Clinical manifestations: acute hepatitis C has mild digestive symptoms, low incidence of jaundice, and the levels of ALT and serum bilirubin are significantly lower than those of acute hepatitis B. ..
Examination: HCV indicators include anti -HCV and HCVRNA.
Treatment: Although some patients with acute hepatitis C can self-heal, all patients with acute hepatitis C should be given active treatment, because the acute phase has better curative effect. Its treatment can be based on the specific situation of patients with appropriate rest, enzyme reduction, liver protection, antivirus and other symptomatic treatment, of which the most important treatment is antiviral treatment.
At present, it is recognized that only interferon is effective in treating chronic hepatitis C at home and abroad, and early treatment is also needed. Clinically, it tends to be combined with drugs. Such as interferon plus thymosin or interferon plus ribavirin tablets. Description of the disease Viral hepatitis is a group of systemic infectious diseases caused by various hepatitis viruses, which damages the liver. According to the classification of etiology, it has been identified as hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E. The above types of hepatitis are excluded by experimental diagnosis and are called non-A-E hepatitis. Whether the recently discovered hepatitis G virus and transfusion-transmitted virus cause hepatitis is still inconclusive. The clinical manifestations of hepatitis A and hepatitis E are similar, mainly manifested as fatigue, loss of appetite, aversion to oil, hepatomegaly, abnormal liver function, and some cases have jaundice. Type A and E are mostly acute infections; B, C and D are mostly chronic infections, and a few cases can develop into cirrhosis or hepatocellular carcinoma. At present, there is no specific treatment for the virus. A and B can be prevented by vaccines, but there is no vaccine for C and D, and the route of etiological transmission is similar to that of hepatitis B. However, due to the low content of HCV and RNA virus in body fluids and low external resistance, its transmission mode is limited and its infectivity is weaker than that of hepatitis B virus. It is mainly transmitted through parenteral routes.
(1) Transmission of blood transfusion and blood products: It used to be the main transmission route. From the late 1980s to the mid-1990s, more than 70% of hepatitis after blood transfusion was hepatitis C. With the improvement of screening methods, this mode of transmission has been obviously controlled, but anti -HCV negative HCV-carrying blood donors still cannot be screened out, and blood transfusion may still spread hepatitis C, especially those who repeatedly transfuse blood and blood products.
(2) Transmission through injection, acupuncture, organ transplantation and hemodialysis: It is reported in China that more than 80% of intravenous drug users are anti -HCV positive. Hemodialysis patients and bone marrow transplant patients are also high-risk groups.
(3) Close contact with life: About 40% of sporadic HCV infected people have no obvious history of blood transfusion, blood products and injection, which is called community acquired, and most of them are spread through close contact with life.
(4) Sexual transmission: HCV exists in semen and saliva, and sexual contact transmission can not be ignored. Polysexual partners and homosexuals are high-risk groups.
(5) Mother-to-child transmission: The probability of HCV infection in infants whose mothers are infected with HCV is about 10%. [Edit this paragraph] Treatment scheme There is still a lack of reliable specific treatment methods for viral hepatitis. Treatment should be differentiated according to different pathogens, different clinical types and histological damage. The treatment principle of various types of hepatitis is to give priority to adequate rest and nutrition, supplemented by appropriate drugs to avoid drinking, overwork and drugs that damage the liver.
(1) Acute hepatitis is generally self-limited and can be completely recovered. General treatment and symptomatic support treatment should be given priority to, isolation should be carried out in the acute stage, those with obvious symptoms and jaundice should stay in bed, and the amount of activity can be gradually increased in the recovery period, but overwork should be avoided. 1-3 months later, normal liver function can be restored. Give light and digestible food and supplement vitamins appropriately. The intake of protein should reach 1- 1.5g/kg per day, and those with insufficient calories should be supplemented with glucose intravenously. It should be supplemented with drugs to treat symptoms and restore liver cold, so as not to increase the burden on the liver. Generally, antiviral therapy is not used, except polar hepatitis C, because acute hepatitis C is easy to become chronic, and early application of antiviral drugs can reduce the slowing rate. Dry interferon or long-acting interferon can be selected for 24 weeks, and ribavirin can be added.
(2) According to the specific situation of patients with chronic hepatitis, a comprehensive treatment plan is adopted, including reasonable rest, nutrition, psychological balance, improvement and recovery of liver function, immune regulation, antivirus and anti-fibrosis.
