How should hepatitis B treated?

Should be based on clinical types, etiology of the different types take different treatment measures. The general principle is: the proper rest, proper nutrition-based, supplemented by selective use of drugs. Ying Ji Jiu, prevent fatigue and to avoid loss of liver drug application. To grasp the simple medication should not fan.
1. The treatment of acute hepatitisEarly strict bed rest is most important, significant

improvement in symptoms can gradually increase the volume of activity in order not to fatigue the principle of treatment until the symptoms disappear, isolation expired with normal liver function can be discharged from hospital. After 1 to 3 months rest, and gradually return to work.
Diet in order to meet the patients with taste, digestible foods suitable light. Should contain a variety of vitamins, there is sufficient heat and the right amount of protein, fat should not be too restrictive. Such as eating less or Outu Zhe, using 10% glucose solution 1000 ~ 1500ml adding vitamin C3g, the liver was too happy 400mg, regular insulin 8 ~ 16U, intravenous infusion, day 1. Can be added to the energy and 10% potassium chloride mixture. In severe cases, bacteria can be used hot Chen Weiling Decoction; equal emphasis on those hot and humid with bacteria and stomach-Ling Chen hao Tang-Fang addition and subtraction; liver qi stagnation by using Xiaoyaosan; the wet spleen were used Pingwei San trapped. Those who favor deep jaundice and effective reuse of Paeonia. General acute hepatitis can be cured.
2. The treatment of chronic hepatitis
Include anti-viral replication and improve immune function, protect liver cells and promote regeneration and so on. Due to illness easily repeated and persistent positive indicators of HBV replication, may be to choose the following methods:
1. Anti-viral treatment
Chronic HBV infection, viral replication continued positive indicators of anti-viral treatment is an important measure. The current antiviral drugs, the effect is not satisfied. After application may be temporarily inhibited HBV replication after withdrawal of this inhibition disappears, so that the original target of pent-reverted to the original level. Some drug effects more slowly, take longer time to see results. Because the efficacy of antiviral drugs is limited, and only if active viral replication only when markedly, so the treatment of chronic hepatitis B in recent years, combination therapy tended to improve efficacy.
(1), interferon (Interferons, IFN) is currently recognized have a certain effect on HBV replication drugs. Its mechanism as follows: ① blocking viral reproduction and replication, mainly through antiviral protein (AVP), leading to mRNA cleavage, preventing HBV replication; ② the infected liver cell membrane induced by MHC class Ⅰ antigens. For Tc cell recognition and killing effects. The main clinical use of genetic engineering the current interferon, including interferon α-1b, α-2a, α-2b. ① recombinant interferon α-2b (Intron, Intron A): every 3 million U, intramuscularly, daily one time used in conjunction 1 week later changed to every other day 1, course 3 in June. HBeAg and HBV-DNA negative conversion rates of up to 30 ~ 70% effect of inhibiting HBV replication sure. But the vast majority are still persistent positive HBeAg, HBV-DNA integration may be related to the. ② α1 type of genetic engineering interferon (interference Ling): Each 2 million ~ 6 million U, intramuscularly, daily one time, course of 2 months, the recent HBeAg seroconversion rate of 55%.
The efficacy of interferon, individual reports vary, HBeAg negative conversion rate is normally 40% ~ 50%. In order to improve efficacy, corticosteroids useful after removal of interferon, but should pay attention to serious condition of the CAH hanged, or else make condition deteriorated. Right that the gene mutation by HBV pre-C infection, that is, anti-HBe positive, HBV-DNA positive chronic hepatitis, use of high-dose interferon, efficacy is not ideal. β and γ-interferon on the efficacy of HBV replication than α-IFN.
Factors that affect the response to interferon therapy: ① CAH than CPH; ② good curative effect more women than men; ③ ALT levels were more effective than ALT normal; ④ HBsAg, HBeAg, HBV-DNA-efficient lowest-good effect; ⑤ unused antiviral drugs and immunosuppressive agents are better efficacy than those who used an invalid; ⑥ dose and treatment, high-dose and long-course like a good person.
