Little Sanyang

Introduction Xiao Sanyang refers to the phenomenon that the hepatitis B surface antigen (HBsAg), hepatitis B e antibody (anti-HBe) and hepatitis B core antibody (anti-HBc) are simultaneously positive in the two-and-a-half-check of hepatitis B, which is called "small three-yang".

Cause

The virus infected with hepatitis B will inevitably cause the body's immune response, resulting in different serum immunological markers. It is currently believed that the pathogenesis of hepatitis B is closely related to the body's immune response, especially the cellular immune response in the body, by the patient or none. Symptoms HBV carriers are transmitted through blood, blood products, and mother-to-infant transmission. Such as blood transfusion, injection, surgical or dental surgery, acupuncture, shared razor or toothbrush, minor damage to the skin and mucous membranes, sexual behavior, etc. Contaminated equipment in hospitals can also be transmitted to hospitals.

an examination

Related inspection

Blood test hepatitis B two pairs of hepatitis B virus e antibody (HBeAb) liver function test

Xiao Sanyang refers to the phenomenon that the hepatitis B surface antigen (HBsAg), hepatitis B e antibody (anti-HBe) and hepatitis B core antibody (anti-HBc) are simultaneously positive in the two-pair examination of hepatitis B, which is called "small three-yang", Xiaosan The clinical significance of yang varies.

Any occurrence of "small three yang" indicates acute or chronic hepatitis B, and the virus replication in the body is the replication status of hepatitis B virus. The clinical significance of "small three positives" in the acute and chronic phases is different.

Clinically, the appearance of "small Sanyang" in acute hepatitis B usually indicates that the acute phase of virus replication is slow, the condition tends to improve, and may recover in the near future. In the chronic phase, "small three yang" usually has two meanings:

(1) Non-mutant strain virus infection changed from big three yang to small three yang, indicating that the virus replication was reduced or disappeared, and the condition was alleviated or stabilized.

(2) When the virus is mutated or infected with the variant virus, the expression of hepatitis B e antigen (HBeAg) is missing, often accompanied by repeated disease, rapid progress, and even develop into cirrhosis and liver cancer, or severe hepatitis.

Differential diagnosis

Commonly known as the big three yang, that is, hepatitis B two pairs of half examination, surface antigen (HBsAg), e antigen (HBeAg) and core antibody (HBcAb) is positive, in the two pairs of hepatitis B report is reflected in HBsAg (+) , HBeAg (+), anti-HBc (+).

In the first few years to more than ten years after the infection of hepatitis B virus in young children, the virus and the body "peaceful coexistence", the serum appears as a big three yang, so the big three yang also reflects the virus in the body is constantly replicating and breeding, and then the liver damage Usually lighter, a considerable number of infected people, especially female infected people, the virus can "peaceful coexistence" with the body for a long time or for life, so we call it "virus carrier", that is, the body has long carried hepatitis B virus, and the liver The damage is lighter and can live up to 60-70 years old. There are no obvious symptoms, and it is not necessarily caused by liver diseases. They mainly play the role of infectious source.

More infected people, 13-23 years old, can recognize the infected liver cells and recognize the infected liver cells due to the maturation of the body's immune system. Naturally, this is a protective response of the body itself. As a result, a large number of viruses are eliminated, and at the same time, infected liver cells are also destroyed. Such repeated elimination and destruction processes are the self-limiting self-limiting (self-healing) process of the body itself. After several years, the virus was basically cleared, the e-antibody in the serum appeared, and the e-antigen disappeared one after another, that is, from the big three-yang to the small three-yang. It can be seen that the process of converting from Dasanyang to Xiaosanyang is a sign that the virus is basically eliminated, or basically healed, and there will be no more hepatitis in the future for most patients with hepatitis B (except for variant strain infection). Activity, if the infected person completes the process before the age of 25-30, there will be no cirrhosis or liver cancer in the future.

Unfortunately, there is still a considerable proportion (about 2/3) of infected people whose own clearance reaction cannot completely eliminate the latent virus in the liver. After several weeks, months, and years, the virus replicates, clears, and the liver. The repairs were carried out in a round-robin manner, so Xiaosanyang turned into a big three-yang, and the big three-yang changed to a small three-yang. Even the strong and weak big three-yang did not clear the virus. The future of this part of the infected person It is the liver fibrosis of some degrees. Some patients have developed liver cirrhosis around 40 years old, and even have ascites or cancer. At this time, although they turned into Xiao Sanyang, they only indicated that the virus was mostly cleared but the liver damage was quite serious. It is. In some patients, hepatitis is still active after cirrhosis, indicating that the clearance reaction is still going on, the liver damage is still developing, and the body's own virus-clearing protection response brings more and more serious irreversible damage to the liver tissue. It is an incredible and sad result that the life of the liver is finally damaged.

It can be seen that if the big three yang is turned into a small three yang, if it is completed before the age of 25-30, the process of clearing the virus is completed for the body, and the damage of the liver is also lighter; if the big three yang turns around, or continues Dasanyang, and the clearance reaction (hepatitis continued activity, repeated transaminase increase) continued, before and after the age of 40, for most patients with chronic hepatitis B, even if turned into small Sanyang, there are different degrees of liver fiber Or cirrhosis. If life continues for the big three yang, there is no obvious hepatitis activity (hepatic function is always normal), maybe you can still live to 60-70 years old, it can be seen that the big three yang does not have to be converted to Xiao Sanyang. The conversion of the big three yang to the small three yang is the performance of the body to remove the virus, but the liver damage caused can not be underestimated. Therefore, whether it is better or not better, the above is very clear.

Big and small Sanyang has nothing to do with the severity of the disease. It can only represent hepatitis B infection. The focus of diagnosis and treatment is to distinguish between carriers and acute and chronic hepatitis and whether they are infected first time.

