HBV carriers(Hepatitis B virus carrier, AsC) refers to a chronic hepatitis B virus (HBV) infected person who is positive for hepatitis B surface antigen (HBsAg) for more than 6 months, has few symptoms and signs related to liver disease, and has basically normal liver function.Hepatitis B serological marker (HBV M) is a necessary test index for diagnosis of hepatitis B virus infection. HBV DNA detection reflects the situation or level of virus replication.
TCM disease name
Hepatitis B carriers
Foreign name
hepatitis B virus carrier
Alias
HBV carriers
Visiting department
Infection Department, Digestive Department
Common causes
It is transmitted from mother to child, infected in infancy, infected with weak resistance, and transformed from chronic hepatitis B
It is mainly caused by the infection of hepatitis B virus (HBV), which is transmitted from mother to child, infant infection, sexual transmission, infected persons with weak resistance, and chronic hepatitis B.
1. Mother to child transmission
Mother to child vertical transmission is the main source of infection for carriers after birth.In the absence of preventive measures, the mother with double positive HBsAg and HBeAg causes almost 100% of mother infant HBV transmission rate.Infants lack the ability of immune clearance against a large number of invasive hepatitis B virus infections, showing "immune tolerance state".The DNA that invades the hepatitis B virus can be combined with the chromosome gene of the infant hepatocyte to replicate and reproduce using the infant hepatocyte and escape the attack of the body's immune system, thus showing a long-term hepatitis B virus carrying state without symptoms.
2. Infant infection
Infants who live in close contact with HBsAg and HBeAg positive mothers, nannies and relatives for a long time, such as breastfeeding, feeding and kissing, may be infected. As the immune system of infants is not fully developed, they are unable to eliminate the virus, and tolerate the long-term peaceful coexistence of hepatitis B virus, so they become carriers;It can also be infected through vaccination and injection.Infants are about 8 times more likely to be infected and carried in susceptible environments than adults.
3. Infected persons with weak resistance
Teenagers and adults with low or incomplete immune function may not get sick after contacting hepatitis B virus, but they cannot eliminate the virus, so that the virus and the body are in a coexistence state and become carriers of hepatitis B.
5. Transformed from chronic hepatitis B
Chronic hepatitis B turns into a carrier of hepatitis B virus after treatment.
clinical manifestation
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Asymptomatic hepatitis B virus carriers are those who have no symptoms and signs of hepatitis, have positive HBsAg for more than half a year, and have normal liver function indicators.Asymptomatic hepatitis B virus carriers check that their liver functions are normal, but their liver tissues will have different degrees of pathological changes. Asymptomatic hepatitis B virus carriers will also become symptomatic patients.According to statistics, about 10% of the population in China may carry hepatitis B virus.Asymptomatic hepatitis B virus carriers do not represent absolute safety. There is still a certain amount of hepatitis B virus in such people. If the hepatitis B virus in the body of hepatitis B carriers is in the continuous replication stage, it will lead to gradual damage to the liver tissue of patients, and then the disease may develop into hepatitis, cirrhosis or even liver cancer.Therefore, hepatitis B carriers should be reviewed regularly.
inspect
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The regular inspection items of hepatitis B virus carriers mainly include the following aspects: ① two pairs and half of hepatitis B; ②Liver function; ③HBV-DNA、Color Doppler ultrasound of liver, gallbladder and spleen; ④HBV mutation detection; ⑤Hepatitis B virus typing test; ⑥Hepatitis B virus biochip detection.
Normal data of hepatitis B test
Test items
Normal state
Inspection significance
Hepatitis B surface antigen (HbsAg)
negative
Whether there is hepatitis B virus in the body
HBsAb
Negative/positive
Unprotected/Protected
HBeAg
negative
Whether the virus replicates and is infectious
HBeAb
negative
Whether virus replication is inhibited
HBcAb
negative
Have you ever been infected with hepatitis B virus
HBV-DNA test, pay close attention to the changes in liver function and whether the hepatitis B virus is replicating in the body, find abnormal liver function and virus replication, and give symptomatic treatment. Don't miss the best treatment time.
complication
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Hepatitis B virus carriers need active treatment. If they are not treated in time, they may lead to cirrhosis and even liver cancer.
treatment
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For hepatitis B virus carriers with normal liver function and negative viral DNA, there is no need for treatment, as long as they develop good living habits and regularly go to the hospital for inspection. For hepatitis B virus carriers with abnormal liver function and/or positive viral DNA, active treatment is required, and if not treated in time, cirrhosis or even liver cancer may result.
At present, the treatment of hepatitis B virus carriers in China mainly adopts antiviral, immune function regulation and anti fibrosis treatment. The key to treating hepatitis B virus carriers is antiviral and anti fibrosis treatment.
Many factors should be considered when deciding to start treatment, including HBeAg status, ALT concentration, HBV viral load, age (40 years old), and liver fibrosis status.Among these variables, ALT concentration, HBV viral load and HBeAg status are the most important.The normal upper limit of ALT concentration in patients with hepatitis B virus (HBV) infection is 30U/L for men and 19U/L for women.
prognosis
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1. Regular inspection
Chronic hepatitis B virus carriers refer to those with positive serum HBsAg, who have been followed up for more than three times in a year. Serum alanine aminotransferase (ALT) is in the normal range, and e antigen HBeAg is positive or negative, and HBV-DNA is positive.Some people's condition is not stable, and even develop cirrhosis.Therefore, for these hepatitis B virus carriers, we should actively mobilize them to do liver histological examination.If liver histological examination shows that Knodell hepatitis activity index ≥ 4, anti hepatitis B virus treatment is required.
