关于长效干扰素佩乐能和派罗欣的治疗心得

关于长效干扰素佩乐能和派罗欣的治疗心得 关于乙肝长效干扰素佩乐能和派罗欣 的治疗心得 大家好，我是RR。很高兴与大家分享本人乙肝治疗的心得，经过61支长效干扰素的注射治疗，本人成功从大三阳转成小三阳。一路经历过很多痛苦，在医生和家人的关爱下，顺利达到治疗目的，本着回馈社会、分享治疗心得、帮助广大病友度过难关的心态，写此心得。以下将附上本人61周(2014年1月-2015年3月)治疗的真实数据，供大家参考，顺便对比一下目前主流的两种长效干扰素(佩乐能和派罗欣)的治疗效果。 先说一下本人的基本情况: 一、本人男，26岁，6岁的时候查出患有乙肝，有20年左右的乙肝携带病历。 二、14岁的时候，DNA定量检测数值为3*10的7次方，注射过几个月的短效干扰素，无明显效果。 三、本人在25岁前，虽然长期携带乙肝病毒，但除了容易感觉疲惫、劳累之外，肝功能及其他指标一切正常。 四、2013年12月底，突然觉得人很疲惫困乏，每天上班回来感觉很累，于是在深圳体检，发现转氨酶ALT数值570，AST数值207，总胆红素偏高，无黄疸。 五、一天后，紧急转到广东省人民医院住院治疗，广东省人民医院因为是使用进口试剂，所以测量数据比深圳的准确，测的method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of ALT数值636、AST数值256，乙肝DNA定量为1.15*10的9次方。当时省人民医院的医生说，我的病毒量很高，如果用最灵敏的试纸，估计能测到10的11~13次方。 六、在省人民医院住院7天，主要是点滴注射“天晴甘美”类的保肝降酶药，出院时候，ALT降到150、AST降到95。 七、出院时，医生建议注射聚乙二醇干扰素治疗，原因一是:25岁人的免疫力旺盛，这个年龄段注射的效果较好。当时医生说大概有30%的几率由大三阳转成小三阳，有不到10%的几率由大三阳完全治愈。就我目前20年的携带病毒的情况，以及10的9次方的高病毒量，完全治愈的可能性比较小，治疗目标应该是从大三阳转成小三阳。原因二是:医生说，即使没有从大三阳转化为小三阳，但是注射长效干扰素24周到48周，可以显著改善病情，不往恶处发展，并且可以减小肝硬化的可能性，建议经济负担没问题的话，应该接受长效干扰素注射治疗。 八、我于是听从医生建议，接受聚乙二醇长效干扰素的注射治疗。当时情况是这样的，医生说ALT在指10倍以内范围才可以注射，我入院时候ALT超过600，不能注射。入院1周后ALT将至150，属于可以注射的范围。由于长效干扰素有一定的副作用，因此医生要求前4针都必须在医院里面完成，特别是第一针，还要求注射完观测1~2天，无状况才能出院。我们家经济没什么负担，只要能治好病就行，于是就打算全部听取医生的建议和意见。 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 九、医生给出了2种目前主流的聚乙二醇长效干扰素，一种是美国生产的佩乐能(α-2b)，另一种是瑞士生产的派罗欣(α-2a)，因为经济没负担，因此不考虑国产的，而这两种都是进口的。当时询问医生，这2种干扰素效果和副作用，医生说，临床结果是2种干扰素的效果差不多，副作用来说，由于注射长效干扰素会导致白细胞下降，佩乐能相对下降的幅度比较少一点，其他区别不大，建议使用佩乐能。(这是医生的建议，每个人的情况可能不一样。当然就本人使用而言，感觉派罗欣的副作用更小，后面具体讲。) 十、听从医生的建议，选择佩乐能注射。注射前要先去全身体检，其实长效干扰素的副作用比较多，不过常见的副作用危害都不大，危害大的副作用都不常见，因此没必要过分害怕。体检有好多，比如验血、CT、X光，还要验眼睛，好像听说有10%的几率会导致眼膜容易脱落之类的(因为我没听清，所以不太肯定，反正是需要提前验眼睛)。体检完毕，结果一出，就在广东省人民医院注射第一支了，是佩乐能，当然，注射前医院是要和你签什么的，告知你有哪些副作用，出现哪些罕见情况医院是不负责的之类的。挥手一签，心想低概率的事件应该轮不到我，遇到极罕见的副作用情况就像中彩票一样，没有过分担心。 十一、接下来谈一下本人注射佩乐能出现的副作用。我是2014年1月6日注射第一支佩乐能的，晚上18点注射，23点的时候开始头晕，24点开始发冷发热，呼吸很热、急促，全身骨 3 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 头、肌肉疼痛、无力，半夜实在难受，叫了护士，一量体温38度多。护士说没问题，并对我说:如果实在难受，可以服用百服宁之类的感冒药缓解，不过我没选择服用。