Anti-hepatitis B pay attention to “individual”
- Filed under: Hepatitis
- Date: Oct 30,2008
With the development of hepatitis B treatment, drugs, autoimmune host, the needs of the three patients with a combination of diagnosis and treatment concept is widely accepted by the medical profession. To completely clear the hepatitis B virus is not easy to do, but the clinical practice tells us that as long as the ongoing exploration of chronic hepatitis B is not a no hope to defeat the disease.
From December 2005 “China’s prevention and treatment of chronic hepatitis B Guide” (referred to as “the Guide”) has formally launched, anti-viral treatment of the concept of people, the formal anti-viral drugs have been more widely used in the process , Anti-viral treatment for many patients benefit from interferon treatment of many patients with hepatitis B patients achieved a long-term remission, and even some patients with a surface antigen seroconversion; nucleotide analogues of the new drugs have emerged so many Interferon is no indication or disease progression to liver cirrhosis patients can also have the opportunity to control drugs for treatment, but with the use of the increase in population, but also exposed the anti-viral treatment of a number of issues, such as the treatment of interferon treatment Issues, such as nucleoside analogues, and so on the issue of drug resistance.
To this end, we interviewed a West China Hospital of Sichuan University, Infectious Diseases Center, Professor Zhao Liansan. Professor Zhao said with deep feeling on this, “each of the patients would like to convert the surface antigen, this is not unreasonable. It is true that the current Clinical Practice has proved that regulation of the immune-based anti-viral therapy can help some patients get this effect, but this ratio is relatively low . To set a reasonable goal of treatment; strengthen the doctor-patient communication, the most appropriate individualized treatment program, is the key to overcome the disease. ”
To rationalize the treatment goal
In general, the treatment of hepatitis B clinical stage is divided into three basic goals.
The first phase: hepatitis B virus replication has been inhibited, liver function returned to normal;
The second phase: e antigen negative, the emergence of e antibody, that is, the e antigen seroconversion, ALT normal liver function, hepatitis B virus replication continued to be inhibited. Clinically, the emergence of e antigen seroconversion in patients with autoimmune been mobilized to fight the virus and that viral replication continued to be suppressed after stopping the disease continued to ease. International clinical trial shows that interferon treatment to obtain e antigen seroconversion can help patients with liver cirrhosis and liver cancer significantly reduced the rate of occurrence.
The third stage: access to e antigen in the serum conversion on the basis of the conditions of patients to continue treatment, there was hope that the surface antigen negative, positive to antibodies on the surface, that is, hepatitis B surface antigen seroconversion. Some experts such as the status of clinical cure. This is to express, in the academic community to explore. However, it is undeniable that it is clinically cured closest to the state. “Guide” made it clear that the surface of B-positive that there is immunity against hepatitis B virus, hepatitis B patients and found in the hepatitis B vaccine inoculation were. This is a long course of chronic hepatitis B has very important significance.
On the current medical standards, only a very small proportion of patients can be achieved in the third stage (in this area are the only large-scale international clinical data to prove the PEG-IFN a-2a, the proportion of all patients only 3-5%), while the ratio is very low, but after all, let us see the hepatitis B “cure” the hope that the experts and scholars are also to how to improve this ratio in the unremitting efforts. The secondary objective is the most realistic, but also a more important goal of clinical research at home and abroad have confirmed that the realization of e antigen serum conversion is not only to achieve sustained remission of the disease, not easy to stop after repeated, and the achievement of this objective is to obtain Higher target surface antigen serology a prerequisite for conversion.
The timing of the treatment of individual
Hepatitis B infection from the disease to be a long process, in the process, and the immune virus among the more it is extremely important, only to recover to master the best time for treatment and timely intervention to choose the right method, treatment can Be maximized. Domestically, the majority of patients with hepatitis B are infected through mother to child transmission, infants and young children in the period, due to the immune unsound and can not identify the hepatitis B virus, resulting in immune tolerance, but with the sound of the immune system gradually, the immune system to start Immune to the virus started to clear role in the formation of a seesaw battle. At this time, if given in a timely manner based on the immune regulation of anti-retroviral therapy, can often get good treatment. Although the treatment is not fixed in time for a certain age, young and middle-aged patients, with regard to regulation of the immune response to treatment is better in general. Clinically, the most commonly used indicator to determine aminotransferase, ALT increase, in normal times 2 to 5 times, this may be the treatment of chronic hepatitis B better time.
Treatment of the individual
The different circumstances of individual patients, treatment is different from the natural. In the early stages of treatment, doctors need to fully understand each patient’s characteristics and needs of their own. For example, for young patients, their survival is still very long time, and there is marriage and child rearing. Anti-viral drug in the treatment of oral nucleotide analogues convenience, in general a short period of time can be seen on the viral replication by inhibiting the effect of long-term, but there is the risk of virus mutation; can not stop without permission, otherwise there is the possibility of disease . This requires a clear account of the patients and help them set reasonable goals of treatment.
Based on the immune regulation of interferon therapy, although able to inhibit viral replication in the host immune mobilization at the same time, in order to obtain a higher conversion rate of e antigen, after the drug is relatively less vulnerable to relapse; in the treatment of the more obvious side effects And require injection therapy, patients need a very good co-ordinated in order to strive for the best effect. 2007 guidelines for the treatment of hepatitis B in the United States pointed out that the young patients, children or the needs of women, advising them to the interferon of choice for anti-viral treatment.
For their own immune system is not very good, or the disease has been developed to cirrhosis patients, treatment must be considered the treatment of patients with the safety and quality of life. Under the supervision of doctors in the use of oral nucleoside analogue therapy can help them maintain a normal life.
With the development of hepatitis B treatment, drugs, autoimmune host, the needs of the three patients with a combination of diagnosis and treatment concept is widely accepted by the medical profession. To completely clear the hepatitis B virus is not easy to do, but the clinical practice tells us that as long as the ongoing exploration of chronic hepatitis B is not a no hope to defeat the disease.
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