Hepatitis B

　　The characteristics of chronic hepatitis are the recurrence of exacerbation and remission of liver inflammation, and various complications will occur. The most common complications of hepatitis B are as follows:

　　1. Liver-origin diabetes

　　The complications of hepatitis B are similar to those of type II diabetes in clinical manifestations. The difference is that the fasting insulin in liver-origin diabetes is significantly increased while C peptide is normal. After taking sugar, insulin is significantly increased while the C peptide peak is still slightly lower than normal. This is because the liver's ability to inactivate insulin is reduced, promoting the increase in insulin. In addition, the reduction in the inactivation of glucagon in the liver and the reduction in insulin receptors on liver cells increase resistance to insulin, so although insulin increases, blood sugar remains high. At the same time, C peptide is less affected by the liver, so C peptide is not high, indicating that there is no obvious abnormality in the secretory function of β cells.

　　2. Fatty liver

　　The mechanism is not yet clear. The characteristics of this complication of hepatitis B are generally good general condition, mild to moderate elevation of ALT, increased blood lipids, fatty liver waveforms visible on B-type ultrasound examination, and diagnosis is based on liver biopsy pathological examination.

　　3. Liver cirrhosis

　　The development of liver cirrhosis from chronic hepatitis is the result of liver fibrosis. The pathogenesis of this complication of hepatitis B has not been fully elucidated. It also occurs in subacute, chronic severe hepatitis, and asymptomatic HBsAg carriers with hidden onset.

　　4. Liver cancer

　　HBV, HCV infection is closely related to the onset of the disease. It is more common in patients with chronic active liver disease and liver cirrhosis who develop liver cancer. It can also be seen in patients with chronic HBV infection that has developed into liver cancer without going through the cirrhosis stage. The mechanism of its occurrence is currently believed to be related to HBV-DNA integration, especially X gene integration.

　　5. Hepatic encephalopathy

　　Hepatic encephalopathy, also known as hepatic coma or hepatic encephalopathy syndrome, is a common complication at the terminal stage of liver cancer in hepatitis B. It is characterized by dysfunction of the central nervous system and metabolic disorders, with intellectual decline, consciousness disorders, neurological signs, and liver damage as the main clinical manifestations, and is also one of the common causes of death from liver cancer, causing about 30% of patients to die.

　　The early symptoms of hepatitis B are generally manifested as loss of appetite, general weakness, aversion to greasy food, nausea, pain in the liver area, jaundice (yellowing of the sclera and skin), liver enlargement (with a sense of fullness) accompanied by tenderness, percussion pain, liver palms, spider nevi, capillary dilation, or a liver face, and in some cases, enlargement of the spleen.

　　1. General symptoms:Mostly manifested as general weakness, lack of energy, easy fatigue, and lack of spirit. Some individuals may also experience insomnia and frequent dreams due to mental stress.

　　2. Gastrointestinal symptoms:The main symptoms are loss of appetite, nausea, aversion to greasy food, discomfort in the upper abdomen, bloating, and so on.

　　3. Jaundice symptoms:Generally manifested as jaundice of the eyes, skin, and urine darkening.

　　4. Liver symptoms:There may be hidden pain in the liver area, located in the upper right abdomen and right costal area discomfort and hidden pain.

　　5. Extrahepatic manifestations:External manifestations such as liver facial appearance, liver palm, and spider nevus may occur in men, and menstrual disorders, amenorrhea, and decreased libido may occur in women.

　　It is estimated that 5% to 10% of acute hepatitis B patients may develop chronic hepatitis. If hepatitis B is not treated in a timely manner, it can lead to many complications. There is currently no completely effective cure for hepatitis B, so preventing hepatitis B is crucial. General preventive measures for hepatitis B virus infection are as follows:

　　1. Control the source of infection

　　The isolation period for patients with all types of acute hepatitis is determined according to the incubation period of each type of viral hepatitis. For asymptomatic HBV and HCV carriers, further detection of various infectious indicators should be carried out, including HBeAg, HBV DNA, anti-HCV, and HCV RNA. Positive individuals should be prohibited from donating blood and engaging in child care work.