到半夜2点多时候，难受，再叫护士，一量体温接近39度，全身骨头肌肉那个疼痛„„我呼吸有点困难，于是护士就给我戴口罩吸氧，感觉会好点。后来昏昏沉沉地半醒半睡就熬过去第一晚了。第二天(1月7日)还是头、睾丸、全身骨头、肌肉疼痛得不得了，这种疼痛分为2种，一种是电击一样的“一过性”的疼痛，属于全身游走性疼痛，位置飘忽，非常非常疼;另外一种是持续性的疼痛，比剧烈运动后的酸痛还要痛，短时间内基本不会消退。 这种疼痛在第一支注射的时候非常明显，伴随高烧(一周内发烧3-4天，不是连着发烧，是断断续续的，如果你身体发寒发冷，基本就是发烧跑不了了，不信的话这时候可以测体温)，我记得第一支注射后，疼痛持续了6-7天，身体第1天会比第2天缓解一点，但仅仅是一点，第2天到第7天都一样，没缓解，超级超级痛，很难受，但是作为男纸汉，这些疼痛还是要容忍的。 1月6日打完第一支，观测了1天多，医院觉得没问题就让我出院回深圳了。接着，根据要求，我1月13日又马不停蹄地从深圳赶到广东省人民医院体检，挂急诊，当天就能出结果，医生评估没有问题，才能开第二支针注射。打完第一支后的化验结果是白细胞从5.32直接降到2.99，中性粒从2.73降到1.05，血小板从179降到129。医生评估说没问题，于是注射第二支。 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 第二支的主要副作用也是全身疼痛，小骨头、大骨头、骨关节、全身肌肉、头、睾丸，反正你想到的地方，都痛。发烧是必然的，烧2-3天，也是断断续续地发烧，虽不是连续烧，但是印象中发烧的频率还挺高的。晚上盗汗十分严重，最多试过一晚上湿了5件衣服，湿了换，继续睡，然后又出汗湿了，又换„„ 前四针都是这样的情况，反正每周都要从深圳跑回去省人民医院化验，副作用来说，前期都是差不多，我感觉身体是在第5支之后，才有一定的缓解，最明显的是疼痛，到了第5支之后，基本就属于可以忍受的范围了，之前都是难以忍受那种。 总结一下我身上出现的副作用: 1、全身疼痛(头、大小骨头、关节、肌肉、睾丸)。分电击型“一过性”(全身游走型，疼痛位置飘忽不定)和持续疼痛，注射的前4个月都会，只是不同程度而已，前期难忍受，后面会缓解。 2、发烧。也分“一过性”和持续性，前1个月内会出现持续性发烧，烧1天左右，特别是刚注射完后6--8小时，准时发作。为了不影响上班工作，我选在每周五下午6点多注射，吃完饭尽量在9、10点前睡觉，发烧都是在睡梦中，可以有效缓解痛苦。1个月之后就慢慢转变为一过性发烧，同样也是发生在注射完6--12个小时之后，有时候发生在注射完18--24个小时后，发烧时间是1个小时--3个小时，不是一整天。本人注射了24支后仍然会碰到发烧的情况，虽不严重，但是对体力、精神的消 5 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 耗很大，这也是我半途停用佩乐能，转用派罗欣的最重要的原因。 3、胃口超差、体重2周内骤降6公斤。什么都不想吃，开始的一个月每天只是喝点粥。胃口差问题直到我停用佩乐能，换派罗欣之后才好转，真正好转是在打完61支并停针1个月之后。医生说初次注射，体重会在短期内骤降，有些人会短期内骤降10公斤，我的体重是骤降6公斤之后，就再也没明显降了。 4、盗汗，每天晚上至少换3次衣服(持续1-2个月，后面会慢慢缓解)。 5、超级嗜睡(每天晚上8点就睡了)。 6、全身极度乏力、伴随精神不振，开车的朋友要注意了(精神无法集中)。 7、注射3个月后，开始明显掉头发(浴室地漏短时间堵了2次，一把头发一把泪)。 8、甲状腺T3、T4升高(停针后可逆，不过要检查多个项目，有些指标是不可逆的，不可逆的指标如果没控制好，就要停针了，具体请咨询医生)。人容易暴怒，情绪容易失控。但出现的较迟，注射半年后才显现(不知怎么地突然就会暴跳如雷，感谢父母的忍让)。 9、抑郁与自杀倾向。这个是我在注射第48-61周的时候出现的，当时会觉得活着很没意思，想跳楼自杀，觉得很抑郁。本人注射前是乐观向上的男生，工作很好家庭也幸福，但是出现这种“厌世抑郁”的感觉很明显、很真实，多亏父母的开导和谅解，method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 不然我真有可能去跳楼。 十二、接下来谈一下本人注射24周佩乐能效果。最主要的指标DNA从1.15*10的9次方下降到1.52*10的6次方，表面抗原(两对半第一项)由67156下降到8846，E抗原(两对半第三项)由411升至657。具体数据后面后附上，我是坚持前期每个月检验一次，后期每3个月检测一次。从整体效果来说，病毒DNA下降了3个次方，佩乐能有疗效，但是疗效不明显。