B型肝炎(Hepatitis B)

一、流行狀況
台灣是B型肝炎之流行區,一般成人中百分之九十五以上感染過B型肝炎,百分之十五至二十為B型肝炎帶原者。台灣全面推行B型肝炎疫苗注射後,固然可能斷絕B型肝炎之持續傳播,然而全台近四百萬已經成為帶原者的民眾,應注意以下事項。
二、B型肝炎帶原者
所謂B型肝炎帶原者,是指一個人受到B型肝炎感染後,未能將病毒清除,血液中持續可測得B型肝炎表面抗原。這表示B型肝炎病毒持續存活於該人之血液及肝細胞內。要知道個人是否為B型肝炎帶原者,唯有驗血:B型肝炎表面抗原(HBsAg)陽性,是為帶原者:表面抗原陰性時,應驗表面抗體(Anti-HBs),如表面抗體陽性則表示已有抵抗力;如表面抗體也陰性則表示未曾感染過B型肝炎,應接受疫苗注注射。由於台灣是B型肝炎之流行區,每一個人最好是及早驗血,知道自已是帶原者、或是已有抵抗力、或須要打疫苗。
三、B型肝炎傳染途徑
B型肝炎的傳染途徑主要是經由血液,例如輸血、生產過程、傷口接觸、醫療器械、刺針、親密行為及性行為等。帶原者本人不能捐血,個人之血液傷口應小心處理別接觸他人傷口黏膜,其親人應驗血並接受疫苗注射。
四、B型肝炎之分期
發現自己是帶原者時,應進一步評估目前肝臟之情況如何?此時可以作肝功能試驗及超音波檢查,以得知個人是處於健康帶原者、慢性肝炎、或肝硬化之狀態。同時也要評估病毒之情況如何?此時要測血清e抗原(HBeAg):e抗原陽性表示病毒活性大,傳染性高,肝炎發作及惡化的機會較大;e抗原陰性則表示低活性,低傳染性,維持穩定的機會大。如果肝功能試驗或超音波檢查異常,經評估有肝炎或肝硬化,則須找醫師密切追蹤檢查。如果評估為健康帶原者,也不可以輕心,因為此時健康,將來仍有發作肝炎或惡化成肝硬化之可能,因此一般建議每半年作一次追蹤檢查。
五、B型肝炎與肝癌
定期追蹤還有一個更重要的目的,就是要早期發現無症狀的小肝癌,以早期治療。肝癌是目前台灣男性最多的癌症(也是女性重要的癌症之一),一旦症狀發生通常已長大到無法治療的程度,唯有在沒有症狀前早期診斷才有治癒之可能。而發生肝癌之原因中最重要的就是B型肝炎。約百分之八十的肝癌患者是B型肝炎帶原者。B型肝炎帶原者發生肝癌的機會是非帶原者的兩百倍以上。唯有定期(至少六個月一次)檢查才能早期診斷治療。
B型肝炎之治療
健康帶原者是指肝功能正常者,不須治療,只須預防肝癌。慢性肝炎是指肝功能不正常者,如有HBeAg陽性,可以考慮注射干擾素治療,但干擾素治療副作用多,必須一、兩星期抽血並密切追蹤,最好在區域醫院以上之胃腸肝膽專科醫師指導下進行。最近上市之新藥Lamivudine效果不錯,但在使用時機上有些須注意處,仍須由專科醫師指示服用。另可口服利膽保肝藥物(通常一種即可)。但如e抗原(HBeAg)陰性,且肝功能不正常時,則須注意其他肝炎(如D型、C型),治療方式稍有不同。已經肝硬化之患者,則須評估剩餘肝功能屬第幾期(Child 氏分類A、B或C),各別治療。在定期追蹤時發現早期肝癌時,則可手術,或局部注射酒精,或血管栓塞治療,此亦須至大醫院評估。  
其他的保養方式包括:禁酒,因為酒精對肝臟有直接毒性,可能加速肝炎、肝硬化及肝癌之發生;勿濫服藥物,坊間廣告之治肝藥物秘方等多誇大不實,濫服藥除浪費錢外也增加肝臟之負擔;男性勿嫖妓,台灣妓女多D型肝炎,可能加重B型肝炎之惡化,同時也有得到性病甚至愛滋病之可能。至於其他飲食及運動,則無限制。
資料來源:慈濟醫院
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