What Are the Symptoms of Hepatitis B?

Viral hepatitis type B ( viral hepatitis type B ) is an infectious disease mainly caused by liver disease caused by the hepatitis B virus. Clinically, the main manifestations are loss of appetite, nausea, upper abdominal discomfort, pain in the liver area, and fatigue. Some patients may have jaundice, fever, and large liver with liver damage. Some patients can become chronic and even develop cirrhosis, and a few can develop liver cancer.

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Can hepatitis B be completely cured? What is the scientific basis? 2018-11-13 19:11

Chronic hepatitis B (hepatitis B for short) refers to those who are positive for hepatitis B virus, whose course of disease is more than six months, or whose onset date is not clear, and who have clinical manifestations of chronic hepatitis. Its clinical manifestations include fatigue, loss of appetite, nausea, bloating, and pain in the liver area. For hepatitis B, because of its greater harm, the prognostic effect may not be cured, and we must actively prevent it. ... more

Basic Information

English name: viral hepatitis type B
Visiting department: Infectious Diseases

Common causes: Caused by hepatitis B virus
Common symptoms: Fatigue, loss of appetite, nausea, oiliness, right upper quadrant pain, etc.

Causes of hepatitis B virus

The cause of hepatitis B virus is hepatitis B virus, abbreviated as HBV, and hepatitis B virus is a DNA virus. The genome is double-stranded, circular, and incompletely closed DNA. The outermost layer of the virus is the outer membrane or envelope of the virus. The inner layer is the core. The nucleoprotein is the core antigen (HBcAg) and cannot be detected in serum. HBsAg-positive sera showed three kinds of particles under the electron microscope, round and filamentous particles with a diameter of 22nm, and a smaller diameter of 42. The spherical particles, also known as Dane's particles, are complete HBV particles.

HBV is very resistant to the outside world and can withstand disinfectants of normal concentrations. It can withstand high temperatures of 60 ° C for 4 hours. It can be inactivated by boiling for 10 minutes, high-pressure steam disinfection and 2% peroxyacetic acid immersion for 2 minutes.

Clinical manifestations of hepatitis B virus

Acute hepatitis

It is divided into acute jaundice hepatitis and acute non-jaundice hepatitis. Hepatitis B has a long incubation period, ranging from 45 to 160 days, with an average of 120 days. The total course of disease is 2 to 4 months.

(1) In the early stage of jaundice, there are chills, fever, fatigue, loss of appetite, nausea, oiliness, abdominal discomfort, pain in the liver area, and gradually deepening of urine color.

(2) Jaundice: fever regression, sclera, skin yellowing, jaundice appearing, and conscious symptoms have improved. The liver is accompanied by tenderness and throbbing pain. Some patients have mild splenomegaly. This period is 2-6 weeks.

(3) Recovery period Jaundice gradually subsides, symptoms alleviate or even disappear, liver and spleen return to normal, and liver function gradually recovers. This period lasts from 2 weeks to 4 months, with an average of 1 month.

2. Chronic hepatitis

Patients with a history of hepatitis B or HBsAg or a history of acute hepatitis for more than 6 months, but who still have symptoms, signs, and abnormal liver function, can be diagnosed as chronic hepatitis. Common symptoms are fatigue, general malaise, loss of appetite, discomfort or pain in the liver area, abdominal distension, low fever, signs of dull complexion, yellow sclera stain, spider nevus or palm of the liver, large liver, medium or full texture, and tingling Severe spleen may have deep jaundice, peritoneal effusion, lower extremity edema, bleeding tendency, and hepatic encephalopathy. According to the degree of liver damage, it can be divided into:

(1) Mild Patients with milder symptoms, no obvious symptoms or signs and symptoms, but only 1 or 2 mild abnormalities in biochemical indicators.

(2) Moderate symptoms and signs, those between mild and severe. Abnormal changes in liver function.

(3) Severe symptoms of obvious or persistent liver inflammation, such as fatigue, poor appetite, bloating, loose stools, etc., may be accompanied by liver disease, liver palms, spider moles, or hepatosplenomegaly, while other causes are excluded without portal hypertension Patients. Laboratory examination of serum, alanine aminotransferase repeatedly or continuously increased: decreased albumin or abnormal A / G ratio, significantly increased gamma globulin, where albumin 32g / L, bilirubin> 85.5mol / L, thrombin 60% to 40% of the original activity, one of the three tests can be diagnosed as severe chronic hepatitis.

