Hepatitis B is a chronic infectious disease caused by hepatitis B virus (HBV), which spreads through blood and body fluids. Its clinical manifestations are diverse, including acute, chronic, cholestatic and severe hepatitis, which is easy to develop into chronic hepatitis and cirrhosis, and a few cases can be transformed into primary liver cancer. The disease is widespread in China, the infection rate is 60%, and the HBsAg positive rate is 10- 15%. It is the most serious infectious disease that harms people's health at present.
Transmission route of hepatitis B
1. Blood-borne transmission: accepting blood or blood products contaminated by hepatitis B virus.
2. Mother-to-child transmission: Hepatitis B virus can be transmitted through placenta (intrauterine transmission) or through birth canal during delivery (perinatal transmission).
3. Iatrogenic transmission: If medical devices are contaminated by hepatitis B virus without disinfection or improper treatment, it can cause transmission.
4. Sexual contact and transmission: promiscuity between husband and wife, same-sex contact and unprotected sex life.
5. Close contact and transmission: The blood, semen, vaginal secretions and milk of hepatitis B patients or carriers may contain hepatitis B virus, which can pollute utensils and articles and is contagious.
Two-and-a-half hepatitis B examination
There are three pairs of immunological markers of hepatitis B virus, which are surface antigen (HBsAg) and surface antibody (anti-HBs or HBsAb), e antigen (HBeAg) and e antibody (anti-HBeAg or HBeAb), core antigen (HBcAg) and core antibody (anti-HBc or HBcAb). Because the core antigen is not easy to be detected in blood, the kit is not enough at present, and there are still two semi-antigen antibodies, which are often called "two and a half" tests for hepatitis B or "five tests for hepatitis B". The five clinical meanings of hepatitis B are as follows:
1. Hepatitis B surface antigen: It is the coat protein of hepatitis B virus and is not contagious, but its appearance is often accompanied by the existence of hepatitis B virus, so it is a sign that it has been infected with hepatitis B virus. From 2 months to 6 months after hepatitis B virus infection, positive results can be detected in serum from 2 weeks to 8 weeks before alanine aminotransferase increases. Its appearance shows that it is an acute hepatitis B patient or pathogen carrier. Most patients with acute hepatitis B can turn negative in the early stage of the disease, and the surface antigen of patients with chronic hepatitis B or virus carriers can continue to be positive.
2. Hepatitis B surface antibody: it is an immune protective antibody against hepatitis B virus. Its positive indicates that it has been infected with hepatitis B virus in the past, but the virus has been excluded, or it has been vaccinated with hepatitis B vaccine and produced protective antibodies. The higher the HBsAg titer in serum, the stronger the protection. However, there are also a few people who are positive for hepatitis B surface antibody and suffer from hepatitis B, which may be caused by infection or variation of different subtypes of hepatitis B virus.
3.e antigen: E antigen can be detected in patients with acute and chronic hepatitis B, and its positive indicates that hepatitis B virus is actively replicated in the body and highly contagious.
4.e antibody: Its positive indicates that the patient's infectivity is reduced and the virus replication is reduced or alleviated. There are also individuals who are positive for E antibody, and their illness is prolonged, mostly caused by infected with mutated hepatitis B virus.
5. Core antibody: Its high titer indicates that hepatitis B virus is replicable and contagious, which can last for several years to decades. The low titer of core antibody indicates that you have been infected with hepatitis B virus in the past.
How to read the test sheet (hepatitis B triple test, liver function test)
Hepatitis B triple test (representing the virus situation in the body)
1. surface antigen
2. Surface antibody
3.E antigen
4.E antibody
5. Core antibody
The positive items of A 1, 3, and 5 indicate that the virus is infected with Dasanyang, and the virus replicates quickly and is contagious.
B 1, 4, 5 positive indicates that Xiao Sanyang is infected, and the virus replication is slow and less contagious.
C 2 positive items alone indicate that you have been infected with hepatitis B or injected with hepatitis B vaccine.
D 1, 5 or 4, 5 is positive, indicating that it is infected or recovering. The specific analysis depends on the condition.
E 1 3 is positive, which means that it is infected and should be treated in time.
