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与乙型肝炎共存

我会从乙型肝炎感染中恢复吗?
大多数刚受感染的健康成年人会毫无问题地恢复。但婴儿和幼儿可能无法成功地消除该病毒。

  • 成年人——90% 的健康成年人会消除该病毒,并毫无问题地恢复;10% 会发展为慢性乙型肝炎。 
  • 幼儿——多达 50% 的 1-5 岁受感染幼儿会出现慢性乙型肝炎病毒。
  • 婴儿——90% 会变为慢性感染;仅 10% 将能够消除该病毒。


“急性”和“慢性”乙型肝炎感染有什么区别?
接触病毒后最初 6 个月期间的乙型肝炎病毒感染被认为是“急性”感染。这是从乙型肝炎感染中恢复的平均时间。

6 个月后,如果您乙型肝炎病毒测试仍然呈阳性 (HBsAg+),则您被认为患有“慢性”乙型肝炎感染,它可以持续一生。


如果我患有急性乙型肝炎,我会生病吗?
乙型肝炎被认为是一种“无声感染”,因为它通常不引起任何症状。大多数人感到健康而且不知道自己已受感染,这意味着他们会不知不觉地将病毒传给它人。其他人可能有轻微症状,比如误以为由流感导致的发烧、疲劳、关节或肌肉疼痛,或者食欲减退。

不常见但更严重的症状包括严重恶心和呕吐,眼睛和皮肤发黄(称为“黄疸”)和胃部肿胀——这些症状需要立即就医,患者可能需要住院。


当我已从“急性”乙型肝炎感染中恢复,我会如何知道?
一旦您的医生通过验血已确认您已从体内消除病毒,并产生保护性抗体 (HBsAb+),您就会免于任何未来的乙型肝炎感染,并且不再对其他人有传染性。


如果我被诊断出患有慢性乙型肝炎,我应该怎么办?
如果您乙型肝炎病毒测试呈阳性长于 6 个月,这表明您患有慢性乙型肝炎感染。您应该与熟悉乙型肝炎的肝脏病学家(肝脏专家)、胃肠病医师或家庭医生预约。医生会嘱咐验血,可能还会嘱咐去做肝脏超声波检查,以评估乙型肝炎病毒在您体内的活跃程度,并监测您的肝脏的健康。您的医生很可能希望每年至少见到您一次或两次,以监测您的乙型肝炎,并确定您是否会从治疗中获益。

所有慢性感染者都应该至少一年看一次(或更频繁地)医生,进行常规的医疗随访护理,无论他们是否开始治疗。即使病毒处于较不活跃的阶段,极少或没有发生任何损伤,但这会随时间发生改变,这也正是定期监测是如此重要的缘由。

大多数慢性乙型肝炎感染者有望活得健康长久。一旦您被诊断为慢性乙型肝炎,病毒可能在您的血液和肝脏中终生停留。重要的是要知道您可以将病毒传给他人,即使您未感觉不舒服。这就是您要确保所有亲密的家庭接触者和性伴侣都接种乙型肝炎疫苗是如此重要的缘由。

哪些测试会用来监测我的乙型肝炎?
医生用来监测乙型肝炎的常见测试包括乙型肝炎血检、肝功能测试(ALT、AST)、乙型肝炎病毒 e 抗原 (HBeAg)、乙型肝炎 e 抗体 (HBeAb)、乙型肝炎 DNA 定量(病毒载量)和肝脏成像研究(超声、FibroScan [瞬时弹性成像] 或 CT 扫描)。


有针对慢性乙型肝炎的治愈方法吗?
目前还没有针对慢性乙型肝炎的治愈方法,但好消息是,一些治疗方法可以通过使病毒减速来帮助减缓慢性感染者的肝病进展。如果产生的乙型肝炎病毒较少,那么对肝脏的损伤就会较少。有时这些药物甚至可以清除病毒,尽管这不常见。

凭着所有令人振奋的新研究,有很大希望在不久的将来找到慢性乙型肝炎的治愈方法。访问我们的 Drug Watch(药品观察 获取研发中的其他有前景药物的清单。


有任何已批准的药物来治疗慢性乙型肝炎吗?
目前针对乙型肝炎的治疗分为两种一般类别:抗病毒药物和免疫调节剂:

抗病毒药物——这些药物可以减缓或阻止乙型肝炎病毒,从而减少肝脏炎症和损伤。这些药物为丸剂,每天服用一次,疗程至少 1 年,通常更久。目前有 6 种经美国 FDA 批准的抗病毒药物,但是只有三种一线抗病毒药物是获得推荐的治疗方法:替诺福韦酯(Viread/TDF)、替诺福韦艾拉酚胺(Vemlidy/TAF)和恩替卡韦(Baraclude)。推荐使用一线抗病毒药物,因为它们更安全、最有效。与旧的抗病毒药物相比,它们还具有更好的耐药性,这意味着当它们按规定服用时,发生突变和耐药性的可能性更小。耐药性增加使得治疗和控制病毒更加困难。

