Guidelines for the prevention and treatment of chronic hepatitis B (2010) (4)

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Six, laboratory examination(a) biochemical examination1 serum ALT and AST levels of serum ALT and AST can generally reflect the degree of li

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Six, laboratory examination

(a) biochemical examination

1 serum ALT and AST levels of serum ALT and AST can generally reflect the degree of liver cell damage, the most commonly used.

2 the level of serum bilirubin is related to the degree of liver cell necrosis, but it needs to be differentiated from the increase of bilirubin caused by intrahepatic and extrahepatic cholestasis. Serum bilirubin in patients with liver failure were increased, rising every day is greater than or equal to 1 times the upper limit of normal (ULN), can be over 10 * ULN; also can appear ALT and bilirubin and AST separation phenomenon.

3 serum albumin reflects the function of the liver, chronic hepatitis B, liver cirrhosis and liver failure patients may have decreased serum albumin.

4 of the prothrombin time (PT) and PTA PT is an important index to reflect the liver coagulation factor synthesis function, said PTA is a commonly used method of determination of PT value, has great value in judging the progression and prognosis in the near future, PTA were below 40% important criteria for the diagnosis of liver failure is one of the 20% < prognosis bad. There is also an international normalized ratio (INR) to express the index, INR value and PTA value of the same significance.

5 cholinesterase can reflect the synthetic function of the liver, to understand the severity of the disease and the development of liver disease reference value.

6 alpha fetoprotein (AFP) AFP increased significantly in HCC, but also can prompt massive liver necrosis after liver cell regeneration, it should be noted that the increment of AFP, ALT, AST and the dynamic changes and the relation of growth, and combined with clinical manifestations of patients with liver ultrasound imaging and imaging examination results comprehensive analysis.

(two) HBV serological test

HBV serological markers include HBsAg, anti -HBs, HBeAg, anti -HBe, anti -HBc and anti -HBc-IgM. HBsAg said HBV positive infection; anti -HBs protective antibody, the positive expressed immunity to HBV in hepatitis B and hepatitis B vaccine rehabilitation; HBsAg negative and anti -HBs positive, that is converted to HBsAg and HBeAg negative serology; anti -HBe seroconversion, said the conversion of HBeAg anti -HBc-IgM serum; expression of HBV replication in acute hepatitis B, but it can also be seen in acute exacerbation of chronic hepatitis B; total anti -HBc antibody is mainly anti -HBc-IgG infection, as long as HBV, regardless of whether the virus is cleared, the antibody is positive.

In order to know whether HBV and HDV have the same or overlapping infection, HDAg, anti -HDV, anti -HDV IgM and HDV RNA can be determined.

(three) HBV DNA, genotype and mutation detection

Quantitative detection of 1.HBV DNA can reflect the level of viral replication, which is mainly used in the diagnosis of chronic HBV infection, the choice of therapeutic indications and the judgment of antiviral effect. The detection value of HBV DNA can be expressed in international units (IU) /mL or copy /mL, according to the different detection methods, 1 IU equivalent to 5.6 copies of [46].

2.HBV genotyping and drug-resistant mutant detection methods commonly used are: (1) genotype specific primers PCR method; (2) restriction fragment length polymorphism analysis (RFLP); (3) linear probes reverse hybridization (INNO-LiPA); (4) gene sequence determination.

Seven, imaging diagnosis

The liver, gallbladder and spleen were examined by ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). The main purpose of imaging examination is to monitor the clinical progress of chronic hepatitis B, to understand whether there is cirrhosis, to find and identify the nature of the space occupying lesions, especially the screening and diagnosis of HCC.

The advantage of 48] (hepatic) is that it has no trauma, simple operation, good repeatability, and can be used to identify the mild fibrosis and severe liver fibrosis (elastography [47). However, the success rate was affected by the factors such as obesity and the size of the intercostal space. The measured values were affected by hepatic steatosis, inflammation, necrosis and cholestasis, and it was not easy to distinguish the two adjacent hepatic fibrosis.

 

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