's treatment of drug therapy of viral liver cirrhosis

's treatment of drug therapy of viral liver cirrhosis
First, treatment having illness coming on originally
Virus hepatitis, especially hepatitis B is after developing liver cirrhosis into, some virus is being still duplicated, detect RNA or DNA of the virus when the blood and liver adopt PCR to find when organized or hybridize in situ. So it is still necessary to carry on the antiviral treatment.
Whether HBV that should understand the patient first in antiviral treatment is in duplicating state. Only at hepatitis B " 2 half-and-half" HBsAg of China is really positive, or HBeAg is negative, but HBV-DNA is still the positive one, prove HBV is being duplicated, can carry on the antiviral treatment. In recent years, launch the quantitative detection of HBV-DNA at home, find the more common spot is hybridized not sensitive enough at present, many spot hybridize result as getting negative, quantitative to find, prove the virus is being still duplicated. So already overcast to look around to HbeAg before improving in that spot hybridize sensitiveness, liver function still getting abnormal, should measure by quantitative method, confirm whether the virus is duplicated. Whether carry on the antiviral treatment. All resist HBV effective medicine or comprehensive measure at present, can only make it duplicate meaning the body is overcast to rotate, that is to say HBeAg and HBV-DNA are overcast to rotate, does not have obvious function on HBsAg. So, rotate and get effectively through treating and duplicating the index overcastly. Some medicine propagate on the market, can make HbsAg turn overcast person who rotate, up to percent dozens of while being so-called, there are no scientific materials and basis, it is certainly incredible. The medical worker should explain to the patient patiently that proves, make the patient grasp common sense in this respect. So as not to take medicine arbitrarily. Spend money in vain.
Generally acknowledge there are the following aspects in the effective medicine abroad, at home at present:
1. Interferon (IFN)
Interferon used for chronic hepatitis B. It is mainly a interferon. A interferon has treated chronic hepatitis B for more than 20 years, basically have a common understanding: ( 1) It is an effective medicine that a interferon treats chronic hepatitis B, but curative effect is unsatisfied with. (mean, park behind the medicine following up a case by regular visits to one year; The overcast rotating rate of serum HBV-DNA and HbeAg is invited 20% - 40% ) .
( 2) Resisting HBV function of a interferon, mainly inhibit HBV from duplicating, is shown as serum HBeAg and HBV-DNA is overcast to rotate, it is difficult to remove HBV, so, the recuring rate is relatively high after treating.
( 3) The domestic experience is that curative effect does not have difference, the domestic one and importing between various interferon, curative effect such as a2a and a2b are similar, can select for use according to the patient's economic endurance.
( 4) There are some side effects in IFN treatment, there are similar influenza and one kind of symptoms in early days, can inhibit weak, depression, bone marrow on later stage and some one's own immune diseases. IFN treats the expenses expensively, uses and is limited.
2. Nucleoside analog
Whom our country is listed is He PuDing who Glaxo Wellcome Company produced now. This strong inhibits the virus from duplicating the nucleoside medicine of new generation of function. The experiment proves Lammi the books and duplicates and affirms function to liver hard compound and active virus, help to delay even reverse the process of liver fiber, liver cirrhosis, just must be longer on the course of treatment.
Because nucleoside analog antiviral function strong, bad reaction little, can take orally, easy to use, advantages such as the all right artificial synthesis simple in construction of chemistry,etc., become the hot subject in the research field of antiviral medicine. Have obvious inhibitory activity on HIV, HBV, HCV, sore rash and virus,etc.. The new nuclear province analog used for resisting HBV, mainly have Lammi fixes (IWhivudine, is listed formally) , suffused with the intersection of Lip river and Wei (Famciclovic, a clinical trial) for less than former times , the Lip river cloth nips Wei (lobucavir) The intersection of good fortune and Wei, ground of A, (ade-forir) And FTC (two membrane oxygen Fluorine sulphur takes the place of pyrimidine of chest) Carry on a clinical trial. FMAU (Fluorine use pyrimidine, glycosuria of A,) And FDDC (oxygen takes off oxygen chest pyrimidine two times) Doing a clinical trial. BMS200475 (oxygen hydroxy carbon of ring takes off glucoside of oxygen bird) Study before doing clinically.
3. Immune modulator: The eight eighth hepatitis B is safe; People's fetus hepatocyte growth factor; Thymic peptide al; Nuclear acid vaccine; Adopt the cell immunity.
4. Jointly use medicine
The antiviral medicine may improve curative effect to jointly treat. The commonly used one jointly treats and adopts a interferon to unite immune modulator, such as thymosin al (reach the celestial being on day) , thymic peptide, anticlockwise imidazole apply pharmaceuticals, hepatitis B vaccine etc.. Also can adopt interferon unite other antiviral medicine, such as the intersection of Lammi and husband make etc.. But jointly treat the curative effect to the chronic hepatitis B, still need to further carry on scientific clinical verification.
Second, treatment to the ill
There is no specific drug therapy yet at present, unsuitable to abuse medicines, otherwise aggravate the liver burden and run counter to desire.
1,Supplementary many kinds of the intersection of vitamin and vitamin C, E, and B clan have, improve the intersection of liver and cellular metabolism, prevent or lighten fat, change the sex and protect function of cell. Can both supplement vitamin k, B12 and folic acid according to the circumstances.
2,Medicine skin glucoside which protects the hepatocyte is activator of cell, can heighten the level of three phosphoric acid gland former times, and can change into other nucleotide.
3,It is various in style that enzyme falls to return the yellow medicine, the curative effect difference is not big. Can select for use and unite benzene one pair of esters, sweet the intersection of profit and happy or licorice root sweet plain, door amino acid potassium beautiful and bear go raise the intersection of gallbladder and acid and traditional Chinese medicine preparation with compositions such as Fructus Schisandrae Chinensis, Herba Sedi, Herba Silybi mariani,etc. winter.
4,It is to infuse albumin to improve the plasma albumin most effective method. 17- 21 days in half-life in albumin, should pay attention to dosage and spacing interval while using clinically, if use l- twice every week, it is difficult to improve the patient's albumin level. During using the treatment of albumin, can use the thick liquid of new blood alternatively. Once there were reports which used methods such as dark chicken white wind pill, compound Chinese angelica slice,etc. previously, but in clinical use, curative effect is not obvious.
5,Improve the liver cirrhosis patient's intermediate and severe confirmed fatigue and symptom after first ester of piperazine of tired symptom can improve hepatitis. First ester 10-20mg of daily oral piperazine, once or 2 times for one day, take for 5 days continuously, suspend medicines for 2 days. The therapeutic time of location of China is 6 months.
Third, treatment of complication
Complication such as ascites, esophagus of liver cirrhosis
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