免疫调节药——这些药物可以增强免疫系统,以帮助控制乙型肝炎病毒。它们在 6 个月至 1 年的时间里以注射方式给药。最常见的处方药物包括干扰素 alfa-2b (Intron A) 和聚乙二醇干扰素 (Pegasys)。这是对同时感染肝炎三角区的患者的唯一推荐治疗方法。

这些药物为慢性乙型肝炎提供了“治愈方法”吗?

虽然它们不能提供彻底治愈,但目前的药物会使病毒减速,并降低日后患上更严重肝病的风险。这导致病人在数月内感觉良好,这是因为病毒对肝脏的损伤有所减缓,或者经长期服用后甚至在某些情况下出现逆转。抗病毒药物不能随意停止和开始,这就是在开始治疗慢性乙型肝炎病毒 (HBV) 之前需要由知识渊博的医生进行彻底评估是如此重要的缘由。


如果我患有慢性乙型肝炎感染,我应该服用药物吗?
重要的是要了解并非每位慢性乙型肝炎患者都需要服药。您应该与您的医生谈谈您是否是药物疗法的良好候选人。无论您和您的医生决定您是否应该开始治疗,您都应该定期去肝脏专家或在乙型肝炎方面知识渊博的医生处看诊。


针对我的乙型肝炎感染,服用草药或补充剂安全吗?
许多人都有兴趣使用草药或补充剂来增强他们的免疫系统和帮助他们的肝脏。问题在于,没有对生产这些产品的公司进行监管,这意味着没有严格的安全性或纯度检测。因此,瓶与瓶之间的草药或维生素补充剂的质量可能不同。另外,有些草药可能会干扰您用于治疗乙型肝炎或其他病情的处方药;甚至有些实际上会损伤您的肝脏。这些草药不会治愈慢性乙型肝炎感染。

有许多公司在互联网上和通过社交媒体对他们的产品做出虚假承诺。Facebook 上的在线索赔和患者感言是假的,并被用来欺骗人们购买昂贵的草药和补充剂。记住,如果它好得令人难以置信,那么它很可能不是真的。
以下是关于药草和替代药物的可靠信息来源。这些信息基于科学证据,而不是虚假承诺。检查您的草药或补充剂中的活性成分是否是真实的并且对您的肝脏安全。最重要的事是要保护您的肝脏免受任何额外伤害或损伤。


对于那些慢性乙型肝炎患者,有哪些健康的肝脏提示?
慢性乙型肝炎感染患者可能需要或可能不需要药物治疗。但是,患者可以做很多其他的事情来保护他们的肝脏和改善他们的健康。以下是我们可以从今天开始的十大健康选择的列表!

  • 安排与您的肝脏专家或卫生保健提供者的定期就诊,以掌握您的健康和您肝脏的健康情况。
  • 接种甲肝疫苗,以保护自己远离攻击肝脏的其他病毒。
  • 避免饮酒和吸烟,因为两者都会伤害您已经受到乙型肝炎病毒损伤的肝脏。
  • 在开始服用任何草药或维生素补充剂之前,先与您的医生谈谈,因为有些药物可能会干扰您的乙型肝炎处方药物,甚至损伤您的肝脏。
  • 向您的药剂师咨询任何非处方药(如:对乙酰氨基酚、扑热息痛)或非乙型肝炎处方药,之后再服用这些药物,以确保它们对您的肝脏是安全的,因为这些药物许多是通过肝脏处理的。 
  • 避免吸入油漆、油漆稀释剂、胶水、家用清洁产品、洗甲水以及其他可能损伤您肝脏的有毒化学物质散发的气味。 
  • 健康饮食,食用水果、全谷类、鱼和瘦肉,以及大量蔬菜。尤其是“十字花科蔬菜”——卷心菜、花椰菜、菜花——已被证明有助于保护肝脏对抗周围的化学物质。 
  • 避免食用生的或未煮熟的贝类(如蛤蚌、贻贝、牡蛎、扇贝),因为它们可能会被一种叫做创伤弧菌的细菌污染,这种细菌对肝脏非常有害,可能造成巨大损伤。
  • 检查坚果、玉蜀黍、玉米、花生、高粱和小米有无发霉迹象,之后再食用。如果食物储存在潮湿的环境中,并且没有妥善密封,那么霉菌则更有可能是个问题。如果有霉菌,那么这些食物可能会被“黄曲霉毒素”污染,这是已知的肝癌风险因素。
  • 通过吃健康的食物、定期锻炼和获得充足的休息来减轻您的压力。 
  • 记住您吃的、喝的、呼吸的、或者通过皮肤吸收的每样东西最终都会由肝脏来过滤。所以,请保护您的肝脏和您的健康!