Inactive HBsAg carriers refer to those whose serum HBsAg is positive, HBeAg is negative, e antibody is positive, HBV DNA is negative or lower than the detection limit, and their serum alanine aminotransferase ALT is within the normal range after more than three consecutive follow-up visits in a year.Liver histological examination showed that Knodell hepatitis activity index was less than 4, and this part of hepatitis B virus carriers generally did not need special treatment.
The annual incidence of cirrhosis in HBV infected patients with normal ALT is about 0.5%.The incidence rate of liver cancer of HBsAg and HBeAg double positive and simple HBsAg positive people is 1169 and 324 per 100000 people per year respectively, while the incidence rate of liver cancer of HBsAg and HBeAg negative people is only 39 per 100000 people per year.It can be seen that the risk of cirrhosis and liver cancer of "carriers" is slightly higher than that of non carriers.
After knowing the status and future outcome of "hepatitis B virus carriers", it can be said that it is difficult to completely eliminate the hepatitis B virus after infection, and long-term dynamic observation is needed to inhibit the replication of the virus for a long time.Patients with inactive hepatitis B virus carrier status should be closely monitored whether their treatment is appropriate or not.
2. HBV carriers and HBV patients should be treated differently
Hepatitis B is quite common in China, where about 10% of the population is infected by hepatitis B.In this huge population, the vast majority of people should not be regarded as hepatitis B patients, but strictly speaking, they are hepatitis B virus carriers.Most of them only have hepatitis B virus in their body, but the liver function test is normal, they can work and study normally, and have no impact on life.Therefore, hepatitis B virus carriers and hepatitis B patients should be treated differently.Now the relevant departments in China have shown a series of policies to protect hepatitis B carriers and safeguard their rights.In addition, it is also clearly pointed out that hepatitis B carriers are not hepatitis B patients.China will cancel restrictions on enrollment and employment of hepatitis B carriers.All circles are studying and discussing this issue, hoping to reach a consensus and better safeguard the rights and interests of hepatitis B virus carriers.
prevention
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Mother to child transmission is the main route of hepatitis B transmission in China.60% of children born to mothers with hepatitis B can be infected with hepatitis B virus within two years. The risk of infection of newborns born to mothers with hepatitis B "big three positive" is about 70%~90%, and the risk of infection of newborns born to mothers with "small three positive" is about 10%~40%.The blocking rate of mother infant transmission blocked by hepatitis B vaccine alone was 87.8%.Newborns born to HBsAg positive mothers should be injected with hepatitis B immunoglobulin (HBIG) as soon as possible (within 12 hours after birth) within 24 hours after birth, with a dose of ≥ 100 IU. At the same time, 10 μ g recombinant yeast or 20 μ g Chinese hamster oocyte (CHO) hepatitis B vaccine should be injected at different sites, and the second and third doses of hepatitis B vaccine should be injected at 1 month and 6 months respectively,It can significantly improve the effect of blocking mother to child transmission.One dose of HBIG can also be injected within 12 hours after birth, and the second dose of HBIG can be injected one month later. At the same time, a dose of 10 μ g recombinant yeast or 20 μ g CHO hepatitis B vaccine can be injected at different sites, and the second dose and the third dose of hepatitis B vaccine can be injected at intervals of 1 month and 6 months respectively.
matters needing attention
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The following five points should be paid attention to in protecting the liver of hepatitis B virus carriers:
1. Pay attention to food balance
Hepatitis B virus carriers should not overeat or be often hungry. This kind of hungry and uneven eating habit will cause abnormal secretion of digestive juice and lead to dysfunction of liver function.Therefore, the diet of hepatitis B virus carriers should be balanced, and the proportion of protein, carbohydrate, fat, vitamins and minerals in the food should be maintained accordingly;Try to eat less spicy food and more fresh vegetables and fruits.
2. Drink more water to nourish and protect the liver
Drinking more water can supplement body fluids, enhance blood circulation, and promote metabolism. Drinking more water can also promote the secretion of glands, especially digestive glands, pancreatic juice, and bile, so as to facilitate digestion, absorption, and waste elimination, and reduce the damage of metabolites and toxins to the liver.
3. Nourish and protect the liver and drink less
The energy of the liver to metabolize alcohol is limited, and drinking too much will hurt the liver.According to medical research, a healthy person weighing 60 kg can only metabolize 60 grams of alcohol every day. If the limit is exceeded, it will affect the health of the liver and even endanger life.
4. Keep your mood comfortable
Optimism makes people healthy.Because the liver likes to relax and dislikes depression, anger and anger can easily lead to stagnation of qi and blood in the liver and become a disease.If you want to have a strong liver, you should first learn to control anger. Even if you are angry, you should not exceed 3 minutes. You should try your best to be calm, optimistic, cheerful, and carefree, so that the liver fire will be extinguished, and the liver qi will be normal.
5. Exercise moderately
Hepatitis B virus carriers should do more outdoor activities, such as walking, outing, playing ball, and playing Taijiquan. These activities can not only make people's blood flow unobstructed, promote the body to vomit the old and absorb the new, and strengthen the body, but also can be happy to nourish the liver, and achieve the purpose of protecting the liver and health care.
In winter, patients with hepatitis B should consciously warm their whole body during exercise, and in summer, they should sweat slightly without feeling their heart beating faster.