3. Severe hepatitis

(1) Acute severe hepatitis has rapid onset, rapid progress, deep jaundice, and small liver. Within 10 days after the onset, neuropsychiatric symptoms quickly appear, bleeding tendency is obvious, and liver odor, peritoneal effusion, hepatorenal syndrome, and prothrombin activity are less than 40%. Excluding other causes, low cholesterol, liver function Obviously abnormal.

(2) Subacute severe hepatitis 10 days after the onset, there is still extreme fatigue, poor appetite, severe jaundice (bilirubin> 171 mol / L), abdominal distension and the formation of peritoneal effusion, and there is obvious bleeding, and the liver is usually reduced Not prominent, hepatic encephalopathy is more common in the later stage of severe liver damage: serum ALT is not increased or increased, and total bilirubin is significantly increased, that is: bile enzyme separation, A / G ratio inversion, and gamma globulin, Prothrombin time prolonged, and prothrombin activity was <40%.

(3) Chronic severe hepatitis Patients with chronic hepatitis cirrhosis or hepatitis B surface antigen carrying history, imaging, laparoscopy or liver puncture to support chronic hepatitis manifestations, and the clinical manifestations and laboratory changes of subacute severe hepatitis are Chronic severe hepatitis.

4. Post-hepatitis cirrhosis

Hepatitis B cirrhosis is the result of the development of chronic hepatitis B. Early liver cirrhosis must rely on pathological diagnosis (the liver tissue has both diffuse fibrosis and pseudolobular formation), ultrasound and CT examinations. Laparoscopy has the most reference value. Clinical diagnosis of liver cirrhosis refers to patients with chronic hypertension who have manifestations of portal hypertension, such as abdominal wall and esophageal varicose veins, peritoneal effusion, liver shrinkage, splenomegaly, portal vein and splenic vein diameter widening, and exclude other causes that can cause portal hypertension According to the degree of hepatitis activity, it is divided into active and resting cirrhosis.

5. Hepatitis B surface antigen (HBsAg) carriers

HBsAg carriers actually include healthy carriers, chronic HBV infection, and even patients with liver cirrhosis. The study found that only 10% to 29% of HBsAg carriers had normal liver tissue, and most had liver tissue damage to varying degrees. The definition of HBsAg carriers in China is: HBsAg positive, but no symptoms and signs of hepatitis, all liver function tests are normal, no changes within half a year.

Hepatitis B virus test

Liver function test

(1) Serum enzymatic test The concentration of alanine aminotransferase (ALT) in liver cells is 104 times higher than that in serum. As long as 1% hepatocyte necrosis can increase the serum concentration by 1 times, the positive rate of acute hepatitis is 80 % To 100%. Aspartate aminotransferase (AST) has the highest concentration in the myocardium, so when determining the effect on liver function, the effect of heart disease should be ruled out first. 80% of AST is in the mitochondria of liver cells. Generally, liver damage is mainly caused by ALT. If the serum AST is significantly increased, it usually indicates that the liver cells are severely necrotic. The release of AST into the blood from mitochondria, the degree of increase in serum transaminase is roughly parallel to the severity of the disease, but in severe hepatitis, bilirubin may continuously increase, while transaminase may decrease, that is, bile enzyme separation, indicating that liver cell necrosis is severe. Serum ALT and AST levels are most commonly used to reflect the degree of liver cell damage.

(2) Serum protein detection Clinically, serum protein is often used as a biochemical indicator of liver protein metabolism, which reflects the liver's synthetic function. When chronic hepatitis cirrhosis occurs, serum albumin often decreases, globulin levels increase, and -globulin Ascent-based.

(3) Detection of serum bilirubin The liver has functions of uptake, transport, binding, and excretion in bilirubin metabolism, and bilirubin levels increase due to liver function damage. Except for cholestatic hepatitis inside and outside the liver, bilirubin levels It is directly proportional to the severity of liver damage.

( 4 ) The prothrombin time ( PT ) can sensitively reflect the liver's synthesis of coagulation factors , , , , and the length of PT in liver disease is positively correlated with the degree of liver damage, which is of great value in judging disease progression and prognosis.

