The key to chronic hepatitis B treatment is antiviral therapy, how to achieve effective antiviral efficacy, so that antiviral drugs play the greatest anti-viral effect is often faced with clinical problems. In real life, many patients with poor efficacy of antiviral, antiviral drug resistance and other phenomena are related to the level of ALT treatment, the clinical treatment of hepatitis B in the ALT has a variety of errors, the author combined with clinical practice, these errors Carried out a summary and put forward the corresponding countermeasures, summarized as follows, hoping to have some help against the virus treatment.
Some young patients only HBV DNA positive, ALT normal, began to antiviral therapy, treatment for some time after the discovery of poor efficacy, because ALT normal, the human body to remove hepatitis B virus immunity and human hepatitis B virus in the peaceful coexistence phase , The human body to tolerate the presence of hepatitis B virus, the human body to remove hepatitis B virus immune capacity can not remove hepatitis B virus, resulting in antiviral efficacy is invalid or poor, and therefore do not have anti-viral treatment. In addition, we must understand a reason, the drug is only external causes, the body's hepatitis B virus immune clearance ability is internal, external causes only through internal factors, to play anti-virus ability, ALT normal, the human body to remove hepatitis B virus immunity is low, not anti-virus Hepatitis B virus is long-term or even life-long, HBV DNA often shows positive, can not see HBV DNA positive antiviral treatment, leading to many hepatitis B patients with antiretroviral treatment for several years or even more than ten years, not only ineffective, and very Easy to make hepatitis B virus against the virus drug resistance, the current limited varieties of antiviral drugs, oral antiviral drugs only 4,5 kinds, and interferon has some limitations, once the antiviral drug resistance is invalid, will make us helpless , So that no antiviral use of the point. Therefore, the HBV DNA positive, normal liver function, do not have anti-viral treatment, do not have to use other hepatoprotective drugs.
Some patients, especially young people, HBV DNA positive, elevated ALT but did not reach the upper limit of the normal value twice, that is, anti-viral treatment. For such patients with mild inflammation of the liver, although the body has a certain degree of immune clearance, but this ability is far from good long-term efficacy, especially hepatitis B HBeAg, more difficult to switch to hepatitis B small Sanyang, and e Antiserum seroconversion is the key goal of treatment of hepatitis B for treatment, but also whether the withdrawal of drugs, when the key indicators of withdrawal, only when ALT increased to twice the normal upper limit and more than twice before the start of antiviral therapy, 3 More than 5 times better efficacy (need to rule out fatty liver caused by elevated ALT). For these patients with ALT less than twice the normal upper limit, patients should be reviewed once every two weeks liver function, once in line with antiviral indications, and then start antiretroviral therapy.
Some patients have reported ALT reports a month or even earlier, and as a basis for starting antiretroviral therapy. I in clinical life, often encountered such patients, do not know, ALT is not static, although the ALT rose to the upper limit of more than twice the normal value, but it will fluctuate with the development of the disease, if the disease was just, Then the ALT will rise over time, if you have entered the late onset, it will fall with the passage of time, so we can not rely on the previous ALT report as the basis for antiviral therapy, such as a long time did not check the ALT , Should be reviewed once ALT and then decide whether to carry out antiviral therapy, so as to follow the poor efficacy.
A small number of doctors for bed utilization in the patient ALT is only about 2-3 times the normal upper limit, that is, hospitalization, and to give intravenous anti-inflammatory liver treatment, ALT almost normal and then antiviral treatment, resulting in poor antiviral efficacy The For such patients, do not be elevated transaminase scared gallbladder and hospitalized intravenous anti-inflammatory liver treatment, should be in the outpatient antiretroviral treatment.
Some patients with high ALT, reaching hundreds of human immune clearance ability is strong, only the use of anti-enzymatic drugs, ALT to the upper limit of about twice the normal and then anti-viral treatment. For such patients, said that regret, because in the most appropriate time did not choose anti-viral treatment, and only selected the enzyme treatment, to know the treatment of palliative treatment, treatment for many years after liver fibrosis or even liver cirrhosis , This by reducing the enzyme treatment to reduce ALT and then anti-viral treatment, often ineffective. For such patients with high ALT, liver protection enzymes at the same time should be anti-viral treatment, this time the body's immune clearance of hepatitis B is very strong, antiviral treatment, better efficacy, easy to turn into small Sanyang.