1, general treatment (1) Appropriate rest: those with obvious symptoms or serious illness should emphasize bed rest, which can increase liver flow and help recovery. For those with mild illness, the degree is that there is no feeling of wholesale after the activity. (2) Reasonable diet: Proper digestion of foods with high protein, high calorie and high vitamins is conducive to liver repair, so it is not necessary to overemphasize high nutrition and avoid drinking alcohol to prevent fatty liver. (3) Psychological balance: make patients have a correct view of the disease and have patience and confidence in hepatitis treatment. Don't go to the doctor indiscriminately, so as not to delay treatment.
2. The only effective drug for hepatitis C is antiviral therapy, that is, interferon combined with ribavirin: the purpose is to inhibit virus replication and reduce infectivity; Improve liver function; Alleviate liver tissue lesions; Improve the quality of life; Reduce or delay the occurrence of cirrhosis and HCC. Give antiviral treatment to salespeople who meet the requirements of needles.
1) interferon α(IFNα) combined with ribavirin: 1992 The US FDA approved interferon α-2b combined with ribavirin to treat acute or chronic hepatitis C. The cure rate was 4 1-47%, that is, the serum was still negative for hepatitis C after more than five years of follow-up.
2) Peginterferon α combined with ribavirin: No matter acute hepatitis C or chronic hepatitis C, the standard treatment is peginterferon α(α-2a or α-2b) combined with ribavirin. Improve the cure rate of hepatitis C to nearly 20%. Peginterferon α combined with ribavirin is the most effective method to treat hepatitis C at present. As pegylated interferon alpha is administered once a week, the frequency of administration is greatly reduced, which is convenient for patients to take medicine. Compared with common interferon, pegylated interferon is also called long-acting interferon. The direct clinical comparison of two kinds of long-acting interferon combined with ribavirin shows that the recurrence rate of 12KD pegylated interferon α-2b is significantly lower than that of 40KD pegylated interferon α-2a, which may be related to the antiviral activity and drug distribution caused by molecular size. It is generally believed that the larger the molecular weight of polyethylene glycol, the lower the antiviral activity, and the activity of 12KD polyethylene glycol interferon α-2b is obviously higher than that of 40KD long-acting interferon. Moreover, 12KD long-acting interferon can be distributed all over the body, which can not only eliminate the main viruses in the liver, but also eliminate extrahepatic viruses such as lymph nodes, kidneys, spleen, adrenal glands and salivary glands, so the recurrence rate is low after drug withdrawal. 40KD PEG-IFN is too large to be distributed in blood vessels and liver, which is not conducive to virus clearance outside the liver. Not only does it increase the burden on the liver and slow excretion, but it is also difficult to stop taking drugs when adverse reactions occur because it does not pass through the kidney. Due to the publication of the head-to-head comparison results of the ideal trial, it is generally believed that 12KD pegylated interferon α-2b should be the first choice for the treatment of hepatitis C.
IFN-α should not be used in any of the following cases: a, serum bilirubin > 2 times the upper limit of normal value; B, decompensated cirrhosis; C, have autoimmune diseases; D, there are important organ diseases (serious heart and kidney diseases, diabetes, hyperthyroidism or hypothyroidism and neuropsychiatric abnormalities, etc.). Treatment plan (adult): 3MU—5MU each time, 5MU each time, 3 times a week, subcutaneous or intramuscular injection for 4-6 months, which can be extended to 65,438+0 years according to the illness. Induction therapy can also be used, that is, 1 time every day for the first 5 days to 3 months, and then changed to 3 times a week until the end of the course of treatment.
Adverse reactions of IFN-α: A. Influenza-like syndrome usually occurs 2-4 hours after injection, and symptomatic treatment such as antipyretic and analgesic can be given without stopping taking the drug. B, bone marrow suppression, manifested as a decrease in granulocyte and platelet counts, which can generally be recovered after drug withdrawal. When the white blood cell count is lower than 3.0× 109/L or neutrophils are lower than 1.5× 109/L or platelets are lower than 40× 109/L, the drug should be stopped. Treatment can be resumed after hemogram recovery, but close observation is needed. Neuropsychiatric symptoms, such as anxiety, depression, excitement, irritability and psychosis. If you have depression and mental symptoms, you should stop taking medicine. D, insomnia, mild rash, hair loss, as the case may be, do not stop taking the medicine. When rare reactions such as epilepsy, nephrotic syndrome, interstitial pneumonia and arrhythmia occur, the drug should be stopped for observation. E, induce autoimmune diseases, such as thyroiditis, thrombocytopenic purpura, hemolytic anemia, rheumatoid arthritis, type I diabetes, etc. , should also stop. Dietary precautions
1, avoid spicy food, which can easily cause damp-heat in digestive tract, mixed damp-heat, disorder of liver and gallbladder qi, and weakened digestive function. Therefore, we should avoid eating spicy products.
