In traditional Chinese medical concepts, if found to have fatigue and physical symptoms of anorexia, it will start to look for whether their own liver problems; or even most people who know their own once in abnormal liver function, it went to the pharmacy will buy the so-called "liver-chip," or taking some unknown "prescriptions"; and some people taking these drugs, but makes the addition of hepatocyte injury happened; the end of the day, I do not know in the end are their own liver problems, or medication caused liver problems.
Liver are the body is like a chemical factory, whose main features include albumin synthesis, immunoglobulin production, bile production and excretion, the clearance of pathogens and toxins, as well as the synthesis of coagulation factors, so as soon as liver problems, The above function will be abnormal or recession. But fortunately, the liver disease itself is a very high tolerance, because as long as the liver remained at about one-quarter of entities, we can meet the individual requirements of the work day metabolism. General clinical practice, the so-called "liver function tests" project, none other than the liver are used to assess the synthesis, excretion and detoxification functions; and the general public are most familiar with is the most important items GOT and GPT. Let us put aside in the GOT and GPT Chinese translation of the name, but the liver GOT and GPT are thousands involved in the metabolism of various substances the most important and most specific enzymes within the liver cells; happen if the liver cell membrane degeneration or liver cells themselves necrosis, which will allow the inherent existence of GOT and GPT into the blood circulation in the overflow. Therefore, by serum GOT and GPT concentrations of high and low, they can indirectly determine whether liver cells are being hurt and necrosis happened phenomenon.
General inspection by the GOT and GPT concentrations of the normal range are forty units in the following, in acute hepatitis or chronic hepatitis, acute fat deterioration, GOT and GPT can be abnormal or even as high as more than a thousand units; if in the follow-up examinations, the GOT and GPT is gradually decreased, and clinically it is represents the phenomenon of liver cell damage is gradually reduced, and even in some cases will fall within the normal range, this stage liver disease is called "remission." The so-called "chronic hepatitis" refers to persons suffering from GOT and GPT, in more than six months of follow-up, the ceiling is still above the normal ups and downs. Other liver function tests also include an assessment of liver synthetic function of serum albumin and prothrombin time (if the liver function, the prothrombin time will be extended) to assess the excretion function of serum total bilirubin to assess the detoxification function of the serum ammonia concentration; addition r-GT can be used not only to assess the phenomenon of liver cell injury is also a kind of alcohol or drugs for liver cell injury indicators; by serum alpha-fetoprotein concentrations of ups and downs can also be convicted of liver cell regeneration itself to what extent These so-called liver function tests in clinical practice does not have absolute significance of confirming the diagnosis, physicians must have to add a wealth of clinical experience, as well as the clinical symptoms and characterization only be able to sum up the full extent of liver function damage assessment .
If the first blood test GOT and GPT, found that its data showed abnormal, do not panic or be too nervous; as a result of examination in itself has some degree of standard error, perhaps coupled with some physiological and drug effects, and data showing "false positive" phenomenon (that is, individuals do not have the potential of liver disease); it is necessary at the appropriate time, and then tracking a check to determine whether the GOT and GPT is still abnormal. In fact, the vast majority of persons suffering from abnormal liver function do not have any clinical symptoms, but common symptoms of hepatitis are non-specific, which is none other than the general malaise, joint pain, loss of appetite, and sometimes just suffering from a cold like. And serious cases that may arise brown urine, as well as jaundice, but in chronic hepatitis and even cirrhosis may occur esophageal variceal bleeding, ascites, jaundice, hepatic coma, as well as the complications, and these complications are sufficient to enable persons suffering from hepatitis "put to an end . " In fact, the majority of those suffering from those who are in the liver do not know the reasons, the rule on the temerity to use the so-called liver drugs; therefore only lead to further understanding or to explore the causes of abnormal liver function, the liver is the proper way .
Abnormal liver function on the need to explore further lead to "abnormal liver function," What is the cause? In Taiwan residents living in its lead to the causes of abnormal liver function has four main categories:
1. Viral hepatitis: the present has been clinically confirmed viral hepatitis can have six: A type, B type, C type, D type, E and G-type hepatitis, including hepatitis A and hepatitis E, the main through the gastrointestinal tract infection, that is, by unclean drinking water and diet and infection, but will not suffer from chronic hepatitis derivative, and the individual can be life-long immune antibodies. While the remaining B-type, C type, D or G-type hepatitis injections are by way of injection or blood transfusion infection, including hepatitis B virus infection, there are about 15-20% will become chronic carriers, while the band the former has 10 percent of those will give rise to chronic hepatitis, and in those suffering from chronic hepatitis has 5% to develop into liver cirrhosis. According to the National Taiwan University Hospital for cirrhosis of those suffering from long-term follow-up examinations found that those suffering from liver cirrhosis have derived 7% hepatocellular carcinoma, and liver cancer is the top cause of cancer deaths. Therefore, B hepatitis prevention and treatment of the Taiwan region are a major public health issue. The Taiwan region of hepatitis C carriers, about 30 million people, the chronic rate is as high as 60 percent, but also the formation of liver cirrhosis and liver cancer, one of the most common causes. Hepatitis D, must at the same time or duplicate infection in hepatitis B carriers who, while hepatitis B carriers once infected with hepatitis D will also add to the deterioration of the original liver disease.
