Does the hepatitis B "small sanyang" state need to receive antiviral treatment?

Guide: Hepatitis B "big" "small" three yangs are not clear? According to epidemiological survey data, there are about 70 million people living with chronic HBV infection in China.
chronic hBV infection does not necessarily accompany clinical symptoms, especially the hepatitis B "small Sanyang" population, usually after the physical examination only found that the presence of hepatitis B virus carrying.
then, what is hepatitis B "small Sanyang", it and hepatitis B "big sanyang" difference is what, this kind of population need to receive antiviral treatment? We use a chart to explain the hepatitis B immunology testing project "two-to-one" testing project and the significance of the test.
"Small Sanyang" usually refers to hepatitis B virus surface antigen, hepatitis B virus e antibody and hepatitis B virus core antibody positive, "Big Sanyang" refers to hepatitis B virus surface antigen, hepatitis B virus e antigen and hepatitis B virus core antibody positive.
hepatitis B virus e antigen positive indicates that the patient is more infectious, therefore, "Big Sanyang" patients in the virus replication is usually more active, more infectious.
however, "Big Sanyang", "Small Sanyang" can only reflect the number and activity of hepatitis B virus in the body, and can not fully reflect the normal liver function or not, so can not be used alone to determine the severity of the disease, even if hepatitis B e antigen test negative, hepatitis B virus can also continue to replicate in the body and cause damage to liver cells.
therefore, hepatitis B "small Sanyang" population needs to undergo long-term follow-up and examination, the relevant guidelines recommend every 6 to 12 months blood routine, biochemistry, virology, a fetal protein, abdominal ultrasound and other examinations, such as the doctor request, also need to carry out liver living tissue examination.
in many examination projects, hepatitis B virus DNA testing can reflect the degree of activity of hepatitis B virus replication in the body, is the antiviral treatment adaptation selection and judge the efficacy of one of the most important basis, liver enzyme index can reflect the degree of damage of liver cells, and abdominal ultrasound and other noninvasive test results can judge the degree of liver fibrosis.
when hepatitis B "small Sanyang" population meets the following indications, should start antiviral treatment in time: 1. serum can detect hepatitis B virus DNA, if the liver enzyme index glutamate transaminase continued abnormality (greater than the upper limit of normal values), and exclude other causes caused by glutamate transaminase elevated enzyme.
2. No family history of cirrhosis/liver cancer but age 30 years, if there is cirrhosis, obvious liver inflammation or liver fibrosis basis, regardless of glutamate transaminase state, as long as the serum can detect hepatitis B virus DNA, should be active antiviral treatment.
3. Have a family history of cirrhosis/liver cancer and age of 30 years, regardless of glutamate transaminase status, as long as the serum can detect hepatitis B virus DNA, should be active antiviral treatment.
4. Physicians diagnosed with hepatitis B-related glomerular nephritis, vasculitis, nodule polyartitis, peripheral neuropathy and so on.
5. Hepatitis B is a patient with cirrhosis in the period of hepatitis B loss.
drugs of choice for first-time patients who need antiviral treatment include the oral antiviral drug entikavir, the nofyvir, or the injection of long-acting interferon.
note that there are more absolute contraindications of interferon, patients with primary diseasesuch diseases such as liver cirrhosis during the period of loss of compensation, pregnancy or short-term pregnancy plans, a history of mental illness, uncontrolled epilepsy, uncontrolled autoimmune disease, severe infection, retinal disease, heart failure, chronic obstructive pulmonary disease and other basic diseases, and the prohibition of interferon.
of course, if the physical examination found hepatitis B "small sanyang", also need not worry too much: develop a good diet of life, quit smoking and alcohol, avoid overwork, and regularly undertest, most people can live in peace with hepatitis B virus for a long time, do not need treatment.
if the examination found the presence of the above-mentioned abnormalities, through active antiviral treatment, if necessary, to receive liver protection, anti-liver fibrosis medication, can also greatly slow down the progress of the disease.
References: Guide to the Prevention and Control of Chronic Hepatitis B (2019), Chinese Medical Association's Infectious Disease Stakes, Chinese Medical Association's Liver Disease Credit Society.