[1] Gong Minli, Luo Wei, Bi Yue. Clinical significance analysis of low serum levels of hepatitis B virus surface antigen[J].Bachu Medicine,2024,7(02):86-91.)
[2] Chen Huangxiang, Zeng Wenlong, Guo Jianyang, et al. Effect of anti-hepatitis B virus therapy on recurrence, metastasis and immune function after TACE for hepatitis B-related liver cancer[J].Clinical Rational Drug Use,2024,17(02):73-75.)
[3] Liu Ruijun, Yan Hongxia, Zhao Haizhen. Effect of antiviral therapy combined with radical surgery on the prognosis of patients with liver cancer infected with hepatitis B virus——A review of the Chinese Guidelines for the Integrated Diagnosis and Treatment of Tumors: Liver Cancer 2022[J].Chinese Journal of Experimental Pharmaceutics,2023,29(20):168.)
Zhou Zhan, a 44-year-old bar singer from Beijing, has been unruly since he was a child, has his own opinions on everything, and rarely cares about other people's opinions. For example, being a singer, such as not getting married and having children, and often going to tattoo earrings and lip studs. At first, Zhou Zhan's parents often dissuaded him, but gradually, they realized that everyone had their own way to go, and they no longer spoke in vain.
On March 12, 2015, Zhou Zhan passed by a blood donation car, and he decided to get on the car to donate his love. Unexpectedly, the staff told him that his liver function was abnormal after a blood test, and he was advised to go to the hospital for a look. Although Zhou Zhan's heart was full of questions, he immediately went to the hospital to register. He thought that he had been drinking and smoking all year round, could it be that he had alcoholic liver or fatty liver?
Unexpectedly, the test result turned out to be Xiao Sanyang, and his hepatitis B was positive for HBSAg, HBeAb, and HBcAg. The doctor patiently explained: "Xiao Sanyang means that you are a carrier of hepatitis B virus, and the virus replication and infectivity are weak, but fortunately, you have no abnormal signs, and you belong to the stable Xiao Sanyang, and you do not need special treatment." However, it is still necessary to insist on regular check-ups and reduce some behaviors that damage the liver in life. ”
Hepatitis B two halves are blood tests used to detect the status of hepatitis B virus infection and include five serological markers, often referred to simply as "hepatitis B pentasome" or "hepatitis B halves". Hepatitis B surface antigen (HBsAg) is the coat protein of hepatitis B virus, and its presence indicates the presence of hepatitis B virus in the body. Hepatitis B surface antibodies (anti-HBs) are antibodies produced by the body after an immune response to the hepatitis B virus, indicating that you have been infected with the hepatitis B virus or have been vaccinated against hepatitis B, and you have immunity.
In addition, hepatitis B e antigen (HBeAg) is a marker of active viral replication, and its presence indicates a high level of viral replication and is highly infectious. Hepatitis B e antibody (anti-HBe) is an immune response to the e antigen, the presence of which usually indicates a reduced level of viral replication and is less infectious. The last hepatitis B core antibody is an immune response to the core antigen of the virus, which is divided into two types: IgM and IgG. The different combinations of these five markers can reflect the infection status, replication status and immune status of hepatitis B virus, which has important guiding significance for the diagnosis, treatment and prevention of hepatitis B.
Zhou Zhan still felt unbelievable, if he had alcoholic liver, he would have admitted it, but he had never been in contact with a hepatitis B patient, and he had never had a history of hepatitis B at home, so why did he get hepatitis B in a good manner? After talking with him, the doctor learned that he often went to some irregular small shops to get tattoos and studs, and said that it was very likely that the equipment in the store was not disinfected properly, resulting in cross-infection with hepatitis B virus. Zhou Zhan's intestines were repentant after hearing this, and he secretly swore in his heart that he would have to pay more attention to this invasive operation in the future.
On May 11, 2015, while shaving his beard, Zhou Zhan accidentally caught a glimpse of a soybean-sized red dot growing on his neck, which gradually spread to the surrounding skin, and at first glance looked like a red spider. Zhou Zhan, who has always been rough-spoken, did not take this matter to heart. After a week, after finishing the work at the bar at 3 o'clock in the morning, I met up with three or five friends for supper. Obviously, his stomach was already grumbling with hunger, but he still couldn't raise his appetite in the face of food, and even felt a little sick to his stomach.
Seeing that it was really abnormal for him to eat so little, his friend was concerned and said, "Lao Zhou, what's the matter with you?" After eating so much, his face is so bad and dull. Zhou Zhan suddenly felt excited, thinking back to all kinds of discomfort in the recent past, it couldn't be that there was another problem with the liver, right? So early the next morning, Zhou Zhan did a detailed liver test. Even though he was mentally prepared during the waiting process, the final result still made him gasp.
His liver function tests showed that alanine aminotransferase was 129U L and aspartate aminotransferase was 104U/L, which exceeded the normal value several times; The surface antigen, E antigen and core antibody of the five items of hepatitis B were all positive, indicating "big three yang". Zhou Zhan never expected that in a short period of time, he would progress from a small Sanyang to a big Sanyang, why is it that he is also a hepatitis B carrier, and others can not deteriorate and not get sick for a lifetime?
After learning about Zhou Zhan's usual living habits, the doctor said earnestly: "Bad habits such as smoking and drinking, irregular life and rest, and staying up late will cause liver damage, leading to decreased immunity and active replication of hepatitis B virus, which greatly increases the risk of progression to Dasanyang." Later, the doctor prescribed entecavir and other hepatitis B treatment drugs for Zhou, and warned him that he must take it on time and in the right amount, as a reduced dose of entecavir may lead to an increase in viral load and even progress to more serious liver diseases such as cirrhosis and liver cancer.