2. Detection of hepatitis B virus markers HBsAg and anti-HBs: HBsAg positive indicates that HBV is currently in the infection stage, anti-HBs is an immunoprotective antibody, and positive indicates that it has developed immunity to HBV. The diagnosis of chronic HBsAg carriers is based on those without any clinical symptoms and signs, normal liver function, and HBsAg positive for more than 6 months. HBeAg and anti-HBe: HBeAg-positive is an indicator of active replication and infectivity of HBV. The change of the test serum from HBeAg-positive to anti-HBe-positive indicates that the disease is relieved and infectivity is weakened. HBcAg and anti-HBc: HBcAg positive indicates that there is a complete direct response of HBV particles, active replication of HBV, and it is rarely used clinically due to the complicated detection method. Anti-HBc is a hallmark of HBV infection. Anti-HBcIgM positive indicates early infection and viral replication in the body. Anti-HBc total antibodies are mainly anti-HBcIgG. As long as they have been infected with HBV, this antibody is positive regardless of whether the virus has been cleared. HBsAg, HBeAg, and anti-HBc positives in chronic mild hepatitis B and HBsAg carriers are highly contagious, and the indicators are difficult to negatively convert.

Molecular biological markers: detected by molecular hybridization or PCR, HBV DNA in serum is positive, and directly reflects the active replication of HBV is infectious.

3. Liver biopsy

It is the main indicator for the diagnosis of various types of viral hepatitis, and it is also the exact evidence for the diagnosis of early liver cirrhosis, but it is not the first choice because the traumatic examination is not universal.

4. Ultrasound and computer tomography (CT)

Ultrasound is widely used. The diagnostic indicators of chronic hepatitis and hepatitis cirrhosis have been identified and can help to distinguish liver cirrhosis from liver cancer and jaundice. CT examination is also of great value in monitoring the progress of chronic hepatitis B, finding space-occupying lesions in the liver, and the above diagnosis.

Diagnosis of viral hepatitis B

The diagnosis of hepatitis B is based on the above symptoms, signs, laboratory tests, pathology, and imaging tests. The diagnosis must be made based on serum HBV markers and HBV DNA test results.

Hepatitis B is divided into different clinical types according to clinical characteristics and laboratory tests, including acute hepatitis B, chronic hepatitis B, hepatitis B cirrhosis, and primary liver cell carcinoma associated with hepatitis B virus.

Acute hepatitis B

(1) Recently, there are weakness and digestive symptoms that can not be explained for other reasons, including yellow urine, yellow eyes, and skin jaundice.

(2) The liver biochemical examination is abnormal, mainly due to an increase in serum ALT and AST, and an increase in serum bilirubin.

(3) HBsAg is positive.

(4) There is clear evidence that serum HBsAg was negative within 6 months.

(5) Anti-HBc IgM positive more than 1: 1000.

(6) Liver histology is consistent with changes in acute viral hepatitis.

(7) Serum HBsAg negative conversion and anti-HBs positive conversion during recovery period.

2. Chronic hepatitis B

(1) Acute HBV infection is still HBsAg positive or HBsAg positive for more than 6 months.

(2) The duration of HBsAg positive is unknown and anti-HBc IgM negative.

(3) The signs and liver disease of patients with chronic liver disease, liver palm, spider mole, liver and spleen, etc.

(4) Repeated or sustained increase in serum ALT, decreased plasma albumin and / or globulin, and elevated bilirubin.

(5) Liver pathology is consistent with the characteristics of chronic viral hepatitis.

(6) Serum HBeAg is positive or HBV DNA can be detected, excluding other causes that lead to elevated serum ALT.

3. Hepatitis B cirrhosis

(1) Serum HBsAg is positive or has a clear history of chronic hepatitis B.

(2) Decreased serum albumin, or increased serum ALT or AST, or increased serum bilirubin, accompanied by hypersplenism (platelet and / or leukopenia), or clear esophagus, gastric fundus varices, or hepatic Encephalopathy or ascites.

(3) Abdominal B-mode ultrasound, CT, or MRI imaging tests have typical manifestations of liver cirrhosis.

(4) Histological manifestations of the liver are diffuse fibrosis and pseudolobular formation.

Hepatitis B virus treatment

General treatment

Acute hepatitis and chronic hepatitis active period, need to be hospitalized, bed rest, reasonable nutrition, to ensure the supply of calories, protein, vitamins, alcohol is strictly prohibited, should gradually increase activities during the recovery period. Chronic hepatitis is at rest, you can do what you can. Severe hepatitis should be absolutely bedridden, try to reduce protein in the diet, ensure calories, vitamins, and can be transfused with human albumin or fresh plasma to maintain water and electrolyte stability.