2. Alcoholic liver disease: in foreign countries, alcohol lead to abnormal liver function are the main reason; In recent years, due to the economic prosperity of Units bends, people drink entertainment opportunities also increased, clinically it has no lack of long-term drinking which led to liver function abnormalities were suffering from. Alcohol abuse caused by alcohol-induced liver disease, at the initial stage of "fatty liver" pattern emerged (abnormal accumulation of fat particles in the liver cytoplasm of the phenomenon), later appeared in lobular liver cell damage in inflammatory cells, and to enter the alcoholic phase of hepatitis; in alcoholic liver disease, the late, due to a large number of cell necrosis and collagen fibers have been admitted, causing liver cirrhosis can not be entered back stage.
3. Drug-induced hepatitis: 90% of the drugs to metabolism in the liver, while long-term use of certain drugs may also cause mild liver cell damage, let alone the people have the habit of taking random; Therefore, clinically it is there are a large number of drug-induced hepatitis.
4. Fatty liver: ultrasound diagnosis of fatty liver are the most accurate tool, but only 20% of those who suffer from fatty liver are abnormal liver function; therefore similar for some who suffer from fatty liver, such as obesity, alcoholism, hypertriglyceridemia, diabetes, lack of over-nutrition, chronic heart failure and so on, may wish to recommend that its further ultrasound scan, with a view to screening out the potential of fatty liver.
Speaking from hepatitis A
In people living in Taiwan, if once found to have abnormal liver function of the phenomenon (the so-called hepatitis), then we must first consider the factors is "viral." Currently in clinical hepatitis have been identified, including hepatitis A has, B-type hepatitis, C hepatitis, D hepatitis, E-type hepatitis, G hepatitis, as well as post-transfusion hepatitis (transfusion-transmitted hepatitis, TTH); Although these so-called "hepatic chemokine virus" (mainly lead to liver cell injury induced by the virus itself) in the characterization of clinical symptoms, there are many similar places, but the prevalence of pathology, immunology, the etiology as well as physiological anatomy study will have different specific place, but from an understanding of each different clinical pathology of viral hepatitis in primary health care on preventive health care to be able to do a good job.
Hepatitis A virus is classified as enterovirus 72, is a small virus Branch, the diameter of about 27nm, it is an RNA virus, are the sole human host. Once infected with hepatitis A after incubation in 15-50 days (average 28-30 days), mainly by the fecal - oral transmission, so the onset of symptoms before one or two weeks can be in the stool in looking for a hepatitis A virus-like particles; happen again abnormal liver function or symptoms, the virus excretion from the feces, however, reduced, at which point the individual will gradually suffer from hepatitis A have corresponding antibodies, certain explosive Hepatitis A large popular places, mainly derived from contamination of drinking water, eating raw seafood, as well as cold food, and rarely by non-gastrointestinal infection of the blood channels.
In developing countries the health of the adult population groups, and individual themselves in a hepatitis A antibodies exist in these places rarely happen Hepatitis A pandemic. In recent years, the improvement of environmental hygiene. People for hepatitis A infection rates reduced, thus making the outbreak of hepatitis A prevalence increased; in the country has developed most of the cancer exists in the nursery, the home has acute hepatitis infection, hepatitis A to the popular tourist areas, even improper intravenous drug injectors.
In Taiwan, 72 years to explore the epidemiology, we found the age group of hepatitis A infection rates have decreased year by year, and even found that children below the age of 10 have not yet have the vast majority of hepatitis A virus antibodies, has not yet been infected have hepatitis A virus, that is, at any time will be subject to its hepatitis A viruses, so children of this age group has the necessary recommendations of its acceptance of hepatitis A vaccination.
In acute or recent hepatitis A virus infection, we can through the serum hepatitis A virus detected in the IgM immunoglobulin to determine the acute hepatitis A virus infection, which can hold such IgM globulin from patients with the serum for about 4-6 weeks; also through large-scale epidemiological evidence to confirm the diagnosis of hepatitis A virus exist; but in the epidemiological point of view, A hepatitis E virus and acute type easy hepatitis C virus confused.
Hepatitis B virus concept today
The basis of epidemiological evidence to explore the world each year has more than 500,000 people died of "liver cancer" and has up to 80% of liver cancer hundred are from "chronic hepatitis B virus" caused by; in chronic B infection hepatitis 400 million population, has 75% are in Asia, including mainland China and Taiwan is the world's hepatitis B and liver cancer population groups most areas. Therefore, the data show the following results:
■ Chinese mainland are chronic hepatitis B virus (Hepatitis B Virus, HBV) and the highest prevalence
Area, all over the world for more than one-third of the hepatitis B virus carriers are in mainland China (about 2000 million
10000-130000000 of hepatitis B carriers).
■ in the Taiwan region with chronic hepatitis B virus infection prevalence of the total population of 15 ~ 20%, it is estimated that
Three million people are hepatitis B carriers.
