.
From 2008 to the present, Xiao Li has been asking me to treat chronic hepatitis B. Every six months, he went to the comprehensive outpatient department of Shangrao Second People's Hospital to draw blood, urine tests, and color ultrasound. Xiao Li's liver function has always been normal. HBVDNA quantitative was detected with a high sensitivity reagent, indicating that it was <20>
Xiao Li asked me in confusion: "Doctor Wang, I have been taking the medicine for 18 years and nine months. Why am I still the hepatitis B three positive?"
I asked back: "What do you think is the ultimate purpose of treating hepatitis B? "
Xiao Li pondered for a long time and replied to me: "It should be to prevent cirrhosis , liver cancer. My sister and I have been taking antiviral drugs, and my brother is unwilling to take the medicine for a long time. He has died of liver cancer. Alas! My brother's two children are now raised by me. "
I continued: "Have you increased the aminotransferase after taking the medicine?"
Xiao Li quickly answered me: "After taking the adefovir ester for half a year, the aminotransferase has been normal and has never fluctuated."
I patiently explained: "Chronic hepatitis B is an immune hepatitis induced by the continuous or intermittent replication of the hepatitis B virus. If the hepatitis B virus is allowed to replicate continuously, the liver cells continue to be inflammatory and necrotic, and the progress of fibrosis and will continue to develop, and there will be a high risk of cirrhosis and liver cancer. Haven't you said many times that more than ten people in your family have died of liver cancer in the past 20 years? Why is this happening? It is because it delays antiviral treatment and delays antiviral treatment for a long time!"
Xiao Li said: "Yes, it turns out that many people in the family laughed at me for taking medicine for a long time, which is a medicine jar! In the past 20 years, more than ten people in the family have died of liver cancer due to hepatitis B, and they have also started taking medication. Because I have been standardizing antiviral treatment for 20 years, they often come to ask me some knowledge about hepatitis B."
Why has been taking the medicine for 18 years and nine months? Xiao Li is still a hepatitis B three positive? Xiao Li started to experience mild increase in aminotransferase after taking herbal medicine for about two years. It is difficult to judge whether it is hepatitis caused by herbal medicine or chronic hepatitis B, or both. It is clear that Xiao Li started to standardize anti-antibody when the virus volume is high, the immune tolerance is obvious, the liver inflammatory response is mild, and the liver fibrosis is very mild. Viral treatment, this treatment is the best for resting liver inflammation and preventing liver cancer. Just imagine, if Xiao Li did not standardize antiviral treatment in the past 20 years, would he die of liver cancer like his father and younger brother?
Currently, the first anti-hepatitis B virus drugs (entecavir, tenofovir , propofol tenofovir or amytenofovir) have a strong inhibitory effect on viral replication, and hepatitis B virus replication is strong Inhibition, liver inflammation can rest quickly, which can minimize the occurrence of cirrhosis and liver cancer. However, existing drugs have limited effects on the quantitative reduction of surface antigens and HBeAg for hepatitis B. The more obvious immune tolerance, the slower the decrease of antigen . This is why Xiao Li has been taking medicine for the past 19 years. I suggest that Xiao Li switch to propofol tenofovir and interferon treatment and try it.
. The quantification of HBVDNA has long been lower than the lower limit of detection. Hepatitis related to hepatitis B was cured 18 years ago. The so-called hepatitis B is really just an "empty hat" and there is no need to worry about it. The fundamental purpose of our treatment of hepatitis B is to prevent cirrhosis, liver cancer and liver failure. Whether it turns into a small three-positive or whether the surface antigen of hepatitis B turns into a negative is really not that important.
Jiangxi Province Shangrao Second People's Hospital Comprehensive Outpatient Department Wang Chunxi
