Hepatitis B Virus DNA View trends Normal value: <20 IU/mL Value <20 <1.30 (NOTE) *Detected below the Limit of Quantitation (NOTE) *Detected below the Limit of Quantitation *Please note: This patient had HBV viral DNA that was detectable, but was below the Lower Limit of Quantitation of the test (<20 IU/mL). This happens on rare occasions, and is due to the presence of very low concentrations of virus that can not be precisely quantified. The results in these cases are reported as "<20 IU/mL, Detected". The clinical significance of HBV viral DNA detected at this low level is not yet known. These results should be correlated with other clinical or diagnostic findings and re-testing is available upon request for confirmation. 13年4月：
Hepatitis B Virus, Quantitative
Normal value: <20 IU/mL
Value
<20
Not Detected
07年五月：
HEP B VIRUS DNA IU/ML: 288 H REFERENCE RANGE: <100 IU/ml
HEP B VIRUS DNA COPIES/ML: 490 H REFERENCE RANGE: <160 IU/ml
Cirrhosis with hematomachromatosis --The benefit of iron depletion is well established in patietns with hereditary hemochromatosis --I am unfamiliar with the data supporting the use of phlebotomy in patients with iron overload associated with NASH or HepC. To the best of my knowledge there is anecdotal evidence to suppor the benefit of iron depletion to slow progression of liver disease. My own survey of the literature has not shown benefit of phlebotomy in patients with iron overload from NASH associated cirrhosis. HepC 应该是HepB的笔误。
“The surplus iron is then stored in the liver, pancreas, heart and other organs, which may lead to chronic liver disease or cirrhosis, diabetes and heart disease, respectively. In addition, excessive iron may impair hematopoiesis, although the mechanisms of this deleterious effect is not entirely known”
Where MRI really excels is showing certain diseases that a CT scan cannot detect. Some cancers, such as prostate cancer, uterine cancer, and certain liver cancers, are pretty much invisible or very hard to detect on a CT scan. Metastases to the bone and brain also show up better on an MRI. This imaging is also used for many purposes unrelated to cancer, including injuries to soft tissue or joints, and injury or disease of internal organs including the brain, heart, and digestive organs.
In conclusion, the diagnostic efficacy of MRI in the diagnosis of small HCC is better than that of CT scan screening. When CT screening is not sufficient to accurately determine liver tumor lesions, MRI can provide a more precise imaging basis. Univariate and Cox multivariate regression analysis showed that the background of hepatitis B liver cirrhosis, tumor staging, and portal vein embolization were independent risk factors for poor prognosis of HCC. Therefore, developing individualized comprehensive treatment programs based on different situations of patients, regularly reviewing and timely taking measures for complications may effectively prolong the survival of patients. Thus, within the affordable scope of medical expenses, MRI diagnosis can provide important basis and screening method for appropriate treatment of HCC.
To the best of my knowledge there is anecdotal evidence to suppor the benefit of iron depletion to slow progression of liver disease. My own survey of the literature has not shown benefit of phlebotomy in patients with iron overload from NASH associated cirrhosis
In addition to therapeutic blood removal, you may further reduce your risk of complications from hemochromatosis if you:
Avoid iron supplements and multivitamins containing iron. These can increase your iron levels even more. Avoid vitamin C supplements. Vitamin C increases absorption of iron. There's usually no need to restrict vitamin C in your diet, however. Avoid alcohol. Alcohol greatly increases the risk of liver damage in people with hemochromatosis. If you have hemochromatosis and you already have liver disease, avoid alcohol completely. Avoid eating raw fish and shellfish. People with hemochromatosis are at risk of infections, particularly those caused by certain bacteria in raw fish and shellfish.
