为什么丙肝能治愈,而乙肝不能

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Estimated data from the World Health Organization show that there are about 90 million people carrying hepatitis B virus in China, of which about 28 million are chronic hepatitis B patients. In patients with liver cirrhosis and liver cancer, the infection caused by hepatitis B virus is as high as 60% and 80%, respectively. At the same time, hepatitis patients with different types of A, B, C, D, and E are also at risk of liver damage and disease progression.

Since 2017, patients with hepatitis C have been able to cure the disease through standardized drug treatment. So why is hepatitis C cured? But hepatitis B can't? Recently, in response to this question, Yu Zujiang, Dean of the Henan Provincial Gene Hospital and Director of the Department of Infectious Diseases of the First Affiliated Hospital of Zhengzhou University, gave a detailed answer.

Why can't hepatitis B be cured?

"In short, hepatitis B virus is a retrovirus, and hepatitis C virus is an RNA (ribonucleic acid) virus. The principle of pathogenesis is very different, which determines that one can cure and one cannot cure." Yu Zujiang said.

The replication of hepatitis B virus first invades the liver cells and removes its "core shell" in the liver cytoplasm, so that hepatitis B virus DNA (deoxyribonucleic acid) can enter the liver nucleus from the cytoplasm to form CCCDNA. Covalent, closed, circular DNA molecules of the helix). Hepatitis B virus uses CCCDNA as a template to replicate by transcription, translation, production of viral proteins, reverse transcription, and assembly.

"In this process, the virus will integrate the human chromosome, and there is currently no drug to remove, which is especially similar to the HIV replication process." Yu Zujiang explained.

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xx而丙肝病毒的复制能力,在血液中存在的水平相对较低。这种病毒只存在于细胞质里,且浓度比较低,用核苷类药物就可以在细胞质内完成病毒清除,从而根治疾病。现在,这一治疗方式已经是临床上的常规治疗手段。

“目前,乙肝虽然不能根治,但是控制是没有问题的。”余祖江说,在临床上,肝功能正常,病毒阴转,疾病进展速度缓慢,并发症减少,就意味着乙肝得到控制,疗效显着, “目前,乙肝的规范治疗率已经达到90%以上。”

乙肝应该如何规范化控制?

乙肝是一种传染病。乙肝病毒感染后,因其难以从体内彻底清除,继而引发慢性感染。统计数据显示,在我国的乙肝病毒携带者中,接受抗病毒治疗的慢性乙肝患者约350万人

“慢性乙肝是我国肝硬化和肝癌的主要成因和死因,超过86%的肝癌与乙肝病毒感染相关。”余祖江说,他和团队长期以来一直致力于因乙肝引起的肝硬化,肝硬化腹水,肝衰竭患者的治疗,“在治疗这些重度患者的过程中,如何减少其脏器,骨骼的损伤,也是临床长期观察,研究的重点。”

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余祖江说,目前在慢性乙肝治疗中涌现出一些诸如丙酚替诺福韦的新药,通过对患者的跟踪观察发现,其具备减少耐药,减少肝癌发生,以及减少肾损伤,骨损伤等优势。但是,因为许多新药仍未列入医保目录,所以其价格较常规治疗药物仍偏高。

XX“对于年龄在60岁以上,或者是合并有肾脏损伤的患者,我们建议使用对肾脏损伤小的新药,来增强治疗效果,改善患者的生存状态。对于普通慢性乙肝患者,我们建议他们不能没有感觉就不就医,一定要定期复查,规范治疗!”余祖江说。

该怎样消除认识误区?

即便是乙肝,丙肝的治疗取得了如此大的进展,可公众依旧是谈“肝”色变。谈及这一点,余祖江说,让每一个人正确认识肝炎的传播途径,仍是近段时期肝炎防治科普宣传的重点。

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比如,甲肝和戊肝经消化道传播,水源或食物被污染可引起暴发流行,注意食品卫生,饮用水卫生等可有效预防甲肝和戊肝;乙肝和丙肝经血液,母婴和性传播;丁肝的传播途径与乙肝相似,与乙肝病毒同时或在乙肝病毒感染的基础上才能感染。

据余祖江介绍,乙肝通过抗病毒治疗可以控制病毒载量,使肝硬化和肝癌的发生率大大降低。我国约有50%的乙肝患者是母婴传播所致,成人肝硬化,90%以上的肝癌是婴幼儿时期感染了乙肝病毒。目前,在全国推广的乙肝母婴“零传播”工程已经取得了很好的成绩,母婴阻断率达到了99.3%。

除了乙肝,丙肝也是常见且没有引起重视的慢性肝炎。数据显示,我国丙肝病毒感染者约790万人,近5年全国法定传染病疫情报告的丙肝感染者大约是20万人/年,而慢性丙肝感染和乙肝一样,也是肝硬化和肝癌的主要病因。

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XX“慢性丙型肝炎是非常隐蔽的,症状不明显,故诊断率低。大多数丙型肝炎患者在诊断时都患有慢性丙型肝炎。”于祖江说,与乙型肝炎不同,如果只是乙型肝炎表面抗原阳性,转氨酶正常,肝脏病变轻微,可以暂时不治疗。但丙型肝炎则相反。一旦感染,它对肝脏的损害将继续。因此,有不安全血液接触史的高危人群应及时接受丙型肝炎检测。此外,一些医源性侵入性检查,如非标准医疗机构的牙科植入物,微整形手术等,可能会传播丙肝,所以高危人群应定期去医院检查。

协调:梁如意主编:朱小娟

编辑:刘景娜王伟

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