The big three

　　It is generally believed that the infectivity of the big three is relatively strong, and the possibility of developing chronic hepatitis B is also relatively high. Then, what are the causes of the big three?

　　1. Familial transmission

　　Including two forms of vertical transmission from mother to child and from father to child, especially the vertical transmission from mother to child is more common.

　　2. Viral infection during infancy

　　Studies have shown that once a fetus or neonate is infected with the hepatitis B virus, 90% to 95% will become chronic virus carriers; after being infected with the hepatitis B virus during childhood, about 20% will become chronic virus carriers; and after adults are infected with the hepatitis B virus, only 3% to 6% will develop into chronic virus carrier status.

　　3. Missed diagnosis

　　Acute hepatitis without jaundice that develops insidiously is more likely to progress to chronic than acute jaundice hepatitis. This is related to the fact that patients with non-jaundice hepatitis are often misdiagnosed or missed, resulting in timely diagnosis, treatment, and rest.

　　4. Patients with low immune function infected with the virus

　　Patients who have undergone renal transplantation, tumor, leukemia, AIDS, or hemodialysis are often prone to develop chronic hepatitis after infection with the hepatitis B virus. Patients who use immunosuppressants such as adrenal corticosteroids during the acute phase of hepatitis B often disrupt the immune balance within the body, making it easy for acute hepatitis to become chronic.

　　5. Patients with a history of other liver diseases infected with the virus

　　If the patient has pre-existing alcoholic liver disease (alcoholic hepatitis, fatty liver, alcoholic cirrhosis, etc.), schistosomiasis, malaria, tuberculosis, and is reinfected with the hepatitis B virus, it is not only easy to become chronic hepatitis but also has a poor prognosis. Other factors, such as excessive fatigue in acute hepatitis patients, excessive alcohol consumption, excessive sexual activity, drug abuse, the use of drugs that damage the liver, malnutrition, severe infections with other pathogenic microorganisms, or drug abuse, can also cause acute hepatitis to become chronic.

　　6. Lack of preventive awareness

　　The hepatitis B vaccine has been available for nearly 20 years and is the best measure to block vertical transmission of hepatitis B. However, due to poor economic conditions and lack of preventive awareness, especially the latter, the hepatitis B vaccination program in China has not been carried out ideally. Up to now, only less than half of the population has been vaccinated against hepatitis B. This makes it difficult to prevent hepatitis B effectively, and the number of chronic cases is increasing.

　　HBV '大三阳' not only causes liver damage but also triggers a series of complications in the body.

　　1. Hepatorenal syndrome

　　This is mainly caused by a large amount of ascites during the decompensation phase of the liver, leading to insufficient effective blood volume and reduced glomerular filtration function.

　　2. Hepatic diabetes

　　This is mainly due to liver damage in patients with HBV '大三阳', leading to impaired carbohydrate metabolism, which can easily cause the liver's ability to inactivate insulin to decrease, promoting insulin levels to rise, which often triggers the appearance of diabetes in patients.

　　3. Hepatic encephalopathy

　　Also known as hepatic coma or hepatic encephalopathy syndrome, it is a common complication in the terminal stage of liver cancer. Characterized by dysfunction of the central nervous system and metabolic disorders, it is primarily manifested by intellectual decline, consciousness disorders, neurological signs, and liver damage. It is also one of the common causes of death in liver cancer, accounting for about 30% of patient deaths.

　　4. Primary liver cancer

　　If the condition of HBV patients is not controlled in time, it may develop towards liver cirrhosis and liver cancer. Patients may experience liver pain, liver enlargement, ascites, and may eventually develop into liver cancer.

　　The presence of '大三阳' often indicates active viral replication within the body, but patients may have no symptoms.

　　1. Chronic HBV carriers often have no symptoms, commonly in an immune tolerance phase. Apart from the presence of '大三阳' and positive viral detection, other growth indicators and even pathological indicators are normal. During this period, although no medication is required, regular testing and observation are necessary to detect disease progression in a timely manner. Studies on carriers also show that a small number of carriers, although with normal liver function, still show a progressive course of the disease. After several years, they may also progress to hepatitis, liver cirrhosis, and even liver cancer. Therefore, regular follow-up and timely intervention are required to detect disease progression.

