LuckCong's Health Blog

Ningbo University School of Medicine Affiliated Hospital of Professor liver disease, liver disease Zhejiang Medical Association vice-chairman of the credits will be Dejan Wang With the domestic and foreign research prevention and treatment of hepatitis B and the continuous progress, there is growing awareness of the chronic hepatitis B is a potentially progressive liver disease, if it is not timely and reasonable treatment, some patients will develop liver cirrhosis, And even liver cancer. Among them, particularly in recent years realize that hepatitis B virus replication and extent of the disease situation and progress is the most important independent risk factors. In other words, after a blood test, all a direct reflection of the hepatitis B virus replication of HBV DNA, the higher the concentration, for the development of cirrhosis, liver cancer, the higher the ratio. Therefore, the hepatitis B prevention and treatment guidelines at home and abroad have made it clear that in the comprehensive treatment of chronic hepatitis B, antiviral treatment is the key. China's "Guide" stressed that "as long as there are indications and conditions allow, they should regulate the anti-viral treatment." "Guide" under the impetus of China's treatment of chronic hepatitis B virus into the beginning of a new era of governance, and so have tens of thousands of patients with chronic hepatitis B benefit. However, a variety of reasons, anti-viral treatment in general is not enough standardization, and no more optimized, so that the anti-viral treatment reduced the effect of this is we must attach great importance. In view of the current problems at home and abroad in recent years, sum up new experience, as well as our clinical practice experience in this special on how to optimize the treatment of chronic hepatitis B to emphasize the following points: First, select a patient, have a good grasp of treatment, "the starting point." . Not all chronic hepatitis B patients need anti-retroviral therapy, not all are suitable for patients with chronic hepatitis B antiviral treatment, it is very important. At present, some medical units, and some expansion of the treatment of any medical personnel, would be the normal liver function has been done and liver histology of chronic hepatitis B virus carriers for the blind anti-viral treatment, the results are often difficult to be effective; more Of hepatitis B virus replication marker negative or low concentrations of non-active carriers of hepatitis B surface antigen also completely unnecessary anti-viral treatment, so that they waste a lot of money, and increase the suffering and psychological burden. This is the case, we are experts in out-patient consultations and in common. As a rule by the medical staff, eager to face the medical treatment of patients (actually a lot of patients but not carriers of hepatitis B), if even the most basic need of treatment or the suitability of treatment Dunong not clear, how can you prescribe some medicine? Knowing that if no rule or rule is not suitable to make money but to deliberately carried out the treatment should not be ruled null and void, is the essence of the hepatitis B as a money tree, is even more loss of medical ethics, it is inevitable that doctors said was a "black doctor" . As we all know, need long-term anti-viral treatment, not low cost, for most patients is a heavier burden. As a result, doctors and patients should be in accordance with China's "Guide" provides carefully selected targets of treatment. At present, domestic and international consensus, and recognized China's "Guide" provides a clear indication of the anti-viral treatment, mainly 2: HBV DNA 105 copies / ml (HBeAg negative for the 104 copies / ml); Second, alanine transferase (ALT) or 2 times the normal liver histology significant inflammatory necrosis. 2 master this indication, that is, select the most suitable for the needs of governance and rule of the object, which is to optimize the treatment of hepatitis B is a basic principle. Second, choose the right drug, the implementation of standardized and individualized treatment. On the market today was that anti-HBV drugs more and more, in particular a large number of false advertising and false propaganda, making a lot of doctors and many patients tell who is an effective drug, which is invalid or uncertain Drugs, which are made with no emphasis on fitness. We have seen many patients completely void of useful drugs and even some of the Liver is a very common Chinese medicines, have been disguising themselves as the anti-viral effects, and strange to the patients or carriers to sell high-priced so-called anti - HIV treatment. Of course, the treatment is ineffective, and spent a large sum of money wronged. Some are also strongly recommended some of the therapy is not yet mature, including some of the ongoing clinical trials, such as the treatment of hepatitis B vaccine, according to the provisions can not be any expansion of the scope of the trial, the charges should not be, but through some The legitimate supply channels so that the patient is assumed to be the pilot, assumed the cost. It is this irresponsible attitude. So who has the responsibility of doctors and patients have a rational, and should be fully aware of the current domestic and foreign anti-hepatitis B drug effective progress in the correct information, the most reliable information comes from domestic and foreign authoritative academic organizations issued guidelines for prevention and treatment of hepatitis B or Related guidance documents, most of them of a medical study, the most fully convincing scientific evidence that the evidence of evidence-based medicine, many focused on the mainstream of the collective wisdom of experts. Therefore, is to guide our direct patient services for clinicians continuously update their knowledge of the best teaching materials. At present, most of the information in a number of regular anti-liver to return to the search site, such as "net win over B" (hbver.com) is a very authoritative public can be fully trusted site. At present, at home and abroad were authentic and authoritative academic mainstream and recognized experts unanimously recommended, after the State Drug Administration formally approved the anti-HBV drug treatment, only six categories, and this is the common drugs interferon and interferon long Effect of interferon (pegylated interferon) (PEGASYS, to carry music), the nucleoside analogue drug lamivudine (Lamivudine), adefovir dipivoxil (Howe, who was in lieu of D ), Entecavir (Bo-channel) and telbivudine (than-V). These two types of drugs in six different characteristics, such as the type of interferon, on the whole course of treatment is the relative merits of fixed (generally from 6 months to 1 year), HBeAg seroconversion rate (that is, HBeAg negative, anti-HBe positive change) higher , The effect is relatively durable, less resistance variation; shortcomings of the need for injection is administered, side effects (such as fever, transient drop in white blood caused by bone marrow suppression, etc.), not suitable for those who decompensated liver function. However, long-acting