2, avoid smoking cigarettes contain a variety of toxic substances, can damage liver function, inhibit liver cell regeneration and repair, so patients with liver disease must quit smoking.
3. Avoid drinking. 90% of alcohol is metabolized in the liver. Alcohol can interfere with the normal enzyme system of liver cells, so it directly damages liver cells and leads to liver cell death. Patients with acute or chronic active hepatitis, even if drinking a small amount, will make their condition repeat or change.
4. Avoid processed food and eat less canned or bottled drinks and food. This is because preservatives are often added to canned and bottled drinks and foods, which are more or less toxic to the liver.
5, to avoid the abuse of hormones and antibiotics "is a three-point poison", any drug is harmful to liver and kidney, patients with liver disease must be under the correct guidance of doctors, rational use of drugs.
6, avoid eating supplements and eating a balanced diet is the basic condition to maintain good health, such as improper nourishing, visceral dysfunction, breaking the balance, it will affect health.
7, avoid eating too much protein diet for patients with severe hepatitis, due to gastric mucosal edema, small intestinal villi thickening and shortening, bile secretion disorders. , people's digestion and absorption function is reduced. Eating too many high-protein foods such as eggs, soft-shelled turtles and lean meat will cause indigestion and bloating.
8, avoid high copper diet When the liver function is not full, it can not regulate the balance of copper in the body well, and copper is easy to accumulate in the liver. Studies have shown that the storage of copper in the liver of patients with liver diseases is 5- 10 times that of normal people, and the content of copper in the liver of patients with biliary cirrhosis is 60-80 times that of normal people. Medical experts point out that too much copper in the liver will lead to hepatocyte necrosis, and too much copper in the body will lead to renal insufficiency. Therefore, patients with liver disease should eat less foods containing more copper, such as jellyfish, squid, shrimp and snails.
9. Avoid irregular life, so it is very important to have enough sleep, reasonable nutrition, regular life, insist on morning exercise every day, and combine work and rest.
10, avoid emotional stagnation Patients with liver disease should avoid anger, pessimism, anxiety, etc. Because patients with liver disease can't be cured for a long time, people tend to be anxious and irritable, and it is easy to get angry and hurt the liver, and stagnation of liver qi is easy to become a habit.
1 1. Avoid fatigue. The liver is an important metabolic organ of human body. Patients with hepatitis have abnormal function and malnutrition, so they are very tired and need more rest. Therefore, more rest is the key to treatment.
12, don't go to the doctor at will, don't trust the quack doctor, so as not to delay the correct treatment and make the condition worse or even worse.
Matters needing attention in daily diet and life should be appropriate.
1, Acidity From the point of view of traditional Chinese medicine, acidic food can introduce drugs into the liver. The traditional Chinese medicine Schisandra chinensis is acidic, which can introduce drugs into the liver and reduce transaminase. In the past, rice vinegar was once popular for treating hepatitis. In addition, acidic foods can also increase appetite.
2. Sweet food can supplement a certain amount of heat to patients with hepatitis, which is easy to absorb and is beneficial to the recovery of hepatitis. Loss of appetite in acute hepatitis, sweets are better.
3. Bitter Chinese medicine believes that bitter food is cold and can clear away heat and detoxify. It is beneficial for patients with hepatobiliary damp-heat liver disease to eat bitter food, except beer. [Edit this paragraph] Disease prevention (1) Control of infectious sources Hepatitis patients and virus carriers are the infectious sources of this disease, and acute patients should be treated in isolation until the virus disappears. Chronic patients and carriers can evaluate infectivity according to virus replication index. Active replicators should be given antiviral treatment as much as possible. Anti-epidemic people cannot engage in food processing, catering services, child care and other work. Strictly screen blood donors, and those who fail are not allowed to donate blood.
(two) cut off the route of transmission, strengthen supervision and management of service industries such as child care institutions, and strictly implement tableware disinfection. Barber, beauty, bath and other appliances should be disinfected according to regulations. Develop good personal hygiene habits. Wash your hands with soap and running water after touching the patient. Advocate the use of disposable injection instruments and implement disinfection measures for various medical instruments and appliances. Contaminants in blood and body fluids should be strictly disinfected. To strengthen the management of blood products, every blood donor and blood unit should carry out the most sensitive HBsAg and anti -HCV detection, and if possible, both HBV DNA and HCV RNA should be detected at the same time. Those who are positive may not donate blood, and positive blood may not be used. Take active and passive immunization to block mother-to-child transmission.
(3) Protection of susceptible population: There is no vaccine, so there is no specific immune preventive measures.