On their statements, the value of HBsAg is sometimes greater than 250( 250), sometimes thousands or tens of thousands; The value of HBV DNA is more likely to be staggering, sometimes tens of millions, sometimes even billions or more.
The rising arrow behind the values of these inspection reports is scary enough, and the values are too high to be completely marked (if it is 500 million, the full display is 500 million, which is too long to print the report). If it is greater than a certain value, or if it is replaced by a mathematical symbol such as "E+08" (5.0 E+08 stands for 500 million), it will inevitably cause.
So, what exactly do these numbers mean? Is it necessary to be afraid? Does a high value really mean that the condition is very serious?
Today, Dr. Long will talk about this problem.
Actually, this question is easy to answer. These two indicators reflect the information about hepatitis B virus, and no matter how high the value is, they all reflect the infection and replication of hepatitis B virus.
For example, when comparing the strength of the "enemy", we only see the strength of the "enemy", but do not show whether we have been "attacked" and hurt by the other side, and our own strength, that is, the strength of immunity.
This unilateral display of the "enemy" virus, of course, is not enough to fully explain whether hepatitis B is very serious.
The severity of hepatitis B depends not only on the strength of hepatitis B virus, but also on whether the human liver has been damaged or destroyed.
Because the symptoms of hepatitis B are obvious or not, sometimes it has little to do with the condition, unless it is severe hepatitis, accompanied by symptoms such as extreme fatigue. Therefore, today we focus on how to judge the severity of liver disease from objective examination.
Whether hepatitis B virus causes damage depends on whether the liver cells infected by the virus are damaged, and the most sensitive indicator of liver cell damage is alanine aminotransferase. However, as an indicator of the severity of hepatocyte inflammation, aspartate aminotransferase (AST) is often more telling.
Alanine aminotransferase and aspartate aminotransferase are derived from cytoplasm and mitochondria in hepatocytes, respectively. These two enzymes originally existed in cells. After the inflammatory necrosis of hepatocytes, the permeability of cell membrane changes, and these enzymes are released to the outside of hepatocytes and absorbed by blood, which leads to the increase of their activity.
Because aspartate aminotransferase comes from mitochondria, if aspartate aminotransferase rises more than aspartate aminotransferase, liver injury may be more serious. In order to check this severity index, there is an aspartate aminotransferase/alanine aminotransferase (AST/ALT).
AST/ALT is a ratio, which is generally less than 1. If it is greater than 1~ 1.5, both alanine aminotransferase and aspartate aminotransferase are increased, so it can be considered that the liver injury is serious.
The "liver function" test we often talk about is actually a "package" project, which is used to indirectly reflect the functions of the liver, including synthesis, metabolism and detoxification.
Substances that can be synthesized by liver cells include albumin, cholinesterase and cholesterol.
Mild liver injury will not affect the synthetic function of the liver. Just like a factory, the door is destroyed, which does not affect the productivity of the factory. Clinically, when more than 1% of hepatocytes are damaged, there will be abnormal transaminase, but if the liver damage is in a small range, albumin can still maintain a normal level.
Severe or persistent liver injury will affect the synthetic function of liver cells, and albumin may decrease, which is common in liver cirrhosis.
When liver cirrhosis or liver failure occurs, most liver cells are destroyed, but the newly born liver cells can not meet the needs of "production", and albumin and cholinesterase will decrease.
The condition of hepatitis B has reached the point where cholinesterase and albumin have decreased, indicating that it may progress to the core link of the trilogy of liver diseases, that is, the late stage of liver fibrosis and cirrhosis, which is more serious than simple liver injury.
Hepatocytes can also synthesize some coagulation factors to maintain the balance of human coagulation function together with other coagulation factors.
How to understand this?
In our daily life, we have such an experience that people with good coagulation function bleed through the skin and coagulate quickly; People with poor blood coagulation function will still bleed after bleeding for a long time, or their bodies are often black and blue.
In patients with decompensated cirrhosis, the coagulation factors synthesized by the liver are reduced, and the coagulation function will become worse. At this time, there is a test called "coagulation function", which will show that prothrombin time (PT) is prolonged and international normalized ratio (INR) is increased.
This test has a very core factor, which is prothrombin activity, or prothrombin activity. Prothrombin activity is one of the most important indexes for diagnosing liver failure. Now it is replaced by the international standardized ratio. When the international standardized ratio is greater than 1.5, it is generally considered that liver function has entered a state of failure.
Patients with liver failure usually need a long time to stop bleeding as long as they have a little skin or mucosal damage, or even if they stop bleeding, there may be blood flowing under the skin. Therefore, after such people are injured, subcutaneous ecchymosis often occurs.
By the way, this ecchymosis is similar to "purpura" in patients with thrombocytopenia, because splenomegaly and hypersplenism in liver cirrhosis can also cause thrombocytopenia.
In patients with poor coagulation function, gingival bleeding is more prominent. It is easy to cause bleeding when brushing your teeth.
Coagulation dysfunction generally indicates that the condition has reached a serious stage. This patient has not only liver cell damage, but also liver cell synthesis and decomposition dysfunction.
Jaundice has never been mentioned before, because some jaundice may have nothing to do with the severity of the liver, and it is an index that needs dynamic observation.
When jaundice is caused by liver failure, bilirubin will increase progressively, increasing by more than 17. 1 micromole or 1 mg every day. Patients whose international standardized ratio is greater than 1.5, patients who still have symptoms for more than 4 weeks after onset, or patients with obvious jaundice and bilirubin greater than 3mg/dL often have poor prognosis. At this time, alanine aminotransferase in patients showed a downward trend.
One goes up and the other goes down. Bilirubin increased and alanine aminotransferase decreased, showing a separation trend, which is called enzyme-bile separation in clinic. The separation of enzyme and bile is an important reference to judge liver failure, which shows that liver cells are almost destroyed and no longer produce enzymes.
Bilirubin reflects the decomposition function of the liver, cholestasis and the degree of liver cell damage. Therefore, when jaundice occurs, some surgical diseases (such as stones compressing bile ducts) and even liver malignant tumors should be ruled out. It is very important to check the B-ultrasound, CT, magnetic resonance, and the tumor marker alpha-fetoprotein (AFP) of liver cancer.
To sum up, if you ask someone who is not serious about hepatitis B, if you only provide the data of hepatitis B surface antigen and hepatitis B virus DNA, the doctor can't judge, at least look at whether the alanine aminotransferase and aspartate aminotransferase of liver function are elevated. If there is an increase, it depends on whether albumin has decreased, whether there is any obstacle to coagulation function, whether bilirubin has increased, and so on.
In order to comprehensively evaluate the patients' liver function and whether further diagnosis and treatment are needed, the tumor marker alpha-fetoprotein and imaging examination should be done to master the basic situation of hepatitis B.
Therefore, when consulting a doctor, don't just take the test sheet, at least provide some other information. For doctors, it is not possible to directly judge whether patients need to take medicine or even prescribe medicine based on a report.
Whether hepatitis B is serious or not, the value of HBV DNA is used as a reference for antiviral treatment and curative effect monitoring, while the value of hepatitis B surface antigen has little relationship with the severity of the disease, and is often used to predict whether there is a treatment trend. To analyze the severity of the disease, we should analyze it layer by layer from the angles of inflammation, synthesis and decomposition of liver cells.
I am a clinician who loves popular science. I see a doctor, consult, answer questions, solve doubts, and have knowledge of popular science. In my hurried clinical work, I felt the power of warm words!
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