如果我有乙型肝炎,我可以献血吗?
不能。即使您已经从急性感染中恢复,血库也不会接受任何已接触过乙型肝炎的血液。

Living with Hepatitis B

Will I recover from a hepatitis B infection?
Most healthy adults who are newly infected will recover without any problems. But babies and young children may not be able to successfully get rid of the virus.

  • Adults – 90% of healthy adults will get rid of the virus and recover without any problems; 10% will develop chronic hepatitis B. 
  • Young Children – Up to 50% of young children between 1 and 5 years who are infected will develop a chronic hepatitis B infection.
  • Infants – 90% will become chronically infected; only 10% will be able to get rid of the virus.


What is the difference between an "acute" and a "chronic" hepatitis B infection?
A hepatitis B infection is considered to be “acute” during the first 6 months after being exposed to the virus. This is the average amount of time it takes to recover from a hepatitis B infection.
If you still test positive for the hepatitis B virus (HBsAg+) after 6 months, you are considered to have a "chronic" hepatitis B infection, which can last a lifetime.


Will I become sick if I have acute hepatitis B?
Hepatitis B is considered a "silent infection” because it often does not cause any symptoms. Most people feel healthy and do not know they have been infected, which means they can unknowingly pass the virus on to others. Other people may have mild symptoms such as fever, fatigue, joint or muscle pain, or loss of appetite that are mistaken for the flu.

Less common but more serious symptoms include severe nausea and vomiting, yellow eyes and skin (called “jaundice”), and a swollen stomach - these symptoms require immediate medical attention and a person may need to be hospitalized.


How will I know when I have recovered from an "acute" hepatitis B infection?
Once your doctor has confirmed through a blood test that you have gotten rid of the virus from your body and developed the protective antibodies (HBsAb+), you will be protected from any future hepatitis B infection and are no longer contagious to others.


What should I do if I am diagnosed with chronic hepatitis B?
If you test positive for the hepatitis B virus for longer than 6 months, this indicates that you have a chronic hepatitis B infection. You should make an appointment with a hepatologist (liver specialist), gastroenterologist, or family doctor who is familiar with hepatitis B. The doctor will order blood tests and possibly a liver ultrasound to evaluate how active the hepatitis B virus is in your body, and to monitor the health of your liver. Your doctor will probably want to see you at least once or twice a year to monitor your hepatitis B and determine if you would benefit from treatment.

All chronically infected people should be seen by their doctor at least once a year (or more frequently) for regular medical follow-up care, whether they start treatment or not. Even if the virus is in a less active phase with little or no damage occurring, this can change with time, which is why regular monitoring is so important.

Most people chronically infected with hepatitis B can expect to live long, healthy lives. Once you are diagnosed with chronic hepatitis B, the virus may stay in your blood and liver for a lifetime. It is important to know that you can pass the virus along to others, even if you don’t feel sick. This is why it’s so important that you make sure that all close household contacts and sex partners are vaccinated against hepatitis B.

What tests will be used to monitor my hepatitis B?
Common tests used by doctors to monitor your hepatitis B include the hepatitis B blood panel, liver function tests (ALT, AST), hepatitis B e-Antigen (HBeAg), hepatitis B e-Antibody (HBeAb), hepatitis B DNA quantification (viral load), and an imaging study of the liver (ultrasound, FibroScan [Transient Elastography] or CT scan).


Is there a cure for chronic hepatitis B?
Right now, there is no cure for chronic hepatitis B, but the good news is there are treatments that can help slow the progression of liver disease in chronically infected persons by slowing down the virus. If there is less hepatitis B virus being produced, then there is less damage being done to the liver. Sometimes these drugs can even get rid of the virus, although this is not common.

With all of the new exciting research, there is great hope that a cure will be found for chronic hepatitis B in the near future. Visit our Drug Watch for a list of other promising drugs in development.


