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To lxlzx2002:
411老师:我老公93年乙肝病发住院干扰素治疗无效,中药治疗肝功能正常,98年拉米夫定治疗连续5年没耐药,一切变好,自行停药,复发,一直是中药治疗,肝功能反反复复。2010年8月又复发,中药治疗,2011年3月B超显示肝硬化早期,门诊医生叫我老公吃拉米夫定,吃了一星期,住院,住院医生一定叫我老公吃恩替卡韦,住了40多天,自我感觉越来越差,到省医院咨询专家,专家叫我老公服用恩替卡韦、阿德福韦酯、易善复。现在已经六个月,DNA小于1000,但肝功能还不正常。病人焦急万分,孩子还只有10岁。我们不知怎么办?烦请前辈指点。谢谢。
我老公93年乙肝病发
what is 乙肝病发, there are acute and chronic hbv. If you are in the acute stage, then you do not need any treatment. You immune system will clear virus by itself. If, on the other hand chronic hbv, then there is 慢性乙型肝炎防治指南. You should have followed the 指南.
住院干扰素治疗无效.
From that I suppose that your husband is chronic HVBer. However there are 4 stages of chronic HBV:免疫耐受期、免疫清除期、非活动或低(非)复制期和再活动期. Anyway, since the doctor used 干扰素治疗, I would guess at that time your husband is 大三阳 (hbeag +). But 干扰素治疗 has a low rate of hbeag + TO hbeag -. Even lower rate of hbsag become -.
"
HBeAg阴性慢性乙型肝炎患者 (60%为亚洲人) 用PegIFN-a2a治疗48周,停药后随访24周时HBV DNA <104拷贝/mL(相当于2000?2 IU/mL)的患者为43%[38],停药后随访48周时为42%;HBsAg消失率在停药随访24周时为3%,停药随访至3年时增加至8%[54]。
98年拉米夫定治疗连续5年没耐药,一切变好,自行停药.
The guideline for antiviral treatment (拉米夫定) is that:
if when you started the treatment your hbeag is +, then the endpoint (停药) is hbeag become - and continuous (2 times test, 3 months apart) alt ast are normal. You may stop treatment and monitor the condition by the tests (hbsag, hbsab, hbeag, hbeab, hbvdna, AND alt ast)
if when you started the treatment your hbeag is -, then there is NO endpoint (停药). But LAM may get drug resistence (耐药). You should have monitored hbvdna and as soon as you find out 耐药 you should change your drug.
自行停药,复发,一直是中药治疗,肝功能反反复复。2010年8月又复发,中药治疗,2011年3月B超显示肝硬化早期
You have done very bad thing to your liver. 中药 does not do any good (they did not suppress the viral load, hbvdna). 肝功能反反复复, you liver got hurt all the time (high alt and ast)
2010年8月又复发,中药治疗,2011年3月B超显示肝硬化早期,门诊医生叫我老公吃拉米夫定.
The doctor was wrong. There are better medicine (entecavir) in 2010. (2.谨慎选择核苷(酸)类药物:如条件允许,开始治疗时宜选用抗病毒作用强和耐药发生率低的药物)
住院,住院医生一定叫我老公吃恩替卡韦
住院医生 is doing the right thing.
到省医院咨询专家,专家叫我老公服用恩替卡韦、阿德福韦酯、易善复。
You should not take 易善复. Ask why 专家 add 阿德福韦酯 which is different from 住院医生.
现在已经六个月,DNA小于1000,但肝功能还不正常(he should stop 易善复).
As long as DNA小于1000, your liver are not being hurt anymore. 肝硬化早期 could be reversed by suppressing hbvdna, but it takes time. RELAX.
恩替卡韦治疗48周(but it takes time)时HBV DNA下降至PCR检测水平以下者为90% (DNA小于1000)、ALT复常率为78%、肝组织学改善率为70% [88]( 肝硬化早期 could be reversed by suppressing hbvdna)。
Take a good care of your husband, do not let him get too tired. He should not drink alcohol or smoke. He should have a good diet (less meat and fat). He should also excercise.
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