■ Korea estimated 2250000-2270000 of hepatitis B carriers.
■ In India, an estimated 34 million of hepatitis B carriers.
■ In Singapore, the chronic hepatitis B virus infection prevalence was 4%, an estimated 150,000 people with hepatitis B
From the original.
■ in the Philippines with chronic HIV infection prevalence rate of 5 ~ 16%.
■ in Thailand with chronic HIV infection prevalence rate of 3 ~ 6%, it is estimated that three million people have are B -
Hepatitis carriers.
■ in Hong Kong infected with chronic HIV infection prevalence of 8.8%, it is estimated that 700,000 of the population has
Are hepatitis B carriers.
■ In the United States have more than one million people are infected with chronic hepatitis B each year has more than 5000 people died of B-type liver
Inflammation, as well as hepatitis B-related complications.
The Taiwan region of hepatitis B virus are high-prevalence areas, over 30 years of age in a healthy population group in Taiwan, B-type hepatitis C virus infection has nearly 15-20% (about three million people are hepatitis B carriers) , and with hepatitis B virus is closely related to the hepatocellular carcinoma, also accounting for the top ten people of the first leading cause of cancer deaths, while the top ten causes of death in people of sixth place on the chronic hepatitis and cirrhosis, with chronic hepatitis B virus infection and therefore for Hepatitis B awareness and prevention in Taiwan are the largest public health prevention and treatment of one of the topics.
Hepatitis B virus is a DNA virus, its diameter of about 42nm, the diameter of its core antibody in the 27nm, while the periphery of the core was another special lipoprotein envelope (or envelope or jacket) surrounded, called hepatitis B surface antigen from hepatitis B surface antigen phenotype of different antigens can be hepatitis B virus is divided into four different subtypes, and different subtypes also have their special characteristics of the geographical distribution, rather than pain subtypes can also happen as each other to protect the role of the immune interaction; but not from clinical symptoms to determine which subtype infection.
In addition to the core antigen and surface antigen, the most important thing is to e antigen, if the serum has the existence of e antigen and its clinical hepatitis B also indicated that Law is highly poisonous highly infected, but if the emergence of e antibodies, selective relative influence is also reduced, but that does not mean there is no appeal; In addition, the first issued by the serum of hepatitis B virus DNA also indicated that the virus itself has a higher activity and fecundity; Therefore, if maternal carriers belonging to e antigen positive, selective formation of the newborn in future carrier probability as high as 90%.
Hepatitis B virus can be parasitic in humans and belongs to a long age of the individual categories of the orangutan, its excretion through the body might have been secondarily infected, including blood, saliva, semen and vaginal secretion, mainly by injection injection (intravenous injection, intramuscular, subcutaneous or intradermal injection), the mucosa damaged skin (the accident was contaminated needles to bar), perinatal infection, as well as means of sexual contact and infection; Therefore, any blood transfusion products such as the injection of whole blood, serum, platelet , serum fiber million, concentrated red blood cells blood products, etc. If we do not, after screening for hepatitis B surface antigen, hepatitis B is a high prevalence area in South-East Asia and the Far East, the main mode of transmission is perinatal transmission, that is, B hepatitis B surface antigen positive, and even e antigen-positive mothers of newborns are born from hepatitis B carriers in high-risk groups; and abroad, B hepatitis is classified as "sex-communicable diseases", which primarily through intimate sexual behavior among homosexual transmission, while a small number of infected persons through sharing toothbrushes and razor blades have been infected.
Hepatitis B virus incubation period is usually in the 45-180 days (average 60-90 days), the main by the virus quantity, mode of transmission, as well as host resistance, and different incubation periods.
Although hepatitis B virus all over the world, but its main prevalent in Africa and Asia, and the main infected infants and young children, while in South America are mainly infected with the young people; While in Asia, B hepatitis carrier rate in between 10-20%, but in each is only between 0.2-0.9%, while in the United States population groups in hepatitis B antibody-positive rate is only 5%, while the vast majority exist in the long-term intravenous drug injection addiction De, multiple sexual partners of heterosexual, male homosexual, host, or working in institutions, as well as hemodialysis patients or medical center staff.
Suffering from hepatitis B also occur in cases of death, the mortality rate at about 1%. If the hepatitis B surface antigen in serum continued to hold more than six months, it can be called hepatitis B virus "chronic carriers" and the carrier itself does not necessarily have a clinical history of hepatitis, which may have three one once the carrier has the phenomenon of abnormal liver function (GOT and GPT and the abnormal rise); and carriers of the liver biopsy, perhaps just a normal, perhaps also chronic hepatitis B Characterization , although a few may have also seen signs of hepatitis and liver cirrhosis. Explore the basis of epidemiological evidence, found all over the world who suffer from liver cancer, 80% were hepatitis B surface antigen positive, while the "B-type hepatitis C virus" in the human carcinogenic role, also second only to "smoke tobacco. " In clinical diagnosis, we can detect by serum hepatitis B surface antigen positive or not, to determine whether the individual is the hepatitis B virus carriers; In addition, serum also can detect whether there are B - hepatitis virus DNA, to assess whether active virus replication period; and in hepatitis B virus serum markers, including three antigen-antibody system, which has B-surface antigen and antibody, B hepatitis B e antigen and antibody ; in which hepatitis B core antigen, the market in general testing centers can detect the corresponding antigen or antibody. Which hepatitis B antigen in clinical symptoms after a few weeks can be detected; and natural history of infection, B-type hepatitis B surface antigen in the recovery phase when the concentration will decrease or even disappear, if in six months more than a view still persists in the serum, it means that infected individuals will become chronic carriers (and once with the original, life-long with the original). As for hepatitis B core antibody in the pathogenesis of view will appear, and life-long existence, the existence of such serum markers, mainly express the individual is or has been infected with hepatitis B virus; It also can detect cancer of serum hepatitis B core antibody IgM globulin, to determine whether individuals suffering from "acute B hepatitis."