在每月的测量中，各项数据总体呈下降趋势，但是属于浮动下降，如两对半第三项E抗原，第一个月可能升，第二个月可能降，第三个月又可能升，但是总体是动态下降的。 注射完12、24支，需要回医院评估是否需要继续注射。(这里评估是: 1、你的身体是否能够承受继续注射的副作用。 2、疗效是否值得你继续注射。如果效果不好，医生会让你放弃注射，免得浪费钱。这里补充一下，医生说，一般是24周和48周的时候确定你的疗效是否值得继续注射，效果不好就不注射了;效果好的话，有可能会超过48周，因为继续注射可以巩固效果。有的人用了效果好，医生认为两对半的第一项有转阴的可能，那么这名患者有可能要注射96周。)我注射完佩乐能24周之后回省人民医院评估，医生说:1、佩乐能单独治疗有效果，DNA下降了3个对数级别(3次方)。2、但治疗效果不明显。3、DNA的数量还很高，需要联合“核苷类”口服药联合治疗。 7 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 十三、因此，我决定听取医生的建议，采取佩乐能注射，外加“核苷类”口服药联合治疗。“核苷类”口服药有很多种，我选择的是最好的进口“恩替卡韦”(每天服一颗，一个月大概1200元左右)。这里要提醒的是，并不是所有的“核苷类”的口服药都能和聚乙二醇长效干扰素联合使用，有些核苷类的口服药(如“替比夫定”)单独使用的效果比“恩替卡韦”要好，但是不能和佩乐能、派罗欣等长效干扰素联合使用，因为会导致周围神经性病变。 2014年6月17日开始服用“恩替卡韦”， 刚好是注射长效干扰素半年左右之际开始联合用药。就我个人而言，“恩替卡韦”的副作用主要是第一次服用会头晕目眩，长期服用会掉头发。我“恩替卡韦”联合干扰素共同治疗的效果不错，主要体现在:联合用药前，6月14日体检结果ALT为122，DNA为1.52*10的6次方。联合后7月17日体检，ALT降到42 ，DNA降到1.05*10的3次方。医生评估说:联合用药1个月效果不错，继续联合用药。 十四、停用佩乐能，改用派罗欣。注射完26支佩乐能后，我决定换派罗欣，主要原因如下: 1、对本人而言，佩乐能有一定治疗效果，但效果不佳。单独用药半年，DNA从1.15*10的9次方降到1.52*10的6次方，只降了3个对数级别(3次方)。虽然说原始HBV-DNA的基数大，前期降3次方与后期降3次方是不同概念，但总体效果未达医生method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 预期，并且注射半年后，再没有显著继续下降的趋势。 2、医生说，一般初次注射1-2月之后，就不会发烧和周身疼痛，但我注射了半年，还经常会发烧、全身游走型疼痛，甲状腺T3、T4有升高趋势，严重影响生活质量。 后期我了解到，佩乐能和派罗欣最大的区别是分子结构，佩乐能的分子结构比较小，可以随意穿过毛细血管，属于随着血液全身流动的那种;而派罗欣的分子结构比较大，基本聚集在肝脏部位，无法通过较细小的血管。简单打个比喻就是:佩乐能的战场在整个身体，而派罗欣的战场只集中在肝脏附近。 因此，由于每个人的体质和患病情况不同，佩乐能和派罗欣的效果及副作用，是因人而异的。 于是有人会问:能否同时注射2种干扰素,医生答复是:不能，原因是同时注射可能会产生干扰素抗体。还有人问换干扰素之间，需要停针多久,医生的回答是:按周期注射即可，转换不需要停针，我也是26周注射完佩乐能，到27周需要注射时，直接换派罗欣。但能否经常性互换，我就不清楚了，需要咨询医生。 十五、派罗欣的效果和副作用。我是从27周开始使用“派罗欣+恩替卡韦”联合用药的，直到61周，主要效果为: 1、联合用药3个月后，DNA从1.52*10的6次方降到1*10的2次方以下(即DNA转阴)，ALT和AST都稳定在正常值1.5倍以内(无论是干扰素还是核苷类口服药都有可能使转氨酶升高)。其他指标有下降，但前3个月不明显。 9 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 2、2015年4月11日，联合用药34周后(即长效干扰素第61支，“恩替卡韦”服用第34周)，对比2014年6月14日联合用药前，ALT、AST一直稳定在20左右，HBV-DNA在联合用药2个多月后，一直保持阴性;两对半第一项“表面抗原”从8846降到1961，第三项“E抗原”从657下降到32.6。(不一一举例了，具体数据可以看后面的表格) 3、副作用:(1)应该说，我身体比较适应派罗欣，除了注射第一支的时候，有点发烧，后面的33支都没有任何不良反应，不再发烧、疼痛，胃口好转，相对注射佩乐能的时候，疲惫感也有明显缓解。