Click on the Shaw Hospital star
During the Spring Festival, Lu Fangfang, director of the Department of Liver Disease and Infection at Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine, was busy as usual. One ends calling the next, and the patients are one after the other.
The big man dragged four to see the doctor
Just to do this item check
Looking at the information on the next patient's computer, the door opened and 5 men suddenly poured in. Director Lu Fangfang reminded: "Now that it is patient No. 20, please ask others to wait at the door." ”
One of the men said busily: "Director Lu, we are the next 5 numbers, we came to see the doctor together, we are brothers, do you remember?" I was discharged from your hospital last month. Taking advantage of the Spring Festival holiday, I asked my brothers to come and bounce the liver. ”
Director Lu Fangfang remembered that this was a patient who had just done a liver puncture biopsy before the Spring Festival: "Yes, it is Old Li, what?" Flick it? ”
Old Li said: "It is the one, the one that does not hurt, use the instrument to click- meow, and after a few clicks, you will know that the liver is not hard." ”
After reading the history of hepatitis B disease of Lao Li and his brothers, Director Lu Fangfang understood that what Lao Li mentioned was the latest liver hardness examination "artifact" introduced by the hospital.
"You're talking about the liver hardness test, I'm going to look at everyone's information first, and then assess whether it needs to be done."
After sorting out everyone's information, Director Lu felt the need to do liver stiffness examination for these patients.
After the examination, Director Lu prescribed anti-hepatitis B virus drugs to two of the patients, and two patients temporarily did not need anti-hepatitis B virus treatment.
Family history of hepatitis B
Intervene early to prevent cirrhosis
Mr. Li is a mother-to-child transmission of hepatitis B patients, more than 40 years, the last 10 years of annual B ultrasound examination liver function is no abnormality, but the number of hepatitis B virus copies has been fluctuating in thousands to tens of thousands. Director Lu suggested that he have a non-invasive liver elasticity test.
Mr. Li was not very happy at first: "I have always done these tests before, they are all good, the doctor has always said that there is no need for treatment if it is stable, how can I have more examinations now?" ”
Director Lu Fangfang patiently explained: "Medicine has been progressing, and now there are new technologies and means, some liver functions are normal, and they have not yet developed to cirrhosis, but on the way to cirrhosis, that is, the part of the patient who has liver fibrosis is screened out, we can intervene early, and it is a little late to intervene until cirrhosis." ”
What Mr. Li did not expect was that once he did the examination, the liver hardness was 8.6, which meant that the liver had grade 2 fibrosis. Mr. Li was shocked and did not want to believe this result, Director Lu suggested that he do liver puncture pathology to assess inflammation and fibrosis grading, and the results also came out quickly, indicating G1S2, and the liver hardness test results were consistent.
"This condition can no longer be just a regular check-up, and it needs to be treated with anti-hepatitis B drugs." Although his heart palpitated, Mr. Li was very glad that he could find liver fibrosis in time, and was particularly grateful to Director Lui Fangfang, who also made him more trusting of the Liver Disease And Infection Department of Run Shaw Hospital.
Back at home, Mr. Li immediately mobilized all his brothers to come to Director Lu for medical treatment. The next scene of the above-mentioned outpatient clinic happened.
Don't take chronic liver disease lightly
Director Lu Fangfang said that the mainland is a big country with chronic liver disease, although chronic hepatitis B has gradually decreased, but fatty liver, alcoholic liver is increasing.
Chronic liver disease caused by various causes is often accompanied by the process of liver fibrosis, which refers to excessive synthesis or insufficient degradation of the extracellular matrix of the liver, resulting in excessive accumulation of liver fibrous tissue, part of which eventually develops into cirrhosis.
"Studies have shown that liver fibrosis is reversible in the early stages, such as antiviral therapy for chronic hepatitis B, alcoholic or non-alcoholic fatty liver disease, etc. Through appropriate intervention treatment, the development of liver fibrosis can be reversed to a certain extent to prevent cirrhosis and liver cancer." Therefore, the timely early diagnosis of liver fibrosis and the quantification of the degree of liver fibrosis have great clinical value in guiding the treatment of chronic liver disease. ”
It is understood that clinically used for liver fibrosis assessment there are blood tests, imaging and liver biopsy pathological examination and other methods, of which the "gold standard" of liver fibrosis examination and staging is liver puncture biopsy. Most patients have concerns about puncture biopsy and hope that there can be a traumatic and painless assessment method, but blood tests, B ultrasound, or magnetic resonance imaging have limitations in assessing the sensitivity or specificity of liver fibrosis.
The instantaneous elastography technology developed in recent years can detect the elastic modulus of soft tissues in a noninvasive and real-time manner, providing a new method for the detection of liver fibrosis and cirrhosis. Since the elastic modulus of liver tissue increases significantly with the aggravation of liver fibrosis, this method has good sensitivity and specificity.
(A: intercostal space; B: shear wave probe; C: liver)
The transient elastography technology carried out by the Department of Liver Disease and Infection of Zhejiang University Shaw Hospital every Tuesday to Friday afternoon is the second generation of FibroScan, which can be used for the staging of disease in patients with chronic liver disease, guiding hepatitis B antiviral therapy, monitoring antiviral efficacy, assessing the degree of fatty liver by detecting liver fat decay; assessing the degree of cirrhosis, predicting the risk of esophageal gastric variceal, etc.
This non-invasive, rapid and reproducible quantitative detection method for liver fibrosis and cirrhosis can help patients with liver disease achieve early diagnosis, early prevention and standardized treatment, thereby blocking the vision of the disease process of "chronic liver disease - liver fibrosis - cirrhosis - liver cancer" and benefiting more patients with liver disease.
Source: Department of Liver Disease and Infection, Run Run Shaw Hospital
Original works, reprinted please indicate the source and source
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