In addition, according to AXA National Cheng Kung University Hospital and hospitals in their common for hepatitis B carriers of the long-term follow-up study, the preliminary findings of chronic hepatitis B, another "carcinogenic mechanism," and are called " Pre-S mutant protein "has been associated; their research that if the hepatitis B carriers with such a special mutant protein, then its in a decade into the chances of liver cancer as much as 56 percent, the cancer machine rate is not a "mutant protein" of 3.5 times. In the study also pointed out that have Pre-S mutant protein of hepatitis B carriers in the decade of the long-term follow-up screening in the incidence of liver cancer as much as 56 percent, while continuing to follow-up after fifteen years the proportion of more raised to 65 percent, while the ratio did not Pre-S mutant protein 3.5 times higher; However, according to their research, however, pointed out that the liver only suffer from the "Pre-S mutant protein," the incidence of only 6%, seven into rather than 100% (which may also show that Pre-S mutant protein, the existence of the specific diagnosis of hepatocellular carcinoma is not very high). According to the researchers claim that as a result of hepatitis B virus mutations would have been in order to evade the human immune system attacks, while the Pre-S mutant protein would lead to chromosome instability, as well as its DNA damage and precancerous changes occur, which in turn leads "liver." According to the research data show that, two, three-year-old about liver B carriers, only 3-5% with Pre-S mutant protein, but after forty-year-old, Pre-S mutant protein, the ratio rose to 24 ~ 40%. In short, B liver with the original must be early treatment to avoid the "Pre-S mutant protein" generation, in turn derived from liver cirrhosis or even liver cancer. Since then, in the next three years China Wei Yuan and the Department of Health who will conduct the 2000 hepatitis B carriers of the study, hope to further determine the "Pre-S mutant protein" can be such as alpha-fetoprotein (α-fetoprotein ), as in clinical screening to become a "hepatocellular carcinoma" special "serum markers" or as the progression of the disease-specific treatment targets, this is also happy to see by the clinicians. (2004/09/10)
Hepatitis B virus has been the marginalization of chronic viral hepatitis-C hepatitis virus
Foreword
Prior to 1989, a group of chronic hepatitis were classified as "non-A non-B hepatitis", mainly because this group of chronic hepatitis has been excluded by the hepatitis A virus, B-type hepatitis virus as well as other common hepatitis virus giant cells such as virus and EB virus, or even caused by drugs or alcohol hepatitis; as a result of these "non-A non-B hepatitis," the vast majority are infected through blood transfusion after, and therefore also known as the "post-transfusion hepatitis," . Until 1989 the United States Karen (Chiron) companies Zhu (Choo) and Kuo (Kuo) the two researchers found that "non-A non-B hepatitis," the main virus RNA genome for the virus-like particles, and the official called " Hepatitis C virus "(Hepatitis C Virus). Basically, with the neonatal hepatitis B vaccine coverage overall, the Taiwan region of hepatitis B carrier rate is bound to decline year after year, it can predict the future of hepatitis C will replace the hepatitis B become the mainstream of chronic hepatitis in Taiwan.
Epidemiology
Hepatitis C virus, yellow fever virus belongs to Branch, the human as its main host, and in the laboratory can also be infected chimpanzees. Hepatitis C virus and A-and D-type hepatitis C virus is the same RNA (RNA) virus, the virus size is about 30 ~ 50 nm (nm = 1/10000000 mm) than the A-and D-type virus is slightly large, the incubation period is about 1 ~ five months (an average of 1.5 ~ 2.0 months) than the hepatitis B incubation period longer.
According to RNA series of studies, C genotype of hepatitis can be divided into six genotypes and more than 100 kinds of the above subtypes, of which there are four genotypes of hepatitis C are the main types of patients. Based on Okamoto's classification of four types are known as I, II, III and IV type. In the United States 70% of the hepatitis C virus genotype are type Ia and Ib-type, while the other 30% are type II and III. In Taiwan, while type II accounted for most (about 73%), and the remaining type-III and IV each accounted for 13% and 11%, and about 3% for the mixed type, I type is very rare. According to clinical experience, interferon for type III and type IV is more effective, while for type II and I-effect of poor, different genotypes have different clinical course as well as the specific antigen and hepatitis C makes the natural course of disease have different prognosis ; Therefore, before the use of interferon to detect hepatitis C genotype is the most specific.