(2)甲状腺T3、T4继续升高(到61周的时候，已经超标很多了)，脾气越来越严重，情绪失落沮丧。但无法判断是派罗欣单独的副作用，还是2种长效干扰素共(都)有的副作用，或者是“恩替卡韦”的副作用。(3)掉头发严重，这项也没办法判断是干扰素的副作用，还是“恩替卡韦”的副作用，反正无论派罗欣、佩乐能还是“恩替卡韦”，说明书都说了会掉头发。 十六、停止注射长效干扰素，改为单独服用“核苷类”药物。在治疗之前，医生给我定治疗和治疗目标是:注射48支长效干扰素，最理想状况是注射完48支后，大三阳转成小三阳。如果注射24支之后完全没有效果，则放弃注射;如果有效果，但效果不明显，则选择“注射+口服”联合用药，第48周的时候重新评估，如果效果不理想，则停止注射，继续口服一段时间“核苷类”抗病毒药;如果效果理想，48支之后还需要再注射一段method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 时间巩固。 我个人的状况比较特殊:前24支干扰素注射后，有疗效，但疗效不理想，因此选择联合用药。联合用药到干扰素第48周时，效果不错，但是“两对半”第三项“E抗原”还一直徘徊在40左右(,1则转阴，大三阳转小三阳)，始终降不下去。有种希望近在咫尺，但就是“好事多磨”就差一点。 这时我再次回到广东省人民医院，医生说:效果不错，但还差一点点，建议继续联合用药12周，3个月后复查再评估。我当时甲状腺T3、T4已经比较高了，情绪、脾气经常出问题，和医生反应后，医生说需要检查一下甲状腺抗体，如果没有问题，就坚持一下，争取在3个月之后转阴。 我选择无条件的听取医生的建议，继续联合用药3个月，回来复查，“两对半”第三项“E抗原”从40(48周时候的结果)降到32.6(61周时候结果)，下降缓慢，依然没有降到1以下。这时我心情很沮丧，与病魔和药物副作用搏斗了那么久，眼见曙光，但就是没有达到预期疗效。那时摆在我眼前的有2条路:一是继续联合用药治疗，但是身体已经扛不住了，甲状腺功能已经有问题了;二是放弃注射长效干扰素，单服“核苷类”抗病毒药，以后生活就需要格外注意饮食和休息。 于是我回到省人民医院请医生评估，医生说我48周-61周的用药效果不好，反而对身体的损害加深，因此需要停针，但口服药不能停，因为一停会病毒会“报复性”复燃。医生说:有一 11 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 部分人对长效干扰素会“迟发反应”，即注射后当下没有什么疗效，但停止注射一段时间后，疗效会慢慢显现。病人不需要完全悲观，可以寄希望于“迟发反应”。另外还可以寄希望于口服类“核苷类”抗病毒药，也有机会通过“血清转换”来达到转阴。退一万步来说，即使既没有“迟发反应”，也没有“血清转换”的情况发生，也不需要太悲观，因为目前转氨酶稳定、DNA转阴的情况下，只要注意休息和饮食，不要喝酒、不要熬夜、过度劳累，干扰素停针一段时间后，疲惫感和副作用消失，一样可以和正常人生活，没有影响。 虽然听医生这么说，本人还是很失望，毕竟目标没达成。我个人希望继续注射3个月，看看能不能把第三项“E抗原”最后那32.6降下来，不过我父母和省人民医院的医生都不同意。于是我返回深圳，去深圳市第三人民医院找那里的医生，听听他们的说法，结果也是和省人民医院医生的说法一致。既然如此，那就只好停针，继续口服药，保持量好饮食和作息规律，并寄希望于“迟发反应”、“血清转换”的情况发生了。 十七、停针之后“迟发反应”、“血清转换”出现，奇迹发生。停针后一个月第三项“E抗原”从32.6下降到20.4，停针后3个月，第三项“E抗原”从20.4下降到0.78(,1则转阴)，第四项“e抗体”由阴转阳，即停针3个月后，奇迹发生，顺利从“大三阳”转化为“小三阳”。我本来都没有报什么希望的，结果很意外，激动得快哭了，与病魔和副作用斗争了1年半，终于method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 达到预期疗效了，真的很开心～ 因为太远，并且疗效达到了，因此我没有回广东省人民医院复诊评估，而是在深圳市第三人民医院评估，医生说:很多人的第三项“E抗原”都是停针一段时间之后才转阴的，能从大三阳转成小三阳，效果算很理想;但是，由于注射完61支后，第一项“表面抗原”还有1861，比较高，继续注射的治疗价值不大，第一项转阴的难度几乎没有，因此，也没有必要继续注射，但口服药不能停。 由于差不多到了要结婚生小孩的时候了，医生建议说，口服药换成“替比夫定”，这对生育小孩没有影响，“恩替卡韦”有致畸性，因此服用期间不能要小孩。