(2) Liver function test (representing the changes of the liver itself)
Project unit reference range
Total protein: grams/liter 60-83.
Albumin G/L 35-53
Globulin: G/L 25-33
Alanine transaminase U/L 0-40
Aspartate aminotransferase U/L 0-50
Total bilirubin umo/l 0-20
Direct bilirubin umo/l 0.0-6.0
Clinical significance of laboratory indexes of liver function;
Usually, the indexes of liver function examination in hospitals include alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ -glutamyltranspeptidase (GGT), albumin/globulin (A/G), total bilirubin (T-Bil) and direct bilirubin (D-Bil). ALT and AST are mainly distributed in hepatocytes of the liver. ALT and AST will increase if hepatocytes are necrotic, but the distribution of these two enzymes in hepatocytes is different. ALT is distributed in the cytoplasm of hepatocytes, while AST is distributed in the cytoplasm and mitochondria of hepatocytes. Acute hepatitis and mild chronic hepatitis are mainly characterized by elevated ALT, so AST/ALT；; 1 even > 2. Alkaline phosphatase and GGT in patients with cholestatic hepatitis and extrahepatic obstruction increased significantly, while GGT in patients with alcoholic hepatitis increased significantly. Albumin is produced in the liver. When liver function is damaged, albumin production decreases, while globulin is produced by the immune organs of human body. When there are "enemies" in the body, the production of globulin will increase. Therefore, due to the decline of liver function, albumin production in patients with chronic hepatitis decreases, and because of the "enemy" of hepatitis virus in the body, globulin production increases, leading to the inversion of A/G ratio. When hepatocytes are damaged, the metabolism and excretion of bilirubin are impaired, so both T-Bil and D -Bil are increased.
What are "big three yang" and "small three yang"
Liver function test 1, 3, 5 are positive, which belongs to "Big Three Yang", that is, surface antigen (HBsAg), E antigen (HBeAg) and core antibody (HBcAb) are positive at the same time. HBeAg(+) exists in these patients, suggesting that hepatitis B virus is active in replication (reproduction) and highly contagious. These patients are also divided into two situations: one is patients with normal liver function, which shows that although these patients are active in the body, they have not caused serious liver damage. These patients can work and study normally. Because of its active virus replication, liver function should be checked frequently, and once abnormality is found, it can be treated in time, and immunotherapy and antiviral treatment should be carried out under the guidance of doctors. The other is patients with abnormal liver function. These patients are not only highly contagious, but also have obvious liver damage. For this kind of patients, first of all, we should actively treat abnormal liver function, add immunomodulatory treatment on the basis of liver-protecting substances, and pay attention to rest. Without good treatment, patients can easily develop cirrhosis. Secondly, when the liver function is stable, the doctor decides whether to use antiviral drugs. Also, because of its strong infectivity, close relatives, spouses and children should also be vaccinated against hepatitis B.
Liver function test 1, 4, 5 positive, belonging to "small three positive", that is, surface antigen (HBsAg), e antibody (HBeAb) and core antibody (HBcAb) were positive at the same time. Compared with patients with big three-yang disease, the virus replication in patients with small three-yang disease changed from active to static, and the amount of virus in blood also decreased significantly, and the infectivity decreased relatively, and the condition began to improve. For patients with "small three yang", we should also distinguish between two situations. One is that the liver function is normal for a long time (check the liver function every three months for 2 ~ 3 years), which is called "stable small three yang". This is a good outcome for hepatitis B surface antigen carriers or patients with acute hepatitis B. They can be regarded as healthy people, and generally will not develop into chronic hepatitis B patients and are not contagious. The second situation is that liver function tests are often abnormal, sometimes good or bad, which is called "unstable little three yang"; This is mainly due to the variation of hepatitis B virus. When liver function is abnormal, it should be treated as hepatitis, which is also highly contagious.
Pathogenesis of hepatitis B
The pathogenesis of hepatitis B is a complex problem, which has not been fully clarified so far. Scholars at home and abroad have done a lot of research on this, and the results show that the liver injury of patients with hepatitis B is not the direct result of the reproduction of hepatitis B virus in liver cells, but the immune response of the body. After hepatitis B virus infects human body, it can stimulate the body to produce various cellular immune responses and humoral immune responses against hepatitis B virus, and stimulate autoimmune responses to cause immune regulation dysfunction. These immune responses can not only remove infected hepatocytes, but also cause liver cell damage, thus leading to different types of pathological changes and clinical outcomes.