In recent years, the "polymerase chain reaction" (PCR) examination of molecular technology, which detect blood of hepatitis C virus nucleic acid (HCV RNA) the existence of hepatitis C virus, making the structure more clear. Global hepatitis C virus infection rate of about 0.5 ~ 1.5 between the (about 170 million people). In fact, C hepatitis in Taiwan are hepatitis B liver disease second only to the second murderer. According to Taiwan with chronic hepatitis C epidemiological investigation, in Taiwan there are about 2% ~ 4% of the population (about 4-60 people) infected with hepatitis C, in which persons suffering from the northern region of the entire population group 1.5 ~ 2%, but in the central and southern coastal areas of prevalence was as high as 20 ~ 60%. In fact, in Taiwan, HBsAg-negative persons suffering from chronic hepatitis, 60% are due to hepatitis C virus infection from. Before the age of 15 population groups of the hepatitis C virus infection rates low, and with age increases, the vast majority of individuals are positive happen in developing countries or socio-economic standard of the lower areas.
Clinically, the vast majority of hepatitis C was found, have been in a state of chronic infection. Since the blood centers in Taiwan from the Republic of China began in July 1992 screening of donated blood in the Anti-HCV (C hepatitis antibody), hepatitis C recipients experienced viral infection to reduce the probability of around 30 ~ 40%, and "post-transfusion hepatitis," the incidence dropped to less than 1%.
In the virus structure, C-type hepatitis C virus is an RNA virus (RNA), in the laboratory testing through "C-type hepatitis C virus antibodies" to diagnose the individual whether or not there is or has been infected with hepatitis C virus. Explore the basis of epidemiological evidence, C hepatitis is mainly by way of non-gastrointestinal tract infection, which is injected through a blood transfusion and injection. Although, C-type hepatitis virus, the vast majority of injections are injections by means of infected body fluids, but there are 40% of the individuals were unable to find a specific infection. In clinical practice, C-type hepatitis virus in high-risk groups include intravenous drug injecting addicts and regular blood transfusions were required, haemophilia and intravenous drug users are hepatitis C infection rate is as high as 90%; to explore the basis of epidemiological evidence by the sex of hepatitis C infection is not a very high probability, but perinatal vertical transmission of hepatitis B is not as the percentage of the virus so high, in which the mother's chances of vertical transmission is also only 5 ~ 10% around; In addition, C-type hepatitis C virus is also transmitted through the diet, at present, has yet to have a very specific support for the theory to prove.
Etiology and Pathogenesis
The basis of clinical observation, C-type hepatitis C virus in persons suffering from AIDS as well as certain long-term intravenous drug users, have more obvious and serious symptoms, and hepatitis C virus, hepatitis B virus, except as by the host immune system will react to lead to liver cells harm outside; also scholars in the study found that hepatitis C virus itself to the liver cells also have a direct killing of the phenomenon.
Hepatitis C virus infection the incubation period, usually 6 to 10 weeks or so, and even some infected individuals will be up to four-five months. In the diagnosis, you can use an enzyme immune assay to detect hepatitis C antibodies to determine the specific diagnosis of hepatitis C virus infection, and hepatitis C antibody is usually three months after the acute infection to appear; but the hepatitis C antibody do not themselves have the Medium and hepatitis C virus, the role, that is, its does not mean that individuals suffering from hepatitis C has on the immune protection capacity.
Suffering from acute hepatitis C who have around 50-70% will be entering the stage of chronic hepatitis (liver function refers to its six-month follow-up in a row still abnormal phenomenon), and chronic hepatitis C China has around 30% of cancer were about to develop into liver cirrhosis; the basis of epidemiological evidence to explore, C-type hepatitis virus formed by persons suffering from liver cirrhosis, two per cent each year will suffer from cirrhosis happened liver cancer. In patients with chronic hepatitis C who suffer from long-term follow-up found in chronic hepatitis C to liver cirrhosis stage for about thirteen years to eighteen years, and the formation of liver cancer time twenty to thirty years required; which C hepatitis liver cancer arising from almost all have 100% of their liver hardening phenomenon; relatively speaking, B-type hepatitis B surface antigen-positive hepatocellular carcinoma, and its rate of cirrhosis in about 85%. Therefore, chronic hepatitis C once the stage of cirrhosis, liver cancer risk of its derivatives will be slower and of hepatitis B carriers high.
Clinical symptoms and characterization of
In fact, C-type hepatitis C virus-infected persons most of them are not having any clinical symptoms, of which only one-quarter and blood transfusion-related hepatitis C virus infection, will appear in the clinical jaundice, general malaise, low - degree of fever and right upper abdominal distension and other symptoms typical of acute hepatitis; but in fact, the vast majority of symptoms are minor, and rarely lead to fulminant hepatitis happen; even in some cases have been found to generate concurrent cirrhosis, but no clinical symptoms of the slightest; while the majority of individuals via blood screening that they found out that he is a hepatitis C virus carriers.