　　2. Chronic hepatitis B: According to the condition, it can be divided into mild, moderate, and severe three types.

　　Mild: The condition is relatively mild, with recurrent symptoms such as fatigue, dizziness, decreased appetite, dislike of greasy food, jaundice, discomfort in the liver area, poor sleep, slightly enlarged liver with mild tenderness, and mild splenomegaly. Some cases may have no symptoms or signs. Liver function indicators are only slightly abnormal in 1 or 2 items.

　　Moderate: Symptoms, signs, and laboratory findings are between mild and severe.

　　Severe: There are obvious or persistent symptoms of hepatitis, such as fatigue, loss of appetite, abdominal distension, jaundice, loose stools, etc., accompanied by liver disease facial appearance, liver palm, spider angioma, splenomegaly, recurrent or persistent elevation of ALT and/or aspartate aminotransferase (AST), decreased albumin, and significantly elevated gamma globulin.

　　If the hepatitis B three positives indicate that the hepatitis B virus has been infected, how should one prevent it?

　　1. Avoid iatrogenic hepatitis B three positives, mainly not going to places with poor medical conditions for ear piercing, dialysis, eyebrow tattooing, tattooing, facial hair removal, foot care, etc. If medical instruments contaminated with hepatitis B virus are used and not properly handled, it can cause iatrogenic hepatitis B.

　　2. Avoid the blood of hepatitis B three positives, avoid injecting infected hepatitis B virus blood, plasma, blood products, and avoid hepatitis B blood.

　　3. Try to reduce the mother-to-child transmission of hepatitis B three positives. When hepatitis B three positives women are planning to have children, they should pay attention to ensure that liver function is normal and the hepatitis B virus DNA is within the normal range, which can reduce the possibility of transmission to the child. At the same time, patients should also do a good job in hepatitis B mother-to-child prevention and interception to avoid the occurrence of hepatitis B three positives mother-to-child transmission.

　　4. If there is contact with the body fluids such as saliva, sweat, tears, breast milk, and secretions of a hepatitis B three positives patient, there is also a possibility of transmission. Therefore, it is necessary to avoid these phenomena. Healthy individuals should maintain good hygiene habits in daily life and can also prevent the transmission of hepatitis B three positives by ensuring the production of hepatitis B antibodies in the body through hepatitis B vaccine injection.

　　Laboratory tests must be based on the objective materials obtained from medical history and physical examination for summarization and analysis. From this, several possible diagnoses are proposed, and then further consideration is given to which laboratory tests should be performed to confirm the diagnosis.

　　1. Hepatitis B two pairs and half test

　　In the hepatitis B three positives test, the surface antigen (HBsAg), e antigen (HBeAg), and core antibody (HBcAb) are positive, while others are negative. This is known as hepatitis B three positives. The hepatitis B two pairs and half test is a preliminary examination to determine whether a person is infected with hepatitis B or to roughly estimate the level of viral replication.

　　2. Liver function tests

　　It is necessary to regularly perform liver function tests. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin are the most commonly used indicators in liver function tests, which can reflect the degree of liver damage.

　　Firstly, the normal values of alanine aminotransferase (ALT) in the liver function test are (0-40 U/L) and aspartate aminotransferase (AST) are (0-45 U/L). If the results of the liver function test show that these two items exceed the normal values, it indicates that there is abnormality and damage to the liver function. Then, total bilirubin is a test of the liver's ability to excrete certain endogenous or exogenous high-absorption substances.

　　3. HBV-DNA testing

　　HBV-DNA testing for chronic hepatitis B with '大三阳' can reflect the amount of hepatitis B virus in the body. If DNA is positive, it indicates a higher viral load in the body, with a higher degree of infectivity. It is necessary to carry out comprehensive treatment in a timely manner to suppress the viral load and control the spread of infection.

　　4. Ultrasound examination

　　Ultrasound examination can assist in the diagnosis of liver injury degree and the presence of substantial lesions, among other things.

　　During the remission period of chronic hepatitis, the liver function examination is close to normal, and there are no obvious gastrointestinal symptoms. At this time, it is emphasized to have a balanced diet.

