A patient from Jiangsu yesterday, 43 years old, male, has a history of hepatitis B minor positive for more than 20 years. After two years of antiviral treatment with entecavir, the virus level dropped below 1000IU/ml, and the liver function returned to normal. Afterwards, he neglected management because of his good condition. Last month, he went to the local hospital for reexamination of liver B-ultrasound, and was diagnosed with early liver cirrhosis with nodular changes.
“Well, why did he suddenly develop liver cirrhosis?” Without any warning, he felt very confused. Then he was tested for hypersensitivity and liver damage, and the result was HBV-DNA 478IU/ml, liver damage 14.6 (fat attenuation coefficient 238), and a slightly enlarged spleen. According to his actual situation, I readjusted the treatment plan for him. In addition to anti-virus, I added some traditional Chinese medicine prescriptions to him. If there is no accident, he should get better soon.
There are many patients with similar situations, and they all have one thing in common, that is After years of treatment, the symptoms improved or even completely disappeared, but eventually the disease developed into cirrhotic nodules. For such patients, how to adjust the treatment plan to delay further changes in the condition?
First of all, regular follow-up visits must be done before the patient is completely overcast.
This liver friend thought he was in a good condition, so he neglected the follow-up visits, giving his condition a chance machine. The treatment of hepatitis B focuses on the comprehensive assessment of the liver as a whole, rather than relying on single indicators such as symptoms or liver function. The persistent, chronic low inflammation in the liver was the direct cause of his progressive fibrosis. And this factor must be found in time through follow-up. Especially in patients with liver cirrhosis, family history of liver cancer, or patients with liver cirrhosis nodules, more attention should be paid. If necessary, it should also be combined with the inspection of alpha-fetoprotein heterogeneity (AFP-L3), abnormal prothrombin, and even liver biopsy to improve the early detection rate of liver cancer screening. In addition, after antiviral treatment, it is recommended to use high-sensitivity reagents to detect the amount of virus, and it is safer if it is less than 20 (or 10) or no virus signal can be detected.
Secondly, optimize and adjust treatment in time after developing hidden dangers
This liver friend has been treated with entecavir alone for many years. Although the virus has been suppressed, it has not turned negative. At this time, the combination of antiviral drugs is especially critical! In addition, Chinese medicine must be combined. why? Because even if the virus remains negative, the hepatic stellate cells can still continue to express the extracellular matrix, so that the fibrosis can continue. Therefore, it is very important to combine traditional Chinese medicine anti-fiber in time. In addition to improving the liver foundation, it can also reduce the risk of liver cancer.
Third, prevent liver cirrhosis nodules from developing into small liver cancer
The appearance of regenerative nodules in liver cirrhosis does not mean that it will definitely develop into liver cancer. However, some regenerative nodules can evolve into small liver cancer. Therefore, in addition to dual-antibody therapy, regular review is also important in order to achieve a good recovery.