Testing and diagnosis
Acute hepatitis C liver function tests GOT or GPT, usually less than 100 milliliters each of the following 1000 international units, while only 10% of the cases, the GOT or GPT would be greater than 100 milliliters per 2000 international units; and serum total bilirubin rarely exceeds 10 per 100 milliliters to 15 mg; Therefore, C-type hepatitis C virus less severe liver function abnormalities. In general, acute hepatitis C will be derived rarely fulminant hepatitis, and liver function tests of GOT and GPT is usually about twice the upper limit of normal ups and downs; but in some cases even in the GOT and GPT almost near normal then once again trigger another acute attack. So, it is not GOT, GPT normal to express hepatitis C have been healed.
In clinical practice can be detected by serum hepatitis C-specific antibodies to determine the diagnosis of hepatitis C virus infection, to explore the basis of epidemiological evidence has 65% of hepatitis C infection in the onset of symptoms within two weeks, can be detected to detect hepatitis C virus antibody; but after three months, C-type hepatitis antibody-positive rate is as high as 90 percent, while the remaining 10% of infected people will need more time, can there be hepatitis C antibody; is Say hepatitis C "window period" than that of hepatitis B for longer. In fact, the current window period for hepatitis C infection, in clinical practice can be used polymerase chain reaction (PCR) for early detection of acute hepatitis C virus infection, but unfortunately the cost of this inspection and the steps are more expensive and complex. In addition, could be implemented in the clinical pathology of liver puncture biopsy, interferon treatment of choice as a reference for tracking the prognosis and treatment.
Treatment and Prognosis
As long as suffering from hepatitis C to receive supportive treatment, combined with proper rest and nutrition, conditioning, in a few weeks to several months or so, the clinical symptoms and liver function will be gradually returning to normal, while in infected persons have suffered 10 ~ 30% of cases will naturally ease and can rule out the possibility the virus in vitro, but unfortunately there are 70 ~ 90% of cancer would be entering the stage of chronic hepatitis.
In fact, chronic hepatitis C in clinical practice are the vast majority do not have any symptoms, and cancer in the course of disease after more than a decade after the normally expected level of complications ranging. And in this stage of chronic infection, chronic hepatitis C in the GOT or GPT, have shown unusually close to the upper limit of normal ups and downs. According to histopathology of and found that chronic hepatitis C genotype Ib has poor prognosis, while in fact 25 percent suffering from chronic hepatitis C, its GOT, GPT can not be restored within the normal range, and in ten years will be derived after "cirrhosis"; In addition, C-type hepatitis C virus chronic infection with hepatitis B carriers, as have a higher ratio was found suffering from hepatocellular carcinoma.
At present, interferon is the treatment of chronic hepatitis C drug of choice, and the role of interferon is mainly directed against hepatitis C virus to be directly eliminated, its standard course of treatment three times a week to receive three million units of interferon injections, and In the six months after treatment, have about half of cases around the liver function would be restored to within normal range, but unfortunately there is half of the cases after six months, the abnormal liver function again; Thus, according to the clinical treatment experience found that interferon treatment of hepatitis C long-term effectiveness of around 20 ~ 25%; a result, some scholars have suggested that chronic hepatitis C to give higher doses and longer treatment, or permit them to resume normal liver function to enhance the efficacy .
Chronic hepatitis C has not yet been associated with liver cirrhosis, infection is shorter, pre-treatment HCV-RNA concentration of low or non-1b gene subtype, may have a higher estimate of the long-term sustainability of interferon therapy efficacy. Clinically, if the use of IFN-3 ~ 4 months, serum GPT value is not reduced to normal or serum HCV-RNA did not significantly decrease or disappear, they should stop to consider the use of combined anti-viral drugs (such as ribavirin) and interferon combination treatment. In recent years, found that while the use of interferon injections and oral antiviral drugs (ribavirin) in treatment of chronic hepatitis C than the superior efficacy of interferon therapy alone; the use of interferon plus ribavirin (grams per day 1000-1200) for six months, its sustained efficacy up to 40% more than is currently the treatment of chronic hepatitis C treatment efficacy of a better way. However, in the course of treatment, interferon certainly need to know the possible side-effects, including flu-like symptoms (such as fever, myalgia, headache), general malaise, hair loss, weight loss), the number of white blood cells or platelets to reduce the , lack of concentration, depression and even immune function variation (such as produce autoimmune antibodies), it is. Suffering from hepatitis C in the specialist physician should closely monitor the use of interferon injections. Furthermore, Ribavirin daily dose of 1000-1200mg, taking six months, Ribavirin itself has a small number of side effects of anemia, cough, itching, rashes, insomnia.
In recent years, by polyethylene glycol of interferon (pegylated), its half-life of up to 40 hours for the traditional short-acting interferon times, blood concentrations of interferon than the traditional high, as long as the injection once a week. According to overseas research, a separate long-acting interferon in the treatment of chronic hepatitis C, and its effect on up to 40 ~ 45%, if the combined oral Ribavirin combined treatment of 24 weeks, the effect can reach 60 ~ 65, than the traditional short-acting interferon Ribavirin combined effects of slightly higher, especially in the difficult treatment of the disease genotype Ib and serum concentrations of high disease patients, its efficacy significantly higher than conventional interferon.