　　2. Cut off the route of transmission

　　Prevent the transmission through blood and body fluids. Each blood donor and each unit of blood must be tested for HBeAg and anti-HCV using the most sensitive method. It is strictly forbidden for positive individuals to donate blood and to use positive blood. It is recommended to use disposable injection equipment and acupuncture needles, and reusable equipment must be disinfected by high-pressure or boiling. Equipment that is not heat-resistant can be soaked in 2% glutaraldehyde for 2 hours for disinfection. Use special rinse tools. Wash hands with soap and running water after contacting patients. Maintain good living habits.

　　Before engaging in sexual behavior with someone who is not clear whether they carry the hepatitis B virus, safety precautions should be taken. Proper use of condoms can reduce the chance of infection. Do not use other people's personal items that may come into contact with blood and body fluids, such as toothbrushes (bleeding while brushing teeth), razors, and syringes. Be cautious about blood contact operations such as tattooing, eyebrow tattooing, ear piercing, acupuncture, and mole removal, and especially do not use unsterilized instruments. Try to use 'disposable' (single-use) tools as much as possible. If necessary to contact patients at work, safety measures should be implemented. If there is a possibility of contacting a large amount of patients' blood and body fluids, gloves, face masks, and protective clothing should be worn. You can also use diluted household bleach (1 part bleach to 49 parts water) to disinfect items contaminated with blood.

　　3. Protect susceptible populations

　　All newborns (especially those whose mothers are HBeAg positive) should be vaccinated with recombinant hepatitis B vaccine immediately within 24 hours after birth, and the protection rate is about 85% after 3 injections. HBeAg positive pregnant women should be injected with hepatitis B high-titer immune globulin (HBIG) in the third month of pregnancy, which may play a preventive role in the transmission between mother and child.

　　Many chronic hepatitis B patients do not pay much attention to regular follow-up, always thinking that the development of the disease is not so rapid, or believing that there is no problem as long as there are no symptoms. In fact, chronic hepatitis B patients should have a comprehensive re-examination once every half year to one year. Only by regular follow-up can the development of the disease be monitored as fully as possible, in order to obtain the best treatment opportunities and treatment effects.

　　1. Liver function tests

　　Liver function tests for patients with chronic hepatitis B include multiple indicators. Among them, alanine aminotransferase, aspartate aminotransferase reflect the severity of liver cell necrosis and liver parenchymal damage. Total bilirubin, gamma-glutamyl transpeptidase, and alkaline phosphatase reflect the metabolism and bile stasis of the liver.

　　2. Hepatitis B virus DNA determination

　　Hepatitis B virus DNA quantification directly reflects the replication status and infectivity of hepatitis B virus and can be used to observe the efficacy of antiviral treatment and guide the selection of antiviral drugs.

　　3. Four coagulation tests

　　Some patients with chronic hepatitis B often have mild bleeding when brushing their teeth, or it is difficult to stop bleeding when bleeding occurs due to trauma. While the four coagulation tests effectively reflect the normality of the coagulation mechanism and to some extent reflect the progression of liver disease.

　　4. Blood routine examination

　　Blood routine tests can reflect the hematopoiesis and blood circulation of the liver, and can also indicate whether there is hypersplenism, whether there is concurrent bacterial infection, and even can discover the early signs of many systemic diseases. For patients with chronic hepatitis B undergoing interferon therapy, regular re-examination of blood routine is more important, and only through re-examination of blood routine can further guide interferon therapy.

　　5. Alpha-fetoprotein measurement

　　Alpha-fetoprotein is generally used as a diagnostic indicator for primary liver cancer, and it is of great value in judging the condition and prognosis of liver cancer. Therefore, for chronic hepatitis B patients with more than ten years of history, especially men over 40 years old, the examination of alpha-fetoprotein is very important.