Side effects and treatment length, dosage related. The most common is the "flu-like syndrome," manifested as chills, fever, headache, body aches, fatigue and so on. But continued after the application or reduction often gradually reduce. Are mostly a transient fever, common in the first dose was not found and efficacy relationship. May also cause leucopenia, thrombocytopenia and so on, often after stopping natural recovery, can not affect the treatment. At present, many believe that with other antiviral drugs or immune regulating drugs in conjunction with, may increase efficacy.
(2) Acyclovir (Acyclovir, ACV, homemade Arp Holloway): This drug is nucleoside analogues, inhibition of various DNA viruses, which in the body by the thymidine kinase (TK) activation into a prime activity of disease-resistant acyclovir triphosphate, which can inhibit viral DNA chain DNAp and the suspension of an extension of the role of TK therefore has the role of viruses such as herpes virus, well, HBV does not have TK, so the role of a general, multi-considered better efficacy of interferon in combination. Use daily 15mg/kg, diluted morning and afternoon hours intravenous infusion for 2 hours, 1 day, qd for 30 days then stopped on the 15th take another 15 days, treatment for 60 days. Domestic reporting different effect, the effect than α-interferon.
(3), adenosine arabinoside (Ara-A) and single-Ara-AMP (Ara-AMP), both of which are purine analogues that can selectively inhibit the virus DNAP and nucleotide reductase activity, preventing DNA-based viral replication. Since Ara-A, Ara-AMP side effects in recent years have been less.
4) Polyinosinic (PolyI: C): as a synthetic interferon inducer, the domestic application of more long, efficacy has not been positive. Effect of chronic hepatitis B is not significant. Usage of 4mg, intramuscular injection, 2 times per week course of 3 June.
2. Immunomodulatory drugs aimed at raising the anti-viral immunity.
(1), thymosin: by influencing cAMP and enhanced T cell activity. Use daily 10 ~ 20mg, intramuscular injection or intravenous drip treatment 2 ~ 3 months.
(2), interleukin-2 (IL-2) can stimulate the immune effector cell proliferation and induced γ-interferon. Use daily 1000 ~ 2000U, intramuscular injection, daily one time, 28 to 56 day course of treatment. HBeAg negative in some patients.
(3) lymphokine-activated killer cells ((Lymphokine-activited Killer Cell, referred to as LAK cells), established with the lymphatic factors (such as IL-2 and γ-IFN) to stimulate their derived precursor cells.
Domestic reporting will enable some patients HBeAg and HBV-DNA negative conversion. 3. Protecting the liver cells, drug
(1) Yiganling grass from milk thistle seed extract corpus luteum glycosides, can stabilize liver cell membrane and promote regeneration. Usage for each 2 tablets 3 times a day course in March. (2) potenline glycyrrhizin extracted from licorice root, poisoning by carbon tetrachloride induced liver injury as effective in the treatment of hepatitis, to the role JiangMei better rebound after drug withdrawal. Existing similar products Ganlixin injection, after looking better than JiangMei potenline. 150mg usage for a 10% glucose solution intravenously, daily one time, treatment 1 to 2 months, pay attention to heart and kidney failure, severe hypokalemia and hypernatremia syndrome is disabled. Pregnant women and infants and young children should not use.
(3), oleanolic acid tablets: use of 80mg, 3 times a day using it, treatment in March. DDB, usage of 15 ~ 25mg, 3 times a day using it, transaminases normal to maintain reduction, treatment in June. JiangMei role in both. 3. The treatment of severe hepatitis Refer to the treatment of fulminant hepatic failure in part. 4. The treatment of asymptomatic HBsAg carriers Where there are positive indicators of HBV replication, application of antiviral therapy, the first choice α-IFN. In short, hepatitis B anti-viral treatment, after drug research pointed out that the key lies in whether drugs inhibit HBV supercoiled covalently closed circular DNA (ccc DNA), while the existing antiviral drugs on liver nuclei of the virus cccDNA no effect, Therefore, after stopping cccDNA re-engineering of viral replication in the transcription template, the virus replication. Recently, hepatitis has been reported biological targeted therapy, antisense RNA may be closed to the gene encoding the key viral replication, the level of the gene targeted therapy could bring new hope for hepatitis B treatment. Therefore, the treatment of hepatitis B needs to pay attention to symptomatic supportive therapy, comprehensive treatment of Chinese and Western medicine