1. Chronic carriers: It is only necessary to re-examine liver function and liver and spleen B-ultrasound every six months or one year. Therefore, the immunity in the body is in a tolerant stage, which means that the virus and the human immune system are in a kind of There is nothing wrong with the situation, well water does not make river water, balance state, liver function, b super normal patients, most of the liver damage is very slight, the treatment benefits are extremely limited, such carriers are medical observation targets, not suitable for anti-viral treatment, Whether it is economically or therapeutically unsatisfactory, it is necessary to respond differently according to different stages and timings. Carriers only need to review liver function, liver and spleen b super regular, if there is mild discomfort, you can use Chinese medicine phase conditioning. The amount of virus is not related to the severity of the disease and whether treatment is needed. However, changes in the amount of virus before and after treatment can be used as a reference for therapeutic effects.

Hepatitis B virus asymptomatic carriers (ASC) are mainly caused by blood exposure, and they do not feel hepatitis symptoms and signs. All liver function tests and liver and spleen B ultrasound are normal. After no more than half a year, there is no abnormal change due to hepatitis B. The virus will not be transmitted to others through the respiratory tract or the normal digestive tract. Therefore, ASC will not cause harm to others in daily life and social interaction. They should have the obligation and right to work, study, live and socialize as usual.

The carrier may be lifelong, or may be converted to an acute and chronic hepatitis stage under the stimulation of internal and external environments (such as fatigue, alcohol, cold, mental blows, etc.).

2, acute and chronic hepatitis: in the case of liver function, b super abnormal progress, no treatment will gradually progress to liver fibrosis, cirrhosis or even liver cancer, there is also the possibility of self-healing, the human body The immune response of the virus (that is, the immune tolerance has been broken, from the carrier stage to the acute and chronic hepatitis stage) has led to repeated fluctuations in liver function, and the immune response may be acute hepatitis, which may self-heal. Most people's immune response is strong and weak, which is manifested as chronic hepatitis, liver function repeatedly fluctuating, b-ultrasonic progress, the immune system can not play a full immune clearance function, resulting in repeated damage to liver cells, some people will gradually go to liver fibrosis, liver Hardening and even the development of liver cancer, with the continuous elimination of viruses and the continuous damage of liver cells, manifested as a phenomenon: some people in the liver fibrosis, cirrhosis and even liver cancer stage showed a virus, but in cirrhosis even Liver injury at the stage of liver cancer has been irreversible and the condition will continue. Therefore, Dr. Lu Peng believes that the significance of early detection and early treatment in the early stage of abnormal liver function and b-ultrasound is here.

(1) The trade-off between immune response and hepatocyte protection is a problem that needs to be weighed in treatment. But there is a limit to the immune response, and the human body will not do things to destroy itself.

(2), between scars and repair is dynamic, some cirrhosis occurs inevitably, but the use of drugs can delay the process, which is also the meaning of treatment.

(3) In the acute and chronic hepatitis stage, the so-called liver-lowering enzyme therapy is not advocated, because the liver cells do not need special protection, the human body can repair itself, and sometimes it is necessary to sacrifice some liver cells in order to eliminate the virus, which is like obeying the national interests. The meaning of interest is the same. Improper use of liver-protecting enzymes can interfere with the antiviral effect of Chinese and Western medicines. Of course, liver-preserving enzymes can come in handy when other drugs fail to achieve the desired results.

(4) The fact that patients with chronic hepatitis B should accept should be the lifelong nature of hepatitis B. At present, there is no specific medicine. Hepuding, He Weili, Ente, etc. are not, Chinese medicine is not, but it can control the progress, especially Chinese medicine is more safe. Patients with chronic hepatitis B can choose Chinese medicine, western medicine or Chinese and Western medicine according to their own economic ability. Mode of treatment, and should take life adjustment as an important part to cooperate with treatment, often have satisfactory results.

3, the first infection: the definition of the first infection, three or half a year before the test in March or half a year is negative, and the recent positive test cases should be the first infection, such as liver function, b super normal can be carriers It is observed that the age of hepatitis B virus infection is closely related to the onset and chronicity of hepatitis B. After a month old baby is infected with hepatitis B virus, more than 80% will be chronically carried, leaving a curse. However, the adult's immune system is relatively perfect. After the initial infection with hepatitis B virus, only about 2% of people will be chronic. A small number of people will actively remove the virus in the form of acute mild hepatitis. Most of them will form antibody positive and will not stay. The next bane, this is why six to seventy percent of adults test two to half of the reason for the recovery period of infection.

Hepatitis B virus (HBV) infection is a worldwide epidemic. According to the World Health Organization, about 2 billion people worldwide have been infected with hepatitis B, of which 350 million are chronic hepatitis B infections. About 1 million people die each year from hepatitis B infection. Liver failure, cirrhosis and liver cancer. In the process of treating hepatitis B, it is necessary to understand the indicators of hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B e antigen, hepatitis B e antibody, hepatitis B core antibody, hepatitis B core antibody IgM, etc. in the detection of hepatitis B virus serum markers. The meaning of different hepatitis B titles such as hepatitis B small Sanyang, hepatitis B and Sanyang. Combined with hepatitis B liver function test, hepatitis B virus (HBV DNA) test, hepatitis B liver biopsy, hepatitis B symptoms, etc., to learn more about hepatitis B treatment common sense, hepatitis B prevention, hepatitis B diet, hepatitis B marriage and childbirth, hepatitis B care, the latest development direction of hepatitis B treatment and Based on the research and development of hepatitis B antiviral drugs, choose hepatitis B antiviral therapy or hepatitis B immune regulation and Chinese medicine to treat hepatitis B.

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