Individualized treatment of chronic hepatitis B

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What is individualized treatment?Heredity and variation are two basic characteristics of living things. Heredity refers to the similarity be

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What is individualized treatment?

Heredity and variation are two basic characteristics of living things. Heredity refers to the similarity between the offspring and the parent or the parent, and the variation refers to the difference between the offspring and the parent or the parent. As a kind of biological carrier of disease, human beings also have heredity and variation.

Heredity and variation cover human morphology, physiology, histology and immunology..... At all levels and sides. The different levels and sides of heredity and variation determine the common and difference of the same disease. Department of Hepatology, Shanghai public health clinical center, Zhang Zhanqing

As a doctor, it is very easy to know the common points of the disease, but it is very difficult to grasp the difference between them. It needs not only the practical experience of some diseases, but also the related theories and methods.

Group treatment is to ignore the differences in the treatment of patients with known disease, or known type of disease; individualized treatment is based on known or known disease type of disease, treatment of fully considering the difference to vary because of illness and It differs from man to man.

The treatment group belongs to science, treatment methods mentioned in the guide for various professional education courses of different levels of medical and popular in basically belong to group treatment; individualized treatment to the art, is an experienced doctor or have rich clinical research background of doctors in the basic carriers of disease characteristics and disease state holding the individual on the specific treatment plan.

The advanced stage of clinical practice should be the perfect combination of group therapy and individual therapy.

Two, the premise of the implementation of individualized treatment?

The premise of individual treatment is to carry out an accurate and precise assessment of individual patients. The condition assessment usually need to be said that it is difficult to describe in words.

The assessment should take into account the characteristics of the disease vectors, such as gender, age, heredity, personality, social environment, physical condition, economic status, and reproductive needs The state of the disease itself (e.g., viral load, surface antigen titer, E antigen content, viral genotype, pathological grade, and stage) Drug characteristics (e.g., price, efficacy, resistance, tolerability, adverse reactions,...).

Three, how to evaluate the condition of chronic hepatitis B?

(a) a correct understanding of the stage of disease

The natural course of chronic hepatitis B virus infection can be divided into 6 stages.

The first stage: during the immune tolerance phase, the body produces almost no immune response to the virus. Its characteristic is "big three, alanine aminotransferase is less than 40 IU/L, the viral load is greater than 5 x 107

IU/mL, liver histopathology showed no significant inflammation or non significant fibrosis.

The second stage: immune activation period: the body produces insufficient immune response to the virus. Its characteristic is "big three, alanine aminotransferase greater than or equal to 40IU/L, the viral load fluctuations in the (5 * 107 ~ 5 * 102) IU/mL [(5 * 107 at most

(5 *) IU/mL, the liver histopathology showed a gradual progression from non significant or non significant fibrosis to significant / severe / progressive inflammation or significant / severe / progressive fibrosis.

The third stage: immune control period: the body of the virus to produce a full immune response. Its characteristic is "small three", alanine aminotransferase is less than 40 IU/L, the viral load is less than 1.5 * 103

In IU/mL, the histopathological changes of the liver were from progressive / severe / progressive inflammation or significant / severe / progressive fibrosis to non significant or non significant fibrosis.

The fourth stage: the immune reactivation period: the body of the virus to produce an unstable immune response. Its characteristic is "small three", alanine aminotransferase greater than or equal to 40IU/L, the viral load is greater than 1.5 x 103

IU/mL, liver histopathology showed a further aggravation or progression on the basis of inflammatory activity or fibrosis in the control period.

The fifth stage: immune clearance: the body of the virus to produce a full immune response. Its characteristic is "Hui Yang", alanine aminotransferase is less than 40 IU/L, the viral load is less than 5 * 102

In IU/mL, the histopathological changes of the liver were from progressive / severe / progressive inflammation or significant / severe / progressive fibrosis to non significant or non significant fibrosis.

The sixth stage: immune activation of the three: the body of the virus to produce a stable immune response. Its characteristic is "Hui Yang", alanine aminotransferase greater than or equal to 40IU/L, the viral load is greater than 1.5 x 103

IU/mL, liver histopathology showed a further aggravation or progression on the basis of inflammatory activity or fibrosis in the immune clearance phase.

(two) correctly understand the severity of the disease

The 6 stages of the natural history of chronic hepatitis B virus infection, liver histopathological changes experienced three times by the dynamic evolution of light to heavy ", and there are also differences in the performance of each patient's" heavy ": or significant or severe or progressive inflammation, or significant or severe or advanced fibrosis.

(three) correctly understand the connotation of the assessment

To assess the condition to the situation, the severity of the natural history of the disease and disease to determine the disease status.

The natural development of the disease is not a one-way curve, but a number of two-way or multi-directional curve; the severity of the disease is shown as two-dimensional or multi-dimensional curve.

