Hepatitis C

　　The root cause of hepatitis C is the infection of hepatitis C virus. Under the influence of external factors such as alcohol consumption, fatigue, and long-term use of hepatotoxic drugs, the condition can be promoted. The transmission of hepatitis C virus mainly has five ways:

　　One, Blood Transmission: After receiving blood and blood products infected with hepatitis C virus, post-transfusion hepatitis C can occur, which is the main transmission route.

　　Two, Sexual Transmission: Hepatitis C patients can be transmitted through sexual contact, which also belongs to a type of body fluid transmission. Kissing can also transmit the virus, and there is also a possibility of infection if the oral mucosa is damaged. Currently, mosquito bites are not confirmed as a transmission route for hepatitis C.

　　Three, Mother-to-child Transmission: The mother-to-child transmission of hepatitis C includes two aspects: vertical transmission and horizontal transmission. The probability of infection during intrauterine transmission and during pregnancy in the fetus is not high, mainly due to horizontal transmission during perinatal period and close contact after birth. As a hepatitis C mother, the child has a high possibility of infection after birth.

　　Fourth, nosocomial transmission: In the process of hospital examination and treatment, infection may occur due to the use of medical instruments that have not been strictly disinfected and repeatedly used, which are contaminated with HCV. This is called nosocomial transmission, including surgery, dental instruments, blood collection needles, acupuncture needles, and endoscopes, etc.

　　Fourth, nosocomial transmission: In the process of hospital examination and treatment, infection may occur due to the use of medical instruments that have not been strictly disinfected and repeatedly used, which are contaminated with HCV. This is called nosocomial transmission, including surgery, dental instruments, blood collection needles, acupuncture needles, and endoscopes, etc.

　　If hepatitis C is not treated in time, a series of serious complications may occur, which can cause serious harm to patients and even lead to death.

　　1. Liver cirrhosis and liver cancer. Hepatitis C is the main cause of liver cirrhosis, and thus also the main pathogenic factor for liver cancer. Up to 20-30% of patients with chronic hepatitis C eventually develop liver cirrhosis and liver cancer.

　　2. Endocrine diseases. Hepatitis C has a higher risk of causing diabetes; it is also prone to complications with thyroid function changes, common thyroid function abnormalities include: hypothyroidism, hyperthyroidism, Hashimoto's disease, increased antithyroid antibodies, and autoimmune thyroiditis, etc.

　　3. Renal diseases. 50% of patients may show mild to moderate renal insufficiency. Hypercoagulability, thyroid dysfunction, vitamin D deficiency, and hyperlipidemia may also be present.

　　4. Skin complications. Chronic hepatitis C can lead to skin complications, such as cryoglobulinemia, urticaria, erythema multiforme, nodular erythema, etc., with cryoglobulinemia being the most common.

　　5. Hepatic encephalopathy. Hepatic encephalopathy may occur in the late stage of liver cirrhosis in hepatitis C, and it is the most common cause of death.

　　6. Large amounts of upper gastrointestinal bleeding. In the late stage of liver cirrhosis in hepatitis C, upper gastrointestinal bleeding is mostly due to the rupture of esophageal-gastric varices, but there are also other factors, such as concurrent peptic ulcers, portal hypertension-related gastritis, acute erosive gastritis, and Mallory-Weiss syndrome.

　　Hepatitis C can be divided into acute hepatitis C, chronic hepatitis C, and liver cirrhosis in clinical practice, with different symptoms.

　　1. Acute hepatitis C

　　Acute hepatitis C in adults is relatively mild, with most cases being acute nonicteric hepatitis, characterized by elevated ALT levels. A few cases are acute icteric hepatitis with mild to moderate jaundice. Symptoms may include nausea, decreased appetite, general weakness, jaundice, and dark urine. Hepatitis C virus infection alone rarely causes liver failure. In a natural state, only 15% of patients can spontaneously clear HCV and achieve recovery, while 85% of patients develop chronic hepatitis C without antiviral treatment intervention; 50% of children with acute hepatitis C infection can spontaneously clear HCV.

　　2. Chronic hepatitis C

　　The symptoms are relatively mild, manifested as common symptoms of hepatitis, such as easy fatigue, poor appetite, abdominal distension, etc. It can also be asymptomatic. ALT levels fluctuate repeatedly, and HCVRNA remains positive. One-third of chronic HCV infections have normal liver function, with persistent positive anti-HCV and HCVRNA, and liver biopsy shows chronic hepatitis, even cirrhosis may be found.

　　3. Hepatitis C cirrhosis

　　After 20-30 years of infection with HCV, 10% to 20% of patients may develop liver cirrhosis, and 1% to 5% of patients may develop hepatocellular carcinoma (HCC) leading to death. Once liver cirrhosis appears with decompensation, such as jaundice, ascites, rupture of varices with bleeding, and hepatic encephalopathy, the survival rate will drop sharply.