医生说:停针之后半年才能要小孩，停“恩替卡韦”3个月后才能要小孩，期间核苷类口服药可以换成“替比夫定”或其他无致畸性的口服药。 十八、最后总结。截至今天2015年8月13日，我已经停针5个月，改服用“替比夫定”1个半月，感觉上来说，身体比起之前要好很多:以前脸色很青，现在红润了;以前很容易累，现在不容易累了，精气神、胃口、肌肉力量这些都好了很多，特别是停针3个月之后。虽然治疗过程漫长、痛苦，但坚持见到曙光～前面写得太罗嗦了，最后总结一下吧: (一)“佩乐能”和“派罗欣”是目前对付乙肝最有效的两种药物之一。虽然比较贵(佩乐能一支大概是1100-1200元，派罗欣一支大概是1000-1100元)，但是经济条件没有问题的人， 13 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 特别是年轻人，建议尝试去治疗:治疗成功的话，个人的身体状况、生活质量会得到很大改善;即使没有达到治疗效果，也可以抑制病毒，防止肝硬化等病情恶化的情况。 (二)“佩乐能”和“派罗欣”的副作用和疗效因人而异。不必过分担心副作用，因为高危害副作用的发生几率是很低的，发生几率高的副作用危害都不大，而且几乎都是停针后可逆的。 就本人用药而言，“派罗欣”的副作用更小;疗效的话则无法直接判断，因为我前26周“佩乐能”是单独用药，而后面“派罗欣+恩替卡韦”是联合用药，虽然后面效果显著，但未必是“派罗欣”单独的效果显著。 (三)出现在本人身上的主要副作用: 前期--发烧、全身疼痛、无力疲乏、没胃口; 注射3个月后--掉头发; 后期--甲状腺T3、T4升高导致脾气暴躁、沮丧抑郁有自杀厌世情绪。 (四)61周治疗总费用:12-15万元(含长效干扰素、“核苷类”抗病毒药、各种抽血体检费等) (五)个人要做好长期斗争的思想准备，不要怕时间长，不要怕痛苦，要乐观并且充满必胜的希望，静静等待奇迹发生。同时要严格注意作息和饮食规律，绝不能喝酒。 (六)和乙肝病毒搏斗的治疗时间比较长，过程比较痛苦，因此需要家人多关心、多呵护、多体谅、多精神安慰和鼓励。 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of (七)治疗期间，各项指标会有反复和波动，属于正常，总体是朝病情好转的方向发展的。 (八)一定要去正规的公立的三甲医院，建议去省医院或者市一级最好的医院，最好找经验丰富的主任医师，并充分地相信他们--绝大多数的医生都是以治好病人为己任的，具有高尚的医德，所以请充分相信他们可以治好你(当然前提是公立医院，私人的医院诊因为要赚钱，所以就不在这个范围之内了)。广东或者深圳的朋友，如果需要，也可以找我看病的那个医生:广东省人民医院陈小萍医生、深圳市第三人民医院戴炜医生，两人都是医德高尚、医术高超，尤其是陈小萍医生，态度很好，真是在世活菩萨。 十九、写了接近8000字来分享自己一年半以来的治疗心得，本着回馈社会，帮助病友挺过难关，走向幸福人生的心态写完此文，心情舒畅。能从大三阳转为小三阳是上帝赐予我的馈赠，我心存无比感恩，以后也将继续地多做好事、做善事，努力回馈社会。由文章篇幅较大，回忆的时间较长，中间存在换药和联合用药，所以时间、顺序和数据难免会有疏漏之处，还请见谅，最准确的应该以后附的表为准。 最后希望此文能够帮助到大家～本文禁止用于任何商业用途。 RR 2015年10月18日 15 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 61周体检主要数据表 血常规 转氨酶 两对半定量 检测 日期 针次 HBV-DNA 单位 白细胞 中性粒 血小板 ALT AST 表面抗原 表面抗体 E抗原 E抗体 核心抗体 龙岗区人2013-12-23 / / / / 570 207 / / / / / / 民医院 2013-12-29 / 5.4 2.7 177 636 256 7.54e+007 67156 2 411 2.72 0.006 同上 广东省人2014-01-01 入院 5.32 2.73 179 512 145 / / / / / / 民医院 2014-01-05 出院 / / / 150 95 1.15e+009 50216 2 415 2.15 0.006 同上 2014-01-13 第1针后 2.99 1.05 129 235 113 / / / / / / 同上 2014-01-20 第2针后 3.31 1.54 145 / / / / / / / / 同上 深圳市第 三人民医2014-02-09 第5针后 3.14 1.34 136 206 91 3.34e+006 11128 0.11 357 12.48 12.47 院 