To assess the condition of chronic hepatitis B, familiar with the natural course of chronic hepatitis B virus infection is the basic conditions necessary; more important, at least to judge the severity of the disease from the two basic dimensions of function and morphology.

Four, what is the treatment of chronic hepatitis B?

Reduce the inflammation of the liver necrosis and fibrosis, delay and prevent the progression of the disease, reduce and prevent liver decompensation, hepatocellular carcinoma, liver cirrhosis and its complications, so as to improve the quality of life and prolong the survival time.

Five, the treatment of chronic hepatitis B drugs?

Drug treatment of chronic hepatitis B is widely used in clinic can be divided into four categories: anti-inflammatory, antiviral, direct liver interferon, thymus peptide.

Mainly from liver anti-inflammatory herbs, including cucurbitacin, silymarin, schisandrin B, oleanolic acid, glycyrrhizin, matrine, Chinese medicine in the treatment of chronic hepatitis B with the drug ingredients can be extracted from herbs; synthetic drugs including polyene phosphatidylcholine, phosphorus ademetionine etc..

Direct antiviral are chemical synthetic drugs, including lamivudine, adefovir, entecavir, telbivudine, for tenofuvir ester, belong to the nucleoside (acid) drugs. The antiviral efficacy decreased in the order of Cave, for entecavir and telbivudine tenofuvir ester, lamivudine, adefovir dipivoxil; virus resistance barrier from big to small order for tenofuvir ester, adefovir, entecavir, telbivudine and lamivudine Cave; reproductive toxicity from large to small order for tenofuvir ester telbivudine and lamivudine, adefovir, entecavir Cave.

Interferon, including common interferon and pegylated interferon, is a synthetic drug. In the treatment of chronic hepatitis C, the efficacy of pegylated interferon was significantly higher than that of conventional interferon. The main side effects of interferon were fever, white cell / thrombocytopenia and depression.

Thymus peptide extracted from calf thymus including thymosin and synthetic thymosin, the former for many components, the latter -. Drugs are stable or thymosin regulating immune function of patients, help stabilize the condition; its adverse reaction is not significant.

Six, what drug treatment of chronic hepatitis B effect is better?

At present, the treatment of chronic hepatitis B from the treatment of antiviral therapy to. In other words, the current mainstream treatment for chronic hepatitis B is nucleoside (acid). The main reason is that clinical trials and clinical practice have been confirmed in reducing inflammatory necrosis of liver cells and liver fibrosis, prevent disease and slow progress, nucleoside (acid) more significant effect of drugs and more precise.

The essence of treatment is to inhibit inflammation of the liver, its focus lies mainly in the direct control of the immune response to viral clearance leads to liver damage. The essence of antiviral therapy is to suppress the virus, its focus is mainly through the inhibition of virus replication or reproduction, indirect control lead to immune response of liver injury; however, in the process of antiviral treatment early, viral load decline, resulting in immune response to liver injury can be enhanced.

Interferon treatment can not only inhibit viral replication or reproduction, but also promote the immune response of the virus. The use of interferon therapy is to promote the immune response from the immune system into the immune control period, or from the immune activation into the immune clearance phase. Although the pathogenesis of interferon in chronic hepatitis B, but the main factor is interferon in patients with chronic hepatitis B virus clearance; therefore, in the period of immune activation or immune reactivation in patients, efficacy of interferon therapy and only a few can get stable disease or delay the progression of the disease.

Thymosin can stabilize or regulate the immune response to viral clearance in patients with liver injury, has certain curative effect in stable condition. The specific mechanism of thymosin therapy has not been elucidated, will be listed as thymosin immunopotentiator is not accurate understanding.

Clinical practice and research has shown that hepatoprotective treatment, antiviral therapy, interferon therapy to a certain extent have slow disease progression and prevent cirrhosis and prevent liver decompensation. However, each treatment, each treatment, each treatment can only solve part of the problem of some patients.

Seven, how to treat chronic hepatitis B?

The 6 stages of the natural course of chronic hepatitis B virus infection, in addition to the first stage - immune tolerance period does not require treatment, the other stages of the need for drug treatment.

However, what kind of intervention strategy should be designed according to the needs of the patients, the needs of the disease and the characteristics of the drug. For example, immune activation period, if no significant / serious / advanced / serious / significant inflammation or advanced fibrosis, liver protection therapy can be considered; if there is significant / serious / advanced / serious / significant inflammation or advanced fibrosis, according to the specific needs of patients (such as fertility), the liver or antiviral or interferon treatment.

It should be emphasized that, regardless of the treatment strategy, including the absence of any treatment, no matter how effective, in accordance with the recommendations of the doctor regularly check and follow up the first important. Only check and follow up, to provide doctor with "situation" and "change over time, because things and making" opportunity, of course, but also to create conditions for the patient's "long period of stability" or "long period of stability.

 

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