新注册的文学城账号来看看这儿有啥信息。我的肝脏医生和血液病医生也许实在是太保守了，也许医术不高明，也许我的病例太复杂。
以前在国内时患过乙肝，但因为种种原因误诊了。等真正查出来时已经是慢性的了。
来美国后忙于读书，工作和家庭，没有严格随访。2007年时乙肝病毒还有复制，表面抗原还是阳性。常年血象偏低: 白细胞低于3000， 红细胞4百万左右，血小板10万左右。
做过多次CT和超声波，10年左右还提示肝脏可能有问题。后来的检测基本上没说有啥问题。五年前开始乙肝指标除了核心抗体阳性，表示以前得过乙肝外，其他指标都是阴性。连DNA复制都检测不到了。所以我也放松了警惕。
21年疫情期间在家上班时间灵活就找血液病医生查为啥血象常年偏低，连骨髓穿刺活检都做了也查不出原因。到了去年夏天，考虑到我的乙肝病史，我的血液病医生让我找消化/肝胆医生看看。
于是我找到肝病医生，医生说我看起来不像有肝病的样子。但为了保险起见，他让我去做了 MRI with elastography。MRI结果显示：
1.Mildly nodular hepatic surface contour. Correlate with clinical risk factors for cirrhosis.
2.Features of mild diffuse iron overload in the liver.
这是以前 CT 和超声波从没揭示的问题。
接下来的肝脏活检有了更精确的结果：
肝硬化外加中到重度肝铁沉积。
肝脏医生让我每半年随访做超声和AFP，至于肝铁沉积他让血液医生考虑做phlebotomy（放血）。血液医生说phlebotomy不适合cirrhosis，只适合遗传性血色病。而iron chelation（铁螯合治疗）可能有副作用，也不敢轻易用。
所以我现在似乎卡住了，没啥可做的了。
不知道版内有谁知道这方面的专家能提供更好的建议和治疗，美国或国内都可以。
提前谢谢了。
不吃玉米，油炸/甜食：
保肝食物Foods for liver
No sugar，不吃甜的东西
朝鲜蓟 橄榄油 畺黄—暂不用 沙文鱼 核桃 牛油果---多油，一天半个即可， 甜菜根 绿花菜 大蒜 柑橘类—也要注意吃多了，胃不好By Dr. Berg:
萝卜—Redish羽衣甘蓝--kale
以前HBVDNA数值高吗？有吃过抗乙肝病毒药？如果从来没吃抗乙肝病毒HBVDNA检测不到.通常1.可能是自愈了-这个概率小. 2.肝病变引起自身抗体反击显示乙肝转阴,好多人误认是乙肝好转了.所以别忘定期复查,以便早期发现恶化.
https://www.mayoclinic.org/diseases-conditions/hemochromatosis/diagnosis-treatment/drc-20351448
定期放血看上去是最方便有效的办法,换个血液医生探讨一下可能性,比如先少放点血试试？
分别在18年11月和21年六月：
Hepatitis B Virus, Quantitative
[IU]/mL
Value
<10
HBV DNA Not Detected
17年12月（我理解是检测到了，但小于10）：
HBV AS IU/mL
IU/mL
Value
<10
HBV DNA detected
15年12月也检测到了，但数值低于下限。检测报告有个特别的注释：
Hepatitis B Virus DNA View trends Normal value: <20 IU/mL Value <20 <1.30 (NOTE) *Detected below the Limit of Quantitation (NOTE) *Detected below the Limit of Quantitation *Please note: This patient had HBV viral DNA that was detectable, but was below the Lower Limit of Quantitation of the test (<20 IU/mL). This happens on rare occasions, and is due to the presence of very low concentrations of virus that can not be precisely quantified. The results in these cases are reported as "<20 IU/mL, Detected". The clinical significance of HBV viral DNA detected at this low level is not yet known. These results should be correlated with other clinical or diagnostic findings and re-testing is available upon request for confirmation. 13年4月：Hepatitis B Virus, Quantitative
Normal value: <20 IU/mL
Value
<20
Not Detected
07年五月：
HEP B VIRUS DNA IU/ML: 288 H REFERENCE RANGE: <100 IU/ml
HEP B VIRUS DNA COPIES/ML: 490 H REFERENCE RANGE: <160 IU/ml
降肝铁才能阻止肝硬化的发展，过多铁沉积也会影响造血也会造成血象偏低不是吗？重点：铁沉积。
降肝铁最直接有效办法就是放血，若医生担心血象偏低，先少放些血把其可控范围，看效果如何？
医学举措在于孰轻孰重，轻重缓急，权衡利弊。要不换个医生再讨论下？
周一刚见过我的血液病医生，她的诊后Note是这样写的：