For those treatment failures, the majority are due to the phenomenon which has already existed in potential liver cirrhosis or liver cell itself contains too much iron; in the interferon therapy, the adverse reactions caused by, with B, like hepatitis. Clinically, some suffering from chronic hepatitis C who are not suitable for interferon therapy, including clinical liver cirrhosis, there are obvious signs of mental illness, accompanied by the phenomenon, and even have low white blood cell phenomenon who suffer from hepatitis C, because these cases in acceptance of interferon treatment, may lead to sudden liver failure.
In fact, has happened to cirrhosis complications of chronic hepatitis C who suffer from diseases such as hepatic encephalopathy, refractory ascites as well as the governance of esophageal variceal bleeding, treatment of its most fundamental is the "liver transplant", and chronic hepatitis C persons suffering from liver transplant patients, the more will not cause immune rejection.
So far, the prevention of the spread of C-type virus is the only person to do a good job of screening blood transfusion due to hepatitis C virus genome itself, the nucleotide sequence variation faster, in the manufacture of vaccines have not been able to break through, it has yet to develop a C-type hepatitis virus vaccine.
Hepatitis D virus
Hepatitis D virus is a diameter size of 35-37nm virus-like particles, mainly from special core antigen (called the delta antigen), as well as to external sets of hepatitis B virus surface antigen and formation of infectious virus particles, its also are RNA viruses; In addition, D-type hepatitis C virus is a defective virus, which infected host cells can not be alone, but must be with the hepatitis B virus infection in the host at the same time only be able to achieve its purpose of reproduction and growth. In addition, D-type hepatitis C virus can also be infected with hepatitis B carriers, and to become the so-called "over the same period of infection"; In addition, according to the clinical virology study, found that hepatitis D virus infection can inhibit the Hepatitis B active virus.
Human hepatitis D virus are the main infected hosts, with similar cases, the route of hepatitis B virus, can also be infected through sexual intercourse, but perinatal infection very rare. According to animal experimental studies have found hepatitis D virus in the incubation period of around 2-10 weeks, and its incubation period in humans has not yet have specific conclusion. Hepatitis D virus is mainly found in hepatitis B virus in high-prevalence areas, including Africa and Asia, South America and southern Italy; fun, according to a study found that hepatitis B carriers have a higher prostitutes hepatitis D virus infection rate (around 21.1% in or so).
Hepatitis D infection is usually sudden, and its clinical symptoms and characterization of infection with hepatitis B are similar. In clinical practice, D hepatitis B virus infection will lead to chronic hepatitis B with acute deterioration, D hepatitis can be self-limited recovery can also be carried out for chronic hepatitis D. Therefore, in hepatitis B carriers in the natural history, if the sudden deterioration of liver function and sexual, we have to consider whether it is hepatitis D virus infection. Also have to consider whether it is hepatitis D virus infection. Discussion on the basis of epidemiological, clinical have 25-50% of fulminant hepatitis B are derived from hepatitis D virus "re-infection", and hepatitis D "re-infection" is also the formation of chronic hepatitis D In clinical, it can be detected by antibody to hepatitis D screening of hepatitis D infection, and detection of its IgM globulin can also be diagnosed with acute hepatitis D (the same period of infection) exists.
Has not yet developed effective against hepatitis D virus drugs. However, in clinical practice through the hepatitis B vaccine injection, to reduce the chronic hepatitis B virus carrier rate in order to achieve deterrence of hepatitis D virus infection and infection.
Hepatitis E virus
Hepatitis E virus is an RNA virus, its morphology and clinical epidemiology of hepatitis A virus similar to, E-type hepatitis C virus itself, the diameter of around 29-32nm in between is a calicivirus Branch, Human are its main host, but also in chimpanzees and Cynmolgus macaques (Macaca 1 objects similar animals) between the transmission.
Hepatitis E virus is mainly through the faecal - oral transmission, and in some areas of the outbreak of a pandemic has been largely due to water pollution (water pollution because of heavy floods), as well as contamination of food caused by heavy infection.
E-type virus, the main endemic areas including India, Nepal, Pakistan, the Soviet Union, Algeria, Libya,SoMaria as well as mainland China, these countries have occurred in regional pandemic, infection risk was also mainly young men , while the mortality rate of pregnant women are infected at about between 10-20%.
According to Taiwan's own epidemiological study and found that some areas in the south are not in the classification of persons suffering from acute viral hepatitis, the serum to detect hepatitis E virus antibodies as high as 22%.
Clinically, the vast majority suffering from acute hepatitis E in the infection of hepatitis E virus, are able to generate relative should have the ability of immune protection of hepatitis E antibodies, and will not evolve into chronic hepatitis.
Hepatitis G virus Color
Hepatitis G virus is yellow fever virus Branch, is a recent (1995) was found in the "chemokine liver virus", the main by non-gastrointestinal tract (injection injection) channels and the spread of infection, the infection can cause persistent chronic "viremia" during nearly a decade, according to epidemiology of, G type hepatitis virus infection in intravenous drug addicts accounted for 50% of hemodialysis were 30%, suffering from hemophilia who accounted for 20 percent, while the chronic type B or C hepatitis were suffering from 15%; In spite of this, at present there is no significant evidence of hepatitis G virus will cause a higher severity of liver disease.