After children are infected with HBV, due to imperfect immune function, they often lack the above immune response, leading to hepatitis B virus carrying status or chronic hepatitis. Most adult patients infected with hepatitis B virus can cause the symptoms of acute hepatitis through the above-mentioned immune response, and at the same time remove the hepatitis virus.
What is the "Australian Resistance Movement"
The full name of "Aokang" is Australian antigen, which is one of the immune indicators of hepatitis B virus, also known as hepatitis B surface antigen (HBsAg). Because it was first discovered in Australia, it was called "Aokang".
Problems that carriers of hepatitis B surface antigen should pay attention to
In addition to not donating blood, carriers can work and study as usual, and generally do not need treatment, but the following points must be noted:
(1) Check regularly (from March to June), including liver function, B-ultrasound, AFP, white blood cells and platelets. Once an abnormality is found, it needs to be handled according to different situations. Although the liver function test is normal, we should also pay attention to hepatosplenomegaly or leukopenia and thrombocytopenia. Carry out necessary treatment;
(2) avoid alcohol;
(3) live a regular life, don't be too tired;
(4) Pay attention to personal hygiene and menstrual hygiene to prevent saliva and blood from polluting the surrounding environment and infecting others. Tableware, scraper shaving appliances, toothbrushes and toiletries used should be separated from others;
(HBeAg positive or HBVDNA positive people should not engage in direct contact with imported food, tableware and babies. We should know that some asymptomatic HBsAg carriers may have inflammation in the liver, which is actually chronic hepatitis; Some carriers may get sick at some time, and carriers of mother-to-child transmission often get sick around puberty. It is generally believed that carriers over the age of 30 are less likely to get sick.
What are the restrictions for carriers of hepatitis B surface antigen?
Because people's understanding of HBsAg carriers is not comprehensive enough, some young people with HBsAg carriers have various problems in further education, employment, marriage and even going abroad. In fact, some problems are not that serious. Hepatitis B surface antigen carriers account for about 10% of China's total population, among which there are many scientists, famous actors and excellent athletes who win glory for our country. Except for some studies, such as kindergarten teachers, nurses, catering services, further studies, employment, and even going abroad, there should not be too many restrictions. This is because hepatitis B is mainly transmitted through blood, occasionally through saliva and semen, and it is unlikely to spread to others through ordinary contact in daily life. As for marriage, as long as the other party is anti-HBs or HBsAg positive, there is no problem of mutual infection. If the other person's signs of hepatitis B are all negative, it is recommended to get married after injecting hepatitis B vaccine.
Why are some transaminase normal and some abnormal in patients with "Xiao San Yang"
Small three-positive patients refer to HBsAg(+), anti-HBc(+) and anti-HBe(+) patients. It is generally believed that virus replication is inactive and not contagious. But the liver injury of hepatitis B does not depend on whether the virus is active or not, but on how the patient's own immune system treats hepatitis B virus. If you live in peace with the virus, you won't cause liver damage and your liver function will be normal. If you "fight" the virus, you will destroy liver cells and cause abnormal liver function. If the virus is effectively removed in the "battle", it will fully recover. In the "battle", only liver cells are destroyed, which is not conducive to the "killing" of the virus and develops into chronic hepatitis, resulting in long-term abnormal liver function.
E antibody positive is not necessarily good?
There may be two cases: e antigen positive and e antibody positive. One is that HBVDNA turns negative as E antigen turns negative, and then the liver function is normal. It is generally considered that the prognosis is good and non-infectious. In another case, e antigen turns negative and e antibody turns positive, but HBVDNA is still positive, or HBVDNA in blood is negative but HBVDNA in liver tissue is still positive. Although the virus replication has decreased, it is still replicating, contagious, the liver is still damaged and the disease is still developing. Therefore, it is not necessarily a good thing for E antibody to turn positive. In addition, there is another variant of hepatitis B virus, which never appears E antigen positive, but HBVDNA continues to be positive, indicating that the virus has never declined, and this type of hepatitis B is more harmful to people.
