acute hepatitis C
Introduction
Introduction to acute hepatitis C Hepatitis C virus (HC) is abbreviated as hepatitis C or hepatitis C (HC), mainly through hepatitis C virus (HCV) through the blood transmission route, a small number of acute liver inflammation caused by close contact with the transmission route, clinical manifestations and B Hepatitis is similar. Liver function in patients with acute hepatitis C is markedly acute. Although some patients with acute hepatitis C can heal themselves, some patients will turn into chronic hepatitis C. Acute hepatitis C can be divided into acute jaundice hepatitis C and acute jaundice-free hepatitis C. Hepatitis C virus is globally distributed and has a strong epidemic. The HCV infection rate in foreign population is as high as 3%. The positive rate of HCV antibody in healthy people in China is 0.7% to 3.1%. Hepatitis C virus is highly contagious. Once the infection is difficult to cure, it is easily converted to chronic hepatitis and cirrhosis, and even liver cancer is induced. basic knowledge The proportion of sickness: 0.7% to 3.1% Susceptible people: no specific population Mode of transmission: blood transmission, sexual transmission, mother-to-child transmission Complications: liver cirrhosis
Cause
Acute hepatitis C cause
Hepatitis C virus infection is the root cause of the disease. Under the influence of external factors, such as drinking alcohol, fatigue, long-term use of drugs with hepatotoxicity, can promote the development of the disease. The pathological changes of hepatitis C are very similar to those of hepatitis B, with hepatocyte necrosis and lymphocyte infiltration. Chronic hepatitis can occur in the portal area fibrous tissue hyperplasia, severe cases can form pseudolobules that become cirrhosis.
The pathogenesis of HCV infection mainly includes immune mediated and direct HCV injury. Viral factors include viral genotype, replication ability, immunogenicity of viral polypeptide, etc. Host factors include human innate immune response, humoral immunity and cells. Immune response, etc. Factors such as the use of alcohol and immunosuppressive agents also have an impact on the course of HCV infection.
HCV routes of transmission: kissing, hugging, sneezing, coughing, food, drinking water, shared cutlery and cups, no skin damage and other exposures without blood exposure generally do not transmit HCV. HCV is mainly transmitted through the following channels:
1, blood transmission
(1) Transfusion and blood product transmission Due to the presence of anti-HCV window, unstable quality of anti-HCV detection reagent and a small number of infected people do not produce anti-HCV, therefore, it is impossible to completely screen out HCV-positive persons, a large number of blood transfusions and blood. Dialysis is still likely to infect HCV.
(2) Disrupted skin and mucous membrane transmission This is currently the most important mode of transmission. In some areas, HCV transmission accounts for 60% to 90% due to intravenous drug use. The use of non-disposable syringes and needles, unsanitized dental instruments, endoscopy, invasive procedures and acupuncture are also important ways of transcutaneous transmission. Some traditional medical methods that can cause skin damage and blood exposure are also associated with HCV transmission; sharing razors, toothbrushes, tattoos, and piercing earrings is also a potential form of menstrual blood transmission for HCV.
2. Sexual transmission.
3. Mother-to-child transmission
The risk of anti-HCV-positive mothers transmitting HCV to newborns is 2%. If the mother is HCV RNA-positive at delivery, the risk of transmission can be as high as 4% to 7%. When HIV infection is combined, the risk of transmission increases. 20%. The high load of HCV virus may increase the risk of transmission.
4, other ways
Found in 15% to 30% of sporadic hepatitis C, the route of transmission is unknown.
Prevention
Acute hepatitis C prevention
1. Reduce the risk of sexual transmission and ensure a healthy and safe sex life.
2, pay attention to personal hygiene, avoid sharing sanitary products such as razors and toothbrushes.
3. Minimize the risk of mother-to-child transmission, reduce the monitoring of fetal dew during childbirth, and shorten the time of delivery after rupture of membranes to help reduce the risk of mother-to-child transmission. Infants born to HCV-positive mothers should be tested for HCV RNA between 2 and 6 months after birth or/and anti-HCV at 15 months. Detection of anti-HCV positive within 15 months after birth may be from maternal .
Complication
Acute hepatitis C complications Complications liver cirrhosis
If left untreated, it may develop into chronic hepatitis C, causing diseases such as cirrhosis and liver cancer.