2014-04-07 第14针后 4.02 1.98 117 71 31 1.06e+007 24237 0.09 809 50.12 10.77 同上 日期 针次 血常规 转氨酶 HBV-DNA 两对半定量 检测method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of 白细胞 中性粒 血小板 ALT AST 表面抗原 表面抗体 E抗原 E抗体 核心抗体 单位 深圳市第2014-06-14 第24针后 3.42 1.88 131 122 45 1.52e+006 8846 0.51 657 27.55 11.78 三人民医 院 第28针后并联 2014-07-17 4.9 2.64 142 42 27 1.05e+003 5736 0.23 357 17.27 10.38 同上 合用药1个月 2014-09-04 第35针后 3.29 1.57 118 62 36 <1.0e+002 3968 0.37 123.4 7.44 9.85 同上 2014-11-30 第48针后 4.06 2.05 108 50 30 <2.0e+001 2237 0.01 41.1 3.25 9.22 同上 2015-02-24 第59针后 3.74 1.38 138 36 25 <2.0e+001 1700 0.74 32.6 2.07 12 同上 打完第61针且停 2015-04-11 6.49 3.84 167 26 22 <2.0e+001 1961 0.91 20.42 1.07 11.1 同上 针约1个月后 2015-06-11 停针3个月后 / / / 25 23 <2.0e+001 1861 0.81 0.788 0.06 10.1 同上 停针6个月后(同时 恩梯卡恩改替比夫2015-09-11 / / / 23 23 <2.0e+001 2302 0.05 0.871 0.05 10.2 同上 定2个半月) 17 method of basic operation; including CT, and MRI various contrast, and Image-guided biopsy, ultrasound, etc. (11) teaching, scientific research and training in clinical teaching, written within three years with some level of review or book reports of not less than 1. Four, to read reference books, Journal of internal medicine (medical college planning materials) and of the medical imaging (medical college planning materials); the practical science; the Harrison Science (in English), Chinese Journal of internal medicine series. Surgical surgical specialist refers to the rules complete the medical undergraduate or graduate education Foundation, accepted and adopted surgical specialist training, surgical diagnosis, treatment, prevention and follow-up of common diseases, surgical diagnosis and treatment of rare or incurable diseases, acute and critical illness in emergency and rescue have preliminary knowledge and experience. Surgical specialist training for 3 years. A surgical specialist, training goals through training, trainees to achieve surgical specialist level, with more skilled surgical skills, can guide the teaching of