Problems that hepatitis B virus carriers should pay attention to when they enter school and get employment.
Hepatitis B is less contagious, and it is not easy to be infected by general contact. Therefore, patients with hepatitis B can enter school and work normally as long as their physical conditions permit. However, when choosing a career, it should be noted that it is not suitable for catering, child care and other jobs, and other occupations can participate. Schools and units should not refuse to accept these people to enter school or work because of HBsAg(+).
How to distinguish hepatitis B virus carriers from chronic hepatitis B
The main difference between hepatitis B virus carriers and chronic hepatitis is that the former does not cause or rarely causes liver cell damage, while the latter causes liver cell damage and shows abnormal liver function and corresponding clinical symptoms.
Can kissing and sexual intercourse spread hepatitis B virus?
Because kissing and sexual intercourse are all in contact with patients' body fluids, it is possible to spread hepatitis B virus. At present, the premarital examination requires HBsAg. If one party has HBsAg(+), the other party should be vaccinated with hepatitis B vaccine. ..
How to prevent hepatitis B from developing into cirrhosis?
Hepatitis B develops into cirrhosis because liver cells are dying. After hepatocyte necrosis, normal liver tissue "collapses", and the body's regenerative function will regenerate some fibers to fill the "collapsed" part. This is the normal compensatory function of the body to necrotic tissue, which represents the healing of necrotic parts and is a good thing. However, if the liver cells continue to die and the liver constantly regenerates fibers, these fibers replace most of the liver tissues and do not have the function of normal liver cells, and the liver becomes hard and small, thus forming cirrhosis. Therefore, the key to prevent hepatitis B patients from developing cirrhosis is to block the necrosis of liver cells. This means ensuring normal liver function. Abnormal liver function is a sign of hepatocyte necrosis. Therefore, patients with hepatitis B must regularly check their liver function, and once the liver function is abnormal, they should be treated in time. In addition, some tonics (Cordyceps sinensis, Carapax Trionycis, etc. ) has the functions of softening the liver and reducing the generation of fibers in the liver.
Can hepatitis B patients get married and have children?
(1) After acute hepatitis B, chronic persistent hepatitis, chronic active hepatitis and active cirrhosis are cured, the liver function is normal within six months or one or two years, and the HBV replication index turns negative, so you can get married.
(2) Liver function has always been normal, and only "two and a half" hepatitis B patients who show "big three yang" are temporarily unsuitable for marriage or sexual life. If one partner shows "big three yang" after marriage and the other partner is completely negative, it is possible not to be infected by the other partner's hepatitis B virus until the completely negative person produces enough protective antibodies. But it can only last for 3-5 years. Contraceptive measures should be taken before one side's disease replication index turns negative (if the patient is male, condoms should be used). And actively take antiviral treatment.
(3) Single HBsAg positive people can get married in principle. However, it is not absolutely non-contagious, and you should get married if you produce enough protective antibodies.
(4) HBsAg carriers with chronic surface antigen can get married if they are only anti-HBe positive.
(5) Those who are 1.4.5 or 1.5 positive in the "two and a half" may be contagious if the anti-HBe drops significantly. Don't get married until the titer of anti-HBe drops significantly.
(6) Even if only patients with HBsAg or anti-HBe are single positive, or patients with 2.4.5 or 2.5 positive, they can get married, but their sexual life should be restrained.
(7) If the parents or family have hepatitis B patients with obvious liver cirrhosis and liver cancer genetic tendency, it is best not to have children after marriage.
Influence of father being a carrier of hepatitis B virus on fetus and children.
The father is a carrier of hepatitis B virus, which has two effects on the fetus and children. One is the spread of hepatitis B virus. In addition to mother-to-child transmission, fathers also have the possibility of vertical transmission, but the probability is far less than that of mother-to-child transmission. Its transmission route is mainly postpartum close contact transmission. The other is to pass on the susceptibility gene of hepatitis B virus to the next generation, making their children vulnerable to hepatitis B virus infection. Therefore, the father is a carrier of hepatitis B virus, and the children should also be injected with hepatitis B vaccine.