interferon is superior to the general effect of interferon, a weekly injection to 1 (interferon to be an ordinary day, 1 pin). Nucleoside (acid) analogues of the common advantage of oral administration of (an ordinary day, very convenient), inhibited the virus stronger, and slightly fewer side effects and can be used to decompensated liver function; shortcomings course of treatment is relatively National (generally more than 2 years), HBeAg negative serum low, the effect of not lasting long-term application of resistance variation, the drug that may arise after the condition deteriorated. One of the first application of lamivudine, the most abundant experience, have been included in the Medicare drug use, but the rate of resistance variation out on top of the list. Adefovir dipivoxil for those who have lamivudine-resistant effects, but untreated cases of slow onset, not resistance, suitable for long-term treatment. Of which 000 are domestic, on behalf of small low-price, more suitable for low-income patients in the long-term treatment. Telbivudine is listed on the new drug, anti-viral effect is better than lamivudine, lower than the rate of lamivudine-resistant variant, also may have a higher rate of HBeAg seroconversion, but the price is also higher than lamivudine . Entecavir is a nucleoside analogue in the existing curb the virus and strong, while the lowest rates of drug resistance mutation (4 newly diagnosed cases in less than 1. /.) Drugs, but also the most expensive prices, economic conditions are more suitable for long-term Treatment. In short, these two types of medicine are six first-line treatment drug, as long as we fully understand its advantages, disadvantages, in view of the patient's condition (viral load, the level of aminotransferase), conditions (economic, health insurance) and the wishes of the individual, in full and Communication between patients and reasonable under the circumstances in which application of any of the drugs should belong to the right choice. Third, the turning point of good, timely adjustment of treatment strategies. Now the medical profession has proposed a "road map hepatitis B treatment," the concept is meant to give patients anti-retroviral therapy six months (24 weeks), the virus DNA as a decision-making level, to predict the treatment of one year and two years. If the treatment six months when the lower the viral load, and a year for two years when the better effect, the emergence of drug resistance are less likely; six months if the therapy when viral load can not be reduced to a low level, said the existing treatment Program is not satisfactory, you can consider adjusting the treatment strategy. As a result, the beginning of the treatment regardless of which type of program, once implemented should pay attention to be monitored in a timely manner, particularly HBVDNA decline in the speed and range, the faster the rate of decline, the greater the range, the effect of inhibiting the virus, the better, opportunities for drug resistance mutation Will be less. Rule by doctors and patients should attach importance to the outcome of the policy-making decisions, often referred to as the "turning point." Which will enable us to more hearts of the bottom of the treatment. The treatment of hepatitis B road map Fourth, guard against resistance, early detection, early to deal with. Nucleoside analogue to receive long-term treatment of patients with resistant virus have occurred in the possibility of mutation, and with the administration time and increase the ratio. However, different drug resistance mutation probability and a greater time difference, for example, patients treated with lamivudine-resistant mutation occurred in a higher rate, the time may be earlier. In particular the treatment of patients with slow decline HBVDNA often have a higher incidence of early-resistant variant, should be closely observed. HBVDNA through regular review and early detection of the virus rebound, that is, the drop in viral load after recovery is the occurrence of signs of resistance mutations. At this point should be conditional on the virus-resistant variation of the relevant detection and timely treatment to continue to adjust and take control of virus resistance to deal with the corresponding. Of lamivudine resistance can be used to increase the preferred long-term adefovir treatment or combination therapy with adefovir effect after a single treatment to continue; also would be able to entecavir treatment, but need to increase the dosage to 1mg (2 Tablets) / day, but there have been in patients with lamivudine-resistant strains, the occurrence of entecavir a marked increase in the incidence of drug resistance. Adefovir resistance on, plus lamivudine or to switch to entecavir. Of entecavir resistance can be used to increase or switch to adefovir. Of telbivudine resistance can be added adefovir or switch to entecavir. In short, with the increasing Nucleotides drugs, the use of these drugs increase the number of patients, prevention of drug resistance mutations, in particular, early detection, early processing of vital importance. Based on our clinical practice experience in long-term treatment-resistant variation is inevitable, but unlike in the past have been terrible NA me, as long as close monitoring and the right time, and more able to achieve the desired effect. It is always worried about is that a small number of patients, in order to save time and money that he pharmacies to the purchase of medicines, or even six months, more than one year are not reviewed until the deteriorating condition was eager to visit, only one review found that the virus not only indicators rebound Pick-up, liver function and increase the rebound, then re-adjust the treatment more difficult, and certainly an increase of fees. These lessons must be learned. Fifth, adhere to treatment, with full course of treatment, to grasp "the ultimate goal." Research and clinical practice shows that the anti-viral chronic hepatitis B treatment, as in the treatment of high blood pressure, diabetes, the need for long-term treatment in order to maximize the sustained suppression of hepatitis B virus replication in order to achieve progress in disease control, prevention of the occurrence of liver cirrhosis and liver cancer goal . So for every anti-virus treatment of patients, all intended to make long-term treatment, interferon treatment for at least 6 months, it normally takes a year; the treatment of nucleoside drugs, at least 2 years, especially in HBeAg-negative Most want a more long-term treatment. Any treatment must not be interrupted, even go out to meet with the tourism also full of drugs, medication on time. Lv Jian some of our patients, for various reasons, the half-way unauthorized drugs alone, inadequate treatment or early termination of treatment, resulting in relapse and even their problems. For the treatment of "the end", there had been consensus at home and abroad, is to meet the basic requirements of HBV DNA disappeared, normalization of liver function after treatment of the consolidation of more than 1 year, preferably at the same time achieve HBsAg negative, the effect may be more lasting.