Since 1995, hepatitis G virus genome was found later, was informed that its lead to post-transfusion hepatitis are the main reason, but there are still clinical 5% of all chronic liver disease are unable to find the causes (and in its causes in order to rule out the possibility all hepatitis viruses, alcohol, drugs and autoimmune or congenital metabolism caused by liver disease), of which about half of those suffering in the past history of receiving blood transfusions by treatment, the incubation period of around 14-145 days in between ; in clinical through PCR (polymerase chainreaction, PCR) test after the discovery of a gene has a special body of virus-like particles, and referred to as "G-type hepatitis C virus", which can be infected in the gorilla or monkey and human.
According to the study of virology, G-type hepatitis virus yellow fever virus also belongs to genera and species, their genetic structure in the 25% sort of similar to hepatitis C virus and other yellow fever virus belongs to the virus section.
As a result of hepatitis G are the newly discovered "super-hepatitis virus", so its exact clinical significance is not very clear, although it can be infected chimpanzees, but infected individuals in clinical practice has not happened on the phenomenon of abnormal liver function, as well as other liver biopsy abnormal pathological changes in organizations. The basis of epidemiological evidence to explore the public areas in the United States are in the blood of hepatitis G infection rates in between 1-2%, and its population in the whole group in a higher infection rate of hepatitis C and its high-risk group with hepatitis C are similar, including recurrent blood transfusion, intravenous drug addicts and persons suffering from hemophilia.
Suffering from hepatitis G presented the clinical symptoms are relatively minor, perhaps only mildly abnormal liver function, but according to the report of the Japanese literature, G hepatitis infection will lead to fulminant hepatitis happen, and in Japan hemodialysis treatment, its G the incidence of hepatitis is as high as 3.1%, of which there are many who have suffered a considerable degree of liver function abnormalities, according to long-term clinical follow-up and found that hepatitis G may be the persistence of in individuals around 10-16 years.
A new viral hepatitis: TTH (Post-transfusion hepatitis)
December 1997 Japanese scholars began to reports, in an unexplained post-transfusion hepatitis patient serum, detected a new DNA virus, and according to TT at the beginning of the names of patients, and is known as "TTV", happens to with "transfusion-transmitted virus" that is, post-transfusion hepatitis (TTH) abbreviation consistent, thus the extension of the disease were used to described with transfusion-associated hepatitis diseases.
Currently in clinical TTV are known like "parvovirus" of an alternative virus, its single strand of DNA viruses, no jacket envelope, and TTV infection in the main detection method is the application of PCR (polymerase chain reaction) technology.
TTV in various types of liver disease and to receive a blood transfusion and blood products in high-risk population groups in both a higher detection rate. Clinically, in some unexplained acute non-A to non-G hepatitis suffering from the faeces, but also the detection of TTV-DNA genome. This is also stated that TTV is a part of the non-A to non-G hepatitis were suffering from disease, one of which factor.
In clinical practice, non-A to non-G hepatitis were indeed also suffering from the existence of the possibility of TTV infection. TTV-DNA exists in the liver cell membrane or cytoplasm. In periods of acute hepatitis, TTV with diffuse distribution in; and during chronic hepatitis, TTV-DNA was mainly distributed in the inter-sinks near pipe. Therefore, TTV is actually a "chemokine liver virus," and can lead to changes in clinical pathology in fulminant hepatitis is also a higher incidence may be known at the end of acute and chronic virus-induced fulminant hepatitis and the etiology of 1. Therefore, TTV is a DNA virus, with unexplained liver cirrhosis and fulminant hepatic failure in acute deterioration. In patients with chronic hepatitis C and chronic hepatitis B patients with a higher rate of incidence.
The Taiwan region are the high prevalence of hepatitis-B District, TTV virus in the population group in the detection rate is also relatively high, therefore, an urgent need of TTV virus present a more in-depth research, such as histological studies, looking epidemic research and set up TIV virus infection model animals in order to do a good job in prevention and health way.
Under normal blood donors in the TTH more common carriers, and intravenous drug addicts more TTH virus infection are high-risk group. Part of the non-A to non-G hepatitis may be related to TTH. According to epidemiological investigation confirmed that in non-A to non-G hepatitis were suffering from, which found that chronic infection TIV has accounted for 43%. Abnormal liver function without AG hepatitis virus infection in blood donors, the TTV-DNA positive rate was as high as 35%, significantly higher than normal liver function of liver donors, which also shows that there is no lack of deposit in blood donors TTH has HIV infection. TTH hepatitis can also be healthy carriers of the state manifested apart from blood transfusion TTH are likely to spread the virus outside of the main avenues, TTH virus can also be via the fecal - oral transmission.
In addition, hemodialysis there were a higher percentage of TTH virus infection, and from epidemiological studies also found that type B and hepatitis C infection often duplicate TTH viruses, which led to B-and C-derived hepatitis complicated with acute deterioration disease.
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