原发性胆汁性胆管炎中西医研究进展

张玮

doi:10.3969/j.issn.1001-5256.2018.04.004

原发性胆汁性胆管炎中西医研究进展

DOI: 10.3969/j.issn.1001-5256.2018.04.004

张玮

上海中医药大学附属龙华医院感染科

详细信息

中图分类号: R575.7
计量
- 文章访问数: 2709
- HTML全文浏览量: 23
- PDF下载量: 471
- 被引次数: 0
出版历程
- 出版日期: 2018-04-20

Research advances in integrated traditional Chinese and Western medicine therapy for primary biliary cholangitis

Zhang Wei

Department of Infectious Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

摘要

摘要: 回顾了原发性胆汁性胆管炎(PBC)的中西医病因病机、中西医治疗的方法和效果,以及笔者在PBC研究中的经验心得。发现PBC发生的风险与环境、遗传、自身免疫、胆管上皮细胞损伤等因素密切相关。中医病因病机分析表明与"虚""瘀""郁""湿""毒"有关,病因病机关键词是湿热、瘀血、肝郁、气滞、脾气虚、肝气虚、肝肾阴虚,中医证型以湿热蕴结证、肝郁脾虚证、瘀血阻络证、肝肾阴虚证多见。熊去氧胆酸是治疗PBC的首选药物,但仍有多达40%的患者应答不良,中医中药的联合使用对于改善PBC患者生存质量,延长生存期,提高疗效具有不可替代的作用。
- 肝硬化,胆汁性 /
- 中西医结合 /
- 中医病因和病机
Abstract: This article reviews the etiology and pathogenesis of primary biliary cholangitis (PBC) based on traditional Chinese and Western medicine, integrated traditional Chinese and Western medicine therapies and their clinical effects, and the author's experience in PBC research.The risk of PBC is closely associated with environmental factors, genetic factors, autoimmunity, and biliary epithelial cell injury.The analysis of etiology based on traditional Chinese medicine (TCM) showed that PBC is associated with " deficiency", " stasis", " depression", " dampness", and " toxin", and the key words of etiology and pathogenesis are damp-heat, blood stasis, stagnation of liver qi, qi stagnation, spleen-qi deficiency, liver-qi deficiency, and liver-kidney yin deficiency.Common TCM syndrome types include damp-heat accumulation, stagnation of liver qi and spleen deficiency, blood stasis obstructing the collaterals, and liver-kidney yin deficiency.Ursodeoxycholic acid is the first-line drug for the treatment of PBC, but 40% of patients have poor response.A combination of traditional Chinese medicine and Western medicine plays an important role in improving quality of life, prolonging survival time, and improving the clinical outcome of patients with PBC.
- liver cirrhosis, biliary /
- integrated TCM WM /
- etiol factor & pathog TCM

HTML全文

参考文献(45)

[1]HIRSCHFIELD GM, BEUERS U, CORPECHOT C, et al.EASL clinical practice guidelines:the diagnosis and management of patients with primary biliary cholangitis[J].J Hepatol, 2017, 67 (1) :145-172.

[2]GRIFFITHS L, DYSON JK, JONES DE.The new epidemiology of primary biliary cirrhosis[J].Semin Liver Dis, 2014, 34 (3) :318-328.

[3]CHEN BH, WANG QQ, ZHANG W, et al.Screening of anti-mitochondrial antibody subtype M2 in residents at least 18 years of age in an urban district of Shanghai, China[J].Eur Rev Med Pharmacol Sci, 2016, 20 (10) :2052-2056.

[4]ZHANG W, WANG L, WANG Y, et al.Measurement of anti-mitochondria M2 antibodies in 1039 patients with cryptogenic hepatitis[J].J Pract Hepatol, 2012, 6 (15) :238-240. (in Chinese) 张玮, 王磊, 王奕, 等.1039例隐源性肝炎患者AMA-M2抗体的筛查[J].实用肝脏病杂志, 2012, 6 (15) :238-240.

[5]ALA A, STANCA CM, BU-GHANIM M, et al.Increased prevalence of primary biliary cirrhosis near Superfund toxic waste sites[J].Hepatology, 2006, 43 (3) :525-531.

[6]WANG YH, YANG W, YANG JB, et al.Systems biologic analysis of T regulatory cells genetic pathways in murine primary biliary cirrhosis[J].J Autoimmun, 2015, 59:26-37.

[7]TANAKA A, LEUNG PS, GERSHWIN ME.Environmental basis of primary biliary cholangitis.[J].Exp Biol Med (Maywood) , 2018, 243 (2) :184-89.

[8]LLEO A, MARZORATI S, ANAYA JM, et al.Primary biliary cholangitis:a comprehensive overview[J].Hepatol Int, 2017, 11 (6) :485-499.

[9]ABE M, HIASA Y, ONJI M.T helper 17 cells in autoimmune liver diseases[J].Clin Dev Immunol, 2013, 9 (60) :70-73.

[10]PENG A, KE P, ZHAO R, et al.Elevated circulating CD14 (low) CD16 (+) monocyte subset in primary biliary cirrhosis correlates with liver injury and promotes Th1 polarization.[J].Clin Exp Med, 2015, 16 (4) :1-11.

[11]TSUNEYAMA K, BABA H, MORIMOTO Y, et al.Primary Biliary Cholangitis:Its Pathological Characteristics and Immunopathological Mechanisms[J].J Med Invest, 2017, 64 (12) :7-13.

[12]WEBB GJ, HIRSCHFIELD GM.Primary biliary cholangitis in2016:high-definition PBC:biology, models and therapeutic advances[J].Nat Rev Gastroenterol Hepatol, 2017, 14 (2) :76-80.

[13]WANG L, LI QM, DU HH, et al.Correlation study of estrogen receptor with peripheral blood cytokines and serum markers in primary biliary cirrhosis patients[J].Chin J Hepatol, 2012, 20 (5) :336-339. (in Chinese) 王磊, 李青梅, 杜慧慧, 等.原发性胆汁性肝硬化患者肝脏雌激素受体与外周血细胞因子及自身抗体的相关性研究[J].中华肝脏病杂志, 2012, 20 (5) :336-339.

[14]CAREY EJ, ALI AH, LINDOR KD.Primary biliary cirrhosis[J].The Lancet, 2015, 386 (10003) :1565-1575.

[15] HIRSCHFIELD GM, MASON A, LUKETIC V, et al.Efficacy of obeticholic acid in patients with