Symptom
Acute hepatitis C symptoms Common symptoms Unexplained fever, loss of appetite, fatigue, abdominal distension, nausea and vomiting, limb pain, weakness, jaundice, liver headache
1, acute jaundice type hepatitis C:
Acute hepatitis C has a rapid onset and has fever symptoms. A few are mainly headaches, fever, sore limbs, etc., similar to a cold. This type of hepatitis C symptoms mainly include general malaise, loss of appetite, nausea and vomiting, anaesthesia of abdominal oil, pain in the liver area, deepening of urine, etc. The change of liver function is mainly caused by elevated alanine aminotransferase (ALT). As the disease progresses, the symptoms of jaundice may occur. Some patients with hepatitis C may have obstructive jaundice such as yellowing, skin itching, and slow heartbeat. Liver function tests showed elevated ALT and bilirubin, and urinary bilirubin was positive. The condition continued to develop, the symptoms of hepatitis C gradually disappeared, the jaundice subsided, the liver and spleen retracted, and the liver function gradually returned to normal.
2, acute jaundice-free hepatitis C:
In addition to no jaundice, this type of performance is similar to jaundice type hepatitis C. However, the onset of jaundice is more insidious, and the symptoms of hepatitis C are mild. Some cases of hepatitis C have no obvious symptoms and are easily ignored. In contrast, no jaundice-type onset is more rapid, the symptoms are heavier, mainly manifested as general malaise, loss of appetite, nausea, abdominal distension, liver pain, liver and other symptoms, recovery is slower. Some cases have no obvious symptoms of acute hepatitis C and are easily overlooked. The incidence of hepatitis C-free hepatitis C is much higher than that of jaundice-type hepatitis C, and no jaundice type accounts for 2/3. Most patients with hepatitis C had no fever and serum ALT was mildly moderately elevated.
Examine
Acute hepatitis C examination
1, liver function
Including serum ALT, AST, total bilirubin, direct bilirubin, indirect bilirubin, albumin, globulin, cholinesterase, alkaline phosphatase, transpeptidase and the like.
2. Hepatitis C virus antibody
Anti-HCV.
3. Hepatitis C virus quantification
Serum HCV RNA to understand the level of activity of hepatitis C virus replication.
4, imaging
Ultrasound examination of abdominal liver, gallbladder and spleen to understand whether the liver has chronic damage. Abdominal enhanced CT or MRI should be performed if necessary to understand the extent of the disease.
5, liver transient elastic wave scanning
It is a non-invasive test that can be used to assess the degree of liver fibrosis in patients with chronic hepatitis C. The assessment of liver fibrosis in patients with hepatitis C is important for determining treatment options.
6, liver tissue biopsy
It is the gold standard for assessing patients' liver inflammation grading and fibrosis stage.
Diagnosis
Diagnosis of acute hepatitis C
diagnosis
1, anti-HCV
That is, hepatitis C antibody is currently the main indicator for the diagnosis of hepatitis C virus. However, anti-HCV is slower after infection with HCV. It usually turns to yang 2 to 6 months after the onset of illness, and even 1 year, so it cannot be used as an early diagnosis method. And 1 negative, can not directly negate the diagnosis. When all types of viral hepatitis-specific markers are negative, clinical symptoms and individual ALT are elevated, suggesting acute viral hepatitis, should consider whether it is hepatitis C.
2. HCV-RNA
That is, the ribonucleic acid of hepatitis C virus, which is a genetic material of HCV, is a direct indicator of HCV infection in the body. The HCV-RNA in blood can be directly detected by PCR, and can be used for early diagnosis of HCV infection. Because it is earlier than hepatitis C antibody, it is a useful indicator for the diagnosis and judgment of hepatitis C.
In conclusion, HCV-RNA and anti-HCV, such as HCV-RNA and anti-HCV, can be further investigated for patients with suspected hepatitis C virus who have typical clinical manifestations and whose incidence is closely related to blood transfusion and blood products. Or HCV-RNA alone can be diagnosed as hepatitis C virus.
Identification
The main identified diseases include: other types of viral hepatitis: type B, type D, hepatitis E, EBV hepatitis, CMV hepatitis. The differential diagnosis is based primarily on specific serological tests.