　　The characteristic of chronic hepatitis is the recurrence of the exacerbation and remission of liver inflammation, so the dietary plan should be adjusted according to the status of liver function. During the remission period of chronic hepatitis, liver function tests are close to normal, and there are no obvious gastrointestinal symptoms. At this time, balanced diet is emphasized.

　　1. Provide an appropriate amount of calories.

　　2. Sufficient protein supply can maintain nitrogen balance, improve liver function, and benefit the repair and regeneration of liver cell damage.

　　3. Provide an appropriate amount of carbohydrates: Carbohydrates should provide 50-70% of the total calories. An appropriate amount of carbohydrates can not only ensure the supply of total calories for patients with chronic hepatitis but also reduce the decomposition of body tissue proteins, promote the liver's utilization of amino acids, increase liver glycogen reserves, and enhance the detoxification ability of liver cells.

　　4. Appropriately restrict fat intake: Fat is one of the three major nutrients, and the unsaturated fatty acids it provides are essential nutrients for the body, which cannot be replaced by other foods, so there is no need to limit it excessively. Additionally, consuming an appropriate amount of fat is beneficial for the absorption of fat-soluble vitamins (such as vitamin A, E, K, etc.). Due to the decreased appetite in patients with chronic hepatitis, they often have gallbladder diseases, and their intake of fatty foods is often insufficient. Patients with chronic hepatitis need to consume an appropriate amount of fatty foods, but it is not suitable to limit fat excessively. The daily fat supply should generally be around 40-60g, or about 25% of the total daily energy intake. Patients with chronic hepatitis complicated with fatty liver, hyperlipidemia, or acute onset of cholecystitis should limit fat intake.

　　5. Supplement adequate amounts of vitamins and minerals: Vitamins play an important role in detoxifying liver cells, promoting regeneration, and enhancing immunity. Vitamins are often used as adjuvant treatment drugs for chronic hepatitis. The main way to supplement vitamins is through food, and it is still beneficial to supplement vitamin preparations in cases of insufficient intake. Chronic hepatitis patients are prone to calcium deficiency and osteoporosis. It is necessary to persistently drink milk or take calcium supplements appropriately.

　　6. Abstain from alcohol and avoid intake of substances that damage the liver: Alcohol can cause damage to liver cells, and the detoxification ability of the liver of chronic hepatitis patients decreases. Even a small amount of alcohol can worsen the damage to liver cells, leading to the exacerbation of liver disease. Therefore, hepatitis patients should abstain from alcohol.

　　Hepatitis B is a common infectious liver disease. What are the treatment methods for Hepatitis B?

　　1. Traditional Liver Protection Treatment

　　The most traditional treatment method for the liver that we usually adopt is traditional liver protection treatment, but this method only treats the symptoms and not the root cause. Liver protection can only be used as daily health care, and the virus cannot be suppressed or killed, leading to the liver being eroded by the virus and eventually leading to the deterioration of liver disease, transforming into liver cirrhosis and liver cancer. The drugs are distributed throughout the body and cannot reach the effect of killing the virus.

　　2. Immune Regulation Treatment

　　Immunotherapy is a common method in the treatment of Hepatitis B, usually adopting anti-immune therapy, with a long course of treatment and requiring combined medication. Imbalance of immune regulatory cell ratios or uncontrolled fluctuations of immune regulatory molecules often lead to dysregulation of the body's immune function and can cause diseases.

　　3. Hepatitis B Antiviral Treatment

　　Hepatitis B antiviral treatment is an important step and the core part of treating Hepatitis B. Because only by long-term suppression or elimination of the virus in the body of Hepatitis B patients can the virus in Hepatitis B patients remain stable for a long time. Currently, the main treatment for Hepatitis B in China is antiviral drug therapy and interferon therapy, and drug therapy is mainly used to inhibit the replication of the virus and cannot kill the virus completely or eliminate it. Chronic Hepatitis B patients need to take long-term medication, which is prone to drug resistance, virus gene mutation, and recurrence of the disease.