2. Antiviral treatment

Acute hepatitis generally does not require antiviral therapy, while chronic viral hepatitis requires antiviral therapy. Interferon: Recombinant DNA interleukin (IFN-) can inhibit HBV replication. The intramuscular injection the next day, for 6 consecutive months, only 30% to 50% of patients achieved a longer-lasting effect. The preferred drug for hepatitis C is interferon, which can be used in combination with ribavirin. Lamivudine: It is a synthetic dideoxycytosine riboside drug with anti-HBV effect. Oral lamivudine can significantly reduce serum HBV-DNA levels, and the negative rate of HBV-DNA over 90% after taking the drug for 12 weeks. Long-term medication can reduce ALT and improve liver inflammation, but the HBeAg negative conversion rate is only 16% to 18%. After treatment for more than 6 months, HBV mutations can occur, but you can continue to take this medicine. Side effects can be continued to take 1 to 4 year. Famciclovir: It is a guanosine drug with long half-life and high intracellular concentration, which can inhibit the replication of HBV-DNA. This medicine has mild side effects and can be combined with lamivudine interferon to improve the efficacy. Other antiviral drugs: such as acyclovir, adefovir, entecavir, sodium phosphonate, etc. have a certain inhibitory effect on HBV.

3. Immunomodulator

Commonly used are: Thymosin 1 (Zidaxian) has a two-way immunomodulatory effect, which can reconstruct the immune function of patients with primary and secondary immunodeficiency. Thymosin The immune response of the cells involved in the body induces the differentiation and maturation of T lymphocytes, amplifies the response of T cells to antigens, and regulates the balance of T cell subgroups. immune RNA can induce interferon in the body and enhance the body's immune function.

4. Guided therapy

New immunotherapy (such as DNA vaccine immune complex therapy), gene therapy (antisense nucleic acid therapy, transgenic therapy) are being studied.

5. Liver protection drugs

Hepatoprotective drugs: Promote hepatocyte growth hormone , promote liver cell regeneration, protect liver cell damage, and regulate the body's immune function and anti-fibrosis effect. Silybin can protect and stabilize liver cell membrane. Diammonium glycyrrhizinate (Ganlixin) has a strong anti-inflammatory effect, protects cell membranes and improves liver function. It is suitable for chronic persistent hepatitis and chronic active hepatitis with elevated alanine aminotransferase. Adenosylmethionine (Simetai) supplementation of exogenous adenosylmethionine can promote the resolution of jaundice and the recovery of liver function.

6. Traditional Chinese Medicine

Syndrome differentiation treatment has a better effect on improving symptoms and liver function, such as Yinchen, Zongzi, Chiba, Salvia and so on.

Prognosis of hepatitis B virus

Chronic hepatitis B has a poor prognosis. Most are unhealed, and a few develop cirrhosis.

Prevention of hepatitis B virus

Hepatitis B virus is mainly transmitted through the blood, so the most important transmission methods are vertical transmission from mother to child and iatrogenic infection. The preventive measures are:

1. Manage the source of infection

Chronic hepatitis and asymptomatic, HBV carriers should be banned from donating blood and engaging in dietary nursery. For patients with HBV-positive liver disease, treatment and management guidance should be based on their symptoms, signs and laboratory results.

2. Cut off the transmission route

The focus of hepatitis B is to prevent transmission through blood and body fluids, strengthen screening of blood donors, and strictly control blood transfusion and application of blood products. If a wound or acupuncture is found or suspected to be infected with hepatitis B virus, high-potency hepatitis B immunoglobulin can be applied For the interventional examination and treatment of syringes, the instruments should be strictly sterilized to control mother-to-child transmission.

3. Protect vulnerable people

Artificial immunity, especially active immunity, is a fundamental measure to prevent hepatitis. Hepatitis B vaccine has been promoted in China to achieve good results. For babies born to HBsAg and HBeAg positive pregnant women, high-potency hepatitis B immunoglobulin (HBIG) is injected within 24 hours of birth. He was also vaccinated with hepatitis B vaccine at the same time, and then injected with HBIG and vaccine one month after birth.

Early detection, early diagnosis, early isolation, early reporting, early treatment, and early treatment of viral hepatitis B are needed to prevent the epidemic.