Are there any approved drugs to treat chronic hepatitis B?
Current treatments for hepatitis B fall into two general categories, antivirals and immune modulators:

Antiviral Drugs - These are drugs that slow down or stop the hepatitis B virus, which reduces the inflammation and damage to the liver. These are taken as a pill once a day for at least 1 year, usually longer. There are 6 U.S. FDA approved antivirals, but only three first-line antivirals are recommended treatments: tenofovir disoproxil (Viread/TDF), tenofovir alafenamide (Vemlidy/TAF) and Entecavir (Baraclude). First-line antivirals are recommended because they are safer and most effective. They also have a better resistance profile than older antivirals, which means that when they are taken as prescribed, there is less chance of mutation and resistance. Building resistance makes it harder to treat and control the virus.

Immunomodulator Drugs - These are drugs that boost the immune system to help control the hepatitis B virus. They are given as injections over 6 months to 1 year. The most commonly prescribed include interferon alfa-2b (Intron A) and pegylated interferon (Pegasys). This is the only recommended treatment for patients coinfected with hepatitis delta.

Do these drugs provide a “cure” for chronic hepatitis B?

Although they do not provide a complete cure, current medications will slow down the virus and decrease the risk of more serious liver disease later in life. This results in patients feeling better within a few months because liver damage from the virus is slowed down, or even reversed in some cases, when taken long-term. Antivirals are not meant to be stopped and started, which is why a thorough evaluation by a knowledgeable doctor is so important before beginning treatment for chronic HBV.


If I have a chronic hepatitis B infection, should I be on medication?
It is important to understand that not every person with chronic hepatitis B needs to be on medication. You should talk to your doctor about whether you are a good candidate for drug therapy. Whether you and your doctor decide you should start treatment or not, you should be seen regularly by a liver specialist or a doctor knowledgeable about hepatitis B.


Is it safe to take herbal remedies or supplements for my hepatitis B infection?

Many people are interested in using herbal remedies or supplements to boost their immune systems and help their livers. The problem is that there is no regulation of companies manufacturing these produces, which means there is no rigorous testing for safety or purity. So, the quality of the herbal remedy or vitamin supplement may be different from bottle to bottle. Also, some herbal remedies could interfere with your prescription drugs for hepatitis B or other conditions; some can even actually damage your liver. These herbal remedies will not cure a chronic hepatitis B infection.

There are many companies that make false promises on the Internet and through social media about their products. Online claims and patient testimonials on Facebook are fake and are used to trick people into buying expensive herbal remedies and supplements. Remember, if it sounds too good to be true, then it’s probably not true.

Below are reliable sources of information about herbs and alternative medicines. This information is based on scientific evidence, not false promises. Check whether the active ingredients in your herbal remedies or supplements are real and safe for your liver. The most important thing is to protect your liver from any additional injury or harm.

What healthy liver tips are there for those living with chronic hepatitis B?
People living with chronic hepatitis B infection may or may not need drug treatment. But there are many other things patients can do to protect their liver and improve their health. Below is our list of the top 10 healthy choices that can be started today!

  • Schedule regular visits with your liver specialist or health care provider to stay on top of your health and the health of your liver.
  • Get the Hepatitis A vaccine to protect yourself from another virus that attacks the liver.
  • Avoid drinking alcohol and smoking since both will hurt your liver, which is already being injured by the hepatitis B virus.
  • Talk to your provider before starting any herbal remedies or vitamin supplements because some could interfere with your prescribed hepatitis B drugs or even damage your liver.
  • Check with your pharmacist about any over-the-counter drugs (e.g. acetaminophen, paracetamol) or non-hepatitis B prescription drugs before taking them to make sure they are safe for your liver since many of these drugs are processed through your liver. 
  • Avoid inhaling fumes from paint, paint thinners, glue, household cleaning products, nail polish removers, and other potentially toxic chemicals that could damage your liver. 
  • Eat a healthy diet of fruit, whole grains, fish and lean meats, and lot of vegetables. “Cruciferous vegetables” in particular -- cabbage, broccoli, cauliflower -- have been shown to help protect the liver against environmental chemicals. 
  • Avoid eating raw or undercooked shellfish (e.g. clams, mussels, oysters, scallops) because they could be contaminated with bacteria called Vibrio vulnificus, which is very toxic to the liver and could cause a lot of damage.
  • Check for signs of mold on nuts, maize, corn, groundnut, sorghum, and millet before using these foods. Mold is more likely to be a problem if food is stored in damp conditions and not properly sealed. If there is mold, then the food could be contaminated by “aflatoxins,” which are a known risk factor for liver cancer.
  • Reduce your stress levels by eating healthy foods, exercising regularly, and getting plenty of rest.

Keep in mind everything you eat, drink, breathe, or absorb through the skin is eventually filtered by the liver. So, protect your liver and your health!


Can I donate blood if I have hepatitis B?
No. The blood bank will not accept any blood that has been exposed to hepatitis B, even if you have recovered from an acute infection.