Cirrhosis with hematomachromatosis --The benefit of iron depletion is well established in patietns with hereditary hemochromatosis --I am unfamiliar with the data supporting the use of phlebotomy in patients with iron overload associated with NASH or HepC. To the best of my knowledge there is anecdotal evidence to suppor the benefit of iron depletion to slow progression of liver disease. My own survey of the literature has not shown benefit of phlebotomy in patients with iron overload from NASH associated cirrhosis. HepC 应该是HepB的笔误。我觉得你前一个回复里说的“过多铁沉积也会影响造血也会造成血象偏低“，我的血液医生就没提到。也许我该另找个血液病医生听听第二意见。
另外，请问你这句话有文献出处吗？
“The surplus iron is then stored in the liver, pancreas, heart and other organs, which may lead to chronic liver disease or cirrhosis, diabetes and heart disease, respectively. In addition, excessive iron may impair hematopoiesis, although the mechanisms of this deleterious effect is not entirely known”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468739/
我的肝胆专科医生曾说乙肝血检不出病毒，只表示血液里很少，但肝胀里病毒多的是；我查看里一些文献，也说慢性乙肝好像要坚持吃药，你也可问问哥大的Robert Brown 医生。
以前还知道有几个遗传性肝铜都走了,这么多年了还记得那位母亲跟我们讲2个未满18岁孩子是肝铜时的无助样子.
<10是没检测到.没检测到不等于肝就没有往坏方向走.如果乙肝转阴往好的方向走,不应该发生肝铁,肝硬化情况.
乙肝携带者有小部分人在10-30年后会转肝癌.知道2个乙肝携带者得肝癌后乙肝检测都是阴性且有抗体产生.一个发现晚已侵入血管,那年代也没抗病毒药,走了.另一个发现早手术10多年还活着.
https://www.sohu.com/a/431944477_99911912
医生建议你每半年B超加血检(AFP),每6个月一定要去做.另最好要求肝医生每年给你做一次核磁加强.核磁灵敏度高可检测0.5cm肿瘤,也可看肝门静脉情况,同时肝脾胆都一起看了.早检早发现早治疗是提高生存唯一办法.
所以我现在有点怀疑是不是乙肝引起的肝硬化。也许是铁沉积引起的肝硬化。
不能隔一阵就做肝穿刺吧？
血中铁过载在体内沉积和损伤，首当其冲的就是肝脏，但为何铁过载还是得进一步查原因，比如某些疾病，或饮酒和饮食等因素相关。
比DNA复制检测到要好很多， 但不能表明治愈。 你可以查一下Hepatitis B Surface Antibodies (HBsAb)。 大于10mIL/mL表明有免愈力即全愈。
只有99
Normal range: 50 - 170 ug/dL
但是Ferritin 偏高达413
Normal range: 18 - 464 ng/mL
其他都阴性。
还在复制。只有产生》10mIL/mL（最好》100mIl/mL) 的Hepatitis B Surface Antibodies (HBsAb)才表明有免愈力即全愈。
另外，血中铁多不一定是肝不好。我也是铁多医生建议献血。通过跑步（3-5mile/day for 2 year) ,血铁完全正常。心肺功能弱，会使身体通过增加血红蛋白提高携氧能力。
我的是这样的： HEP B CORE ANTIBODY, TOTAL
Reactive
Hepatitis B Core IgM
Nonreactive
我其他指标都阴性。
https://baike.baidu.com/item/%E4%B9%99%E8%82%9D%E6%A0%B8%E5%BF%83%E6%8A%97%E4%BD%93/4862758
身体感觉不好，容易累。这几年掉了有三十磅。睡眠也不好。
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232559/
for unknown reasons naturally. 乙肝核心抗体，英文缩写HBcAb，阳性（+）表示目前正感染乙肝病毒或过去曾感染过乙肝病毒。只有乙肝核心抗体表示既往感染过乙肝，目前已恢复但体内无抗体，或病毒变异，无法检测到乙肝表面抗原，需要就医进一步评估。
阳性（+）表示：曾经感染过乙肝但机体已将病毒清除从而产生了抗体，或曾接种过乙肝疫苗而产生了抗体。
我在国内患甲、乙型肝炎。那时西医没药吃，吃中药吃了一两年也不见效。后我只好去打拳。我坚持打了两年太空拳，什么都毛病都没了。
其他都阴性，包括：
Hepatitis B Surface Antigen
Hepatitis B Surface Antibody
Hepatitis B core IgM
Hepatitis Be Antigen
Hepatitis Be Antibody网上好像不是这么说的。
你的肝胆医生是Robert Brown吗？我这个复杂病例他能看吗？哎，现在不知到找啥医生好了。
找到铁沉积的原因要么不可能，要么要费很长时间。
如果能把肝铁去除，即使原因还在，也要很长时间让铁重新沉积。况且如果我持续去铁，铁也许不再能沉积现在这么多。
现在缺好医院/好医生，我现在的血液病医生看来是不想给我做放血疗法了，说对肝硬化不安全。去铁氨又说有副作用。
昨天AFP 结果出来正常（2.4)。马上要约5月份的B超，正好和去年11月的MRE 隔半年。
然后可以知道是否有肝硬化。结果意外发现铁沉积。MR elastography not technically feasible due to iron overload.