Entecavir is an antiviral drug used in the treatment of chronic hepatitis B, which is very effective in inhibiting the replication of hepatitis B virus and has become one of the first-line drugs for the treatment of chronic hepatitis B because of its high selectivity and low drug resistance. On the way out of the hospital, Zhou Zhan was preoccupied, and he realized that he could no longer treat his body so casually. So he not only strictly followed the doctor's instructions to take the medicine, but also made up his mind to change to a regular job, go to bed early and get up early every day, and ensure adequate rest.
With his persistence day after day, his liver function test results are very good, and all indicators are almost close to the ideal range. The doctor smiled with relief and said, "Hepatitis B can't be cured overnight, but it takes long-term perseverance." Zhou Zhan immediately nodded, indicating that he would definitely continue to maintain. The results of the subsequent review have been stable and improving, and there is even a high probability that it can be turned into a small Sanyang.
This undoubtedly gave Zhou Zhan great confidence, and on the basis of his previous healthy lifestyle, he also began to exercise every day and eat lightly. Just when he thought the dawn of victory was at hand, the unexpected happened......
On October 26, 2020, Zhou Zhan was having dinner with his elderly parents, and when he was about to go out for a walk together after eating, a violent cramping pain suddenly came from his right upper abdomen, as if he was tightly wrapped around his abdomen by a giant python that released venom, and his facial features were twisted together, and he shouted pain to his parents again and again. Zhou Zhan's father quickly called the emergency number, and soon, Zhou Zhan was taken to the hospital.
The results of the examination almost did not make Zhou Zhan's parents faint on the spot, and it was written: liver function test found aminotransferase 388U/L and alpha-fetoprotein 886ug/L. CT showed that a space-occupying lesion was seen in the right lobe of the liver, with a size of about 5.4 cmx4.1 cm, and the diagnosis was primary liver cancer. Combined with the past medical history, the doctor regretfully said that there is a high probability that it is liver cancer caused by the deterioration of hepatitis B.
Zhou Zhan's hands holding the inspection report couldn't stop trembling, the defense line in his heart instantly collapsed, he grabbed his hair fiercely and shook his head wildly, all this in front of him must not be true! Then, he grabbed the doctor's hand and said, "Are you mistaken?" Although I have hepatitis B, I have been actively cooperating with medication in the past few years, not to mention quitting smoking and drinking, and I have even changed my job and have a regular schedule. And the follow-up test shows that the viral load has been within the normal range, how can it still deteriorate into liver cancer? ”
The doctor also wondered in his heart, if he did what he said, then even if it was another 10 years, the chance of him progressing to liver cirrhosis and liver cancer was very low. The doctor repeatedly reviewed Zhou Zhan's review reports in recent years, and soon found a key point. So, the doctor began to ask about the details of Zhou Zhan's life and medication. When I asked, I was really taking entecavir.
After a long time, the doctor couldn't help but sigh and said, "Although entecavir is good, any drug has side effects." Although you have been insisting on medication, quitting smoking and drinking, and having a regular schedule and rest, these behaviors can indeed prevent the condition from worsening, but you ignore these two key points of medication when taking entecavir. Not only may the poor efficacy cause liver and kidney toxicity, but even let the cancer cells take root and sprout in your body, if you can pay attention to these two points, medication is a safe and secure thing......''
First: Don't stop taking the drug at will
Entecavir is an antiviral drug used to inhibit the replication of the hepatitis B virus. If the drug is stopped at will, the virus may rebound rapidly, leading to elevated levels of the virus in the serum, which may exacerbate inflammation and damage to the liver. In addition, irregular treatment or arbitrary discontinuation of drugs can lead to mutation of the virus and the development of drug resistance. Once the virus becomes resistant to entecavir, the drug becomes much less effective and may need to be replaced with other antiviral drugs, which may be less effective or have more side effects.
It is well known that chronic hepatitis B requires long-term treatment to control viral replication and reduce the risk of liver inflammation and fibrosis. Stopping the drug at will may lead to the progression of liver disease, increasing the risk of cirrhosis and even liver cancer. Elevated levels of viral replication trigger the immune system to attack infected liver cells, leading to increased liver inflammation, manifested by increased aminotransferase levels and impaired liver function. Therefore, hepatitis B patients should take entecavir under the guidance of their doctor and maintain good adherence during treatment. If you need to stop taking the drug or adjust your treatment regimen, you should consult your doctor first to avoid the above damage.
2. Pay attention to drug interactions
When entecavir is used, it is often necessary to be aware of interactions with other drugs to avoid reducing the efficacy of entecavir or increasing the risk of adverse effects. Among them, the more representative ones are liver enzyme inducers, which mainly include phenytoin, carbamazepine, rifampicin, oxcarbazepine and barbiturates. The reason why entecavir cannot be taken with hepatic enzyme inducers is mainly related to drug metabolism and pharmacodynamics.
This is because hepatic enzyme inducers are able to increase the activity of drug-metabolizing enzymes in the liver. When entecavir is used simultaneously with hepatic enzyme inducers, the inducers accelerate the metabolic process of entecavir, resulting in a decrease in the concentration of entecavir in the body. Reduced blood concentrations of entecavir mean that its antiviral effect may be weakened, which may lead to treatment failure or the development of viral resistance, which can affect the treatment effect of chronic hepatitis B.
In addition, hepatic enzyme inducers not only affect the metabolic rate of the drug, but also may affect the distribution and excretion of the drug, further affecting the pharmacokinetic properties of entecavir. When the metabolism of entecavir is affected, it may become more difficult to monitor its blood levels and adjust the dose, increasing the uncertainty of treatment. To avoid these problems, it is often recommended to use entecavir under the guidance of a doctor and inform the doctor of all the medications being used before starting treatment to ensure that no harmful drug interactions occur.