Hadzijahić N
Gastroenterologic Division, Detroit, Michigan, USA.
Med Arh. 1991;45(1-2):67-70.
VHB infection together with alcohol ist the most important ethiologic factor in the genesis of chronic liver parenchyma damage in our sample. Selection of patients with chronic diseases of the liver should be done on the basis of hepatitis markers determination, that is on the presence of HBsAg and HBeAg and the activity of aminotransferases in blood. Doing this it can be seen that more that half of the patients with chronic liver damage do not need therapy, and they have work capacity preserved. In these cases occasional controls of hepatitis markers and the level of AT in blood are needed. Presence of the virus replication can be determined on the basis of presence of the HBeAg in blood and HBcAg in the hepatocyte nucleus (histologic assay), since HBV-DNA and HBV-DNA polymerases in blood are not determined in the day's routine. Biopsy and rebiopsy of the liver tissue (pathohistologic assay) is the only confident my to determine the degree of liver damage. Introducing of the unique criteria in the management of the patients who have the signs of chronic liver damage would lower the diagnosis and treatment costs, as well as the unnecessary patient's absence from work. Proceeding of the preventive measures, vaccination of the persons who are exposed to VHB infection, as well as the struggle against alcoholism, stay on as the main source in prevention of chronic liver damage genesis.
在我们的样本中，丙型肝炎病毒感染与酒精共同作用是导致慢性肝实质损伤的最重要病因。慢性肝病患者的选择应基于肝炎标志物的检测，即血液中乙肝表面抗原（HBsAg）和乙肝e抗原（HBeAg）的存在情况以及转氨酶的活性。通过这样做可以发现，超过一半的慢性肝损伤患者不需要治疗，并且他们的工作能力得以保留。在这些情况下，需要偶尔检测肝炎标志物和血液中的转氨酶水平。病毒复制的存在可以根据血液中HBeAg的存在以及肝细胞核中乙肝核心抗原（HBcAg）的存在（组织学检测）来确定，因为血液中的乙肝病毒DNA（HBV-DNA）和乙肝病毒DNA聚合酶在日常检测中无法确定。肝组织活检和再次活检（病理组织学检测）是确定肝损伤程度的唯一可靠方法。在管理有慢性肝损伤迹象的患者时引入统一标准将降低诊断和治疗成本，以及减少患者不必要的缺勤。采取预防措施，对接触丙型肝炎病毒感染的人员进行疫苗接种，以及与酗酒作斗争，仍然是预防慢性肝损伤发生的主要手段。