　　1. Supplement adequate protein, generally higher than that of healthy people. Among them, high-quality protein should account for 50%, such as milk, eggs, lean meat, aquatic products, tofu, etc.

　　2. Fat intake should be moderate. Consume vegetable oils, avoid animal fats, and control the intake of cholesterol.

　　3. Appropriately supplement human energy. Control daily energy intake between 2000-2500 kcal, as moderate energy can save protein consumption, enhance physical strength, promote the regeneration and repair of liver cells, and avoid excessive energy intake, which may cause weight gain and induce fatty liver.

　　4. Vitamins, especially vitamin A, B-group vitamins, and vitamin C.

　　5. Appropriately increase the intake of carbohydrates. You can supplement pure sugar foods such as sugar, glucose, and candy in moderation.

　　6. Choose fresh and non-contaminated green food, eat less processed food, and avoid moldy and various deteriorated food.

　　7. Eat less fried, baked, smoked, and roasted food, and use more steaming, boiling, braising, stewing, blanching, and stir-frying cooking methods.

　　One: Antiviral treatment for chronic hepatitis B with '大三阳'

　　Currently, the main treatment for chronic hepatitis B with '大三阳' is antiviral therapy, with commonly used antiviral drugs including interferon, nucleoside drugs, and immunomodulators. Interferon is the main drug for antiviral treatment due to its definite antiviral efficacy, as well as its ability to prevent liver fibrosis and reduce the incidence of liver cancer.

　　1. The liver function of patients with chronic hepatitis B remains normal

　　Most patients with chronic hepatitis B, often referred to as '大三阳', have a good prognosis and generally do not require treatment. At this stage, medication is difficult to be effective, and it is more recommended to combine nourishment and follow-up, balancing work and rest, and not to overuse medication for treatment and to strictly require the conversion of the three positive results to negative. Various antiviral drugs may be difficult to make any significant contribution.

　　2. Liver function is slightly abnormal in patients with hepatitis B大三阳

　　In this case, antiviral therapy is the main treatment, mainly for nucleoside drugs, with auxiliary drugs being liver-protecting and enzyme-lowering drugs. The goal is to maintain normal liver function for a long time, become negative for hepatitis B virus replication, and the course of treatment is 1-2 years.

　　3. Serum bilirubin and transaminase levels are significantly elevated in patients with hepatitis B大三阳

　　At this time, the treatment should be carried out simultaneously with liver protection, prevention of liver necrosis, and antiviral therapy, with the goal of gradually balancing liver function and gradually becoming negative for hepatitis B virus replication. After liver function is balanced, the dosage of drugs can be reduced or stopped, and antiviral therapy should be continued.

　　4. B-ultrasound of patients with hepatitis B大三阳 indicates liver cirrhosis

　　In this case, treatment should be carried out simultaneously with antiviral and antifibrotic therapy, with the goal of negative viral replication, reduced degree of liver fibrosis, and prevention of complications (ascites, pleural effusion, hemorrhage, infection, etc.) and recovery of liver function.

　　Second, treatment for hepatitis B大三阳 through enhancing immunity

　　The hepatitis B virus can exist in the blood and liver cells. The hepatitis B virus does not directly damage the liver but causes liver cell damage during the process of clearing the hepatitis B virus when the body's immune system detects the hepatitis B virus. It is difficult for ordinary drugs to kill the hepatitis B virus directly, and it is necessary to mobilize the function of the human immune system to clear the hepatitis B virus. At present, most antiviral drugs have the effect of regulating immune function, but traditional Chinese medicine has a more significant effect on conditional immune function.

　　1. Thymosin: Enhances T cell activity by affecting cAMP. The dosage is 10-20mg per day, intramuscular or intravenous infusion, for 2-3 months.

　　2. Interleukin-2 (IL-2) can stimulate the proliferation of immune effector cells and induce γ-interferon. The dosage is 1000-2000U per day, intramuscular injection, once a day, for 28-56 days. HBeAg becomes negative in some patients.

　　3. Lymphokine-activited Killer Cells (LAK cells), obtained by stimulating their precursor cells with lymphokines (such as IL-2 and γ-IFN). Chinese reports show that it can make HBeAg and HBV-DNA negative in some patients.