　　Hepatitis C is an infectious disease, so the prevention methods for hepatitis C are the same as those for preventing other infectious diseases, including controlling the source of infection, cutting off the route of transmission, and protecting susceptible populations.

　　1. Perform anti-HCV screening on blood donorsIt is an important measure to reduce post-transfusion hepatitis C.

　　2. Manage the source of infection

　　Isolate patients according to hepatitis types, use disposable medical supplies; publicize the knowledge of prevention and treatment of hepatitis C, and comply with the disinfection and isolation system.

　　3. Cut off the route of transmission

　　Medical devices should be disinfected after single use, and disposable medical supplies should be used; strictly control the indications for blood transfusion, plasma, and blood products; ensure the quality of blood and blood products.

　　4. Protect susceptible populations

　　There are reports that using immunoglobulin to prevent hepatitis C is effective, with a dosage of 0.06ml/kg, intramuscular injection. Ultimately, the prevention of this disease relies on vaccine prevention, and the successful cloning of HCV has provided conditions for the vaccine prevention of the disease.

　　To diagnose whether it is hepatitis C, some examinations need to be done.

　　1. Liver function: Includes serum ALT, AST, total bilirubin, direct bilirubin, indirect bilirubin, albumin, globulin, cholinesterase, alkaline phosphatase, transpeptidase, and others.

　　2. Hepatitis C virus antibody: Anti-HCV.

　　3. Quantitative hepatitis C virus: Serum HCVRNA, to understand the activity of hepatitis C virus replication.

　　4. Imaging: Includes abdominal color Doppler ultrasound of the liver, gallbladder, and spleen to understand whether there is chronic liver damage. In necessary cases, perform abdominal enhanced CT or MRI to understand the extent of the disease damage.

　　5. Liver transient elastography (Fibroscan): It is a non-invasive examination that can be used to assess the degree of liver fibrosis in patients with chronic hepatitis C. Assessing the degree of liver fibrosis in hepatitis C patients is very important for determining the treatment plan.

　　6. Liver tissue biopsy: It is still the gold standard for evaluating the grade of liver inflammation and the stage of fibrosis in patients.

　　Due to the pathological changes in the liver of hepatitis C patients, they need to follow some special dietary principles.

　　Abstain from alcohol

　　Alcohol is a great taboo for patients with liver disease, and excessive drinking can also cause liver damage in healthy people.

　　Less 'Fat'

　　Hepatitis C patients should maintain their weight within the normal range. It is better to eat less of high-fat foods such as butter, cheese, other dairy products, edible oils, meats, nuts, desserts, etc.

　　Less 'Sugar'

　　Excessive sugar intake may lead to fatty liver, and the metabolites of sugar will increase the burden on the liver and are easy to cause gastrointestinal bloating. It is recommended that hepatitis C patients supplement the lack of sugar by eating more fruits.

　　Less 'Iron'

　　Hepatitis C patients sometimes have difficulty in excreting iron, and excessive iron is very harmful to the liver. Therefore, hepatitis C patients should limit high-iron foods such as animal livers, and avoid using iron cookware.

　　Less 'Medication'

　　The liver is a filter and detoxifier for drugs, whether it is traditional Chinese medicine or Western medicine, it will cause varying degrees of damage to the liver. Therefore, medication must be under the guidance of a professional doctor.

　　Hepatitis C is caused by the hepatitis C virus, and the main treatment method is to use interferon to inhibit the virus.

　　1. Interferon (IFN)

　　The sustained response rate of interferon in the treatment of post-transfusion chronic hepatitis C is 25%, and it can prevent 30% of acute hepatitis C from developing into chronic. To date, interferon is still recognized as the drug for treating hepatitis C virus.

　　2. Alpha-interferon (α-IFN)

　　Alpha-interferon therapy for chronic hepatitis C has certain efficacy. The rate of HCV RNA becoming negative in serum after treatment can reach 50% to 80%, but about half of the HCV RNA becomes positive again after stopping the drug, and alpha-interferon is still effective. Improvements in liver function and liver lesions can be seen at the same time as the negative conversion of HCV replication indicators. This suggests that interferon has an inhibitory effect on HCV but cannot completely clear the virus. The recurrence time is mostly within 6 to 12 months after treatment. If ALT remains normal for 12 months after treatment, and the serum HCV RNA is negative, it may be cured.

　　3. Ribavirin (Virazole)

　　Ribavirin is a broad-spectrum antiviral drug, and its efficacy in treating chronic hepatitis C is not as good as interferon. It has no significant effect on the reduction of HCV-RNA in serum and liver.

　　4. Liver Transplantation

　　Advanced chronic hepatitis C can be treated with liver transplantation. However, the newly transplanted liver often occurs HCV infection, which is caused by the transmission of HCV outside the liver, and acute fulminant hepatitis may also occur.