MRI简单讲就是测体内水分子变化.人体含水,血液里含水.肝癌的早期检测MRI优于CT.这些年你的医生开CT却不做MRI蛮奇怪.你应该找教学医院的医生看,他们一边做研究一边看病可能会对你的情况感兴趣.
你回贴说血铁含量正常.但Ferritin 偏高413,当地的检测的Normal range是18-464 ng/ml.那也在正常范围.
2个都在正常范围血液医生也不回启动放血疗法的,需要自己想办法减低.
一般HBVDNA10的5次方开始吃抗乙肝病毒药,大概率美国医生不会开乙肝抗病毒药给你吃.
乙肝抗病毒的药吃了就得吃一辈子,HBVDNA是用PCR方法检测,小于10不等于病毒真的没有.擅自停肝抗病毒万一反跳很容易在短期内引起肝衰竭.
https://m.thepaper.cn/newsDetail_forward_17108630
CT Scan vs. MRI: What’s the Difference? And How Do Doctors Choose Which Imaging Method to Use?
https://www.mskcc.org/news/ct-vs-mri-what-s-difference-and-how-do-doctors-choose-which-imaging-method-use#:~:text=Some%20cancers%2C%20such%20as%20prostate,up%20better%20on%20an%20MRI.
What are the advantages of MRI?
Where MRI really excels is showing certain diseases that a CT scan cannot detect. Some cancers, such as prostate cancer, uterine cancer, and certain liver cancers, are pretty much invisible or very hard to detect on a CT scan. Metastases to the bone and brain also show up better on an MRI. This imaging is also used for many purposes unrelated to cancer, including injuries to soft tissue or joints, and injury or disease of internal organs including the brain, heart, and digestive organs.
CT与MRI影像对肝细胞癌诊断价值的比较及预后因素分析
https://www.spandidos-publications.com/10.3892/ol.2018.9690#
In conclusion, the diagnostic efficacy of MRI in the diagnosis of small HCC is better than that of CT scan screening. When CT screening is not sufficient to accurately determine liver tumor lesions, MRI can provide a more precise imaging basis. Univariate and Cox multivariate regression analysis showed that the background of hepatitis B liver cirrhosis, tumor staging, and portal vein embolization were independent risk factors for poor prognosis of HCC. Therefore, developing individualized comprehensive treatment programs based on different situations of patients, regularly reviewing and timely taking measures for complications may effectively prolong the survival of patients. Thus, within the affordable scope of medical expenses, MRI diagnosis can provide important basis and screening method for appropriate treatment of HCC.
铁过载是肝病中常见的一种情况，治疗方法包括药物治疗、腹腔灌注和红细胞回收等方式。药物治疗主要是通过口服或静脉注射的方式，使用铁螯合剂将多余的铁离子结合，排出体外。腹腔灌注是一种直接将药物注入腹腔，通过肝脏清除多余的铁离子。红细胞回收则是通过回收自身的红细胞，避免铁离子进一步积累。
但病理报告提示： Congestive hepatopathy, mild
所以昨天又做了心脏检查，结果：
Left Atrium: Left atrium is dilated
Right Atrium: Right atrium is dilated.
Tricuspid Valve: Mild transvalvular regurgitation.
从去年开始问题查出一堆，却没任何治疗。感觉不知做啥好。
自己怎么降铁呢？饮食已经很注意了。
你们那儿有啥好医生吗？
我的血液病医生的报告是这样写的：
To the best of my knowledge there is anecdotal evidence to suppor the benefit of iron depletion to slow progression of liver disease. My own survey of the literature has not shown benefit of phlebotomy in patients with iron overload from NASH associated cirrhosis
我觉得就是啥也不给我做了。
不知如何是好。
DR.Robert Brown,他是肝内科也搞科研看肝硬化,你找他去看一下.
https://weillcornell.org/rsbrown
你要自学一下MRI，CT，B超等在肝上检测的区别.
https://www.mayoclinic.org/diseases-conditions/hemochromatosis/diagnosis-treatment/drc-20351448
Lifestyle and home remediesIn addition to therapeutic blood removal, you may further reduce your risk of complications from hemochromatosis if you:
Avoid iron supplements and multivitamins containing iron. These can increase your iron levels even more. Avoid vitamin C supplements. Vitamin C increases absorption of iron. There's usually no need to restrict vitamin C in your diet, however. Avoid alcohol. Alcohol greatly increases the risk of liver damage in people with hemochromatosis. If you have hemochromatosis and you already have liver disease, avoid alcohol completely. Avoid eating raw fish and shellfish. People with hemochromatosis are at risk of infections, particularly those caused by certain bacteria in raw fish and shellfish.你的AFP不高.如果MRI做出来肝胆脾,肝门静脉走向都好.你就可以放心了6个月了.
我和我肝病医生提到半年检测用MRI而不是Ultra Sound。他说做MRI保险公司可能有问题。我也没仔细看保险公司的条文。
我下周就约这个DR.Robert Brown医生。
你提到的生活中注意事项我都做到了。
我也曾经想去Mayo Clinics 看，但没有人推荐具体的哪个专家，所以也很犹豫。
查不出病毒是血液里，而肝胀里的病毒多的是--医生说的；他要求继续吃药
“My own survey of the literature”， 这不就是说没经验所以只能查文献吗？
刚才给保险公司发了封信问了下。
我的肝病医生是不是也有问题啊？为啥让我做UltraSound而不是MRI呢？
另外，你说的MRI+加强，强在哪里？
其次任务才是降低肝铁.你的铁血和铁蛋白都在正常范围(按你当地正常范围看).何况降低也不是立竿见影的事
MRI+加强(就是静脉打造影剂)是目前检测早期肝癌的最好手段.(当然大概率你目前无早期肝癌）
https://www.xyyfy.com/health/241.html
https://m.medsci.cn/article/show_article.do?id=8f8de63816f9
早期肝硬化了,保险公司有啥理由不让你做MRI？肝B超影像没MRI清晰,你从没有做过MRI加强,做一下给自己留个病史记录,方便以后比较.做完MRI别忘要一张CD的copy,这样方便带去给纽约医生看.
做血检时有没有同时做血脂检测和血糖检测？你目前的肝功能血检和MRE结果看,可能情况没你想的那么糟糕,心理负担不要太重.
只有核心抗体阳性，不是说只代表曾经得过乙肝吗？现在病毒也不复制了。https://bbs.wenxuecity.com/health/1094382.html
https://www.hepb.org/prevention-and-diagnosis/diagnosis/understanding-your-test-results/
还是我理解有误？
https://www.sciencedirect.com/topics/medicine-and-dentistry/hepatitis-b-e-antibody
这是啥原因？水平问题吗？
如果血液里病毒DNA检测不到，医生会以什么标准开抗病毒的药呢？
https://www.sciencedirect.com/topics/medicine-and-dentistry/hepatitis-b-e-antibody
https://microbiology.testcatalog.org/show/HBC
https://www.cdc.gov/hepatitis/hbv/interpretationOfHepBSerologicResults.htm
星期五做的。没有不舒服的感觉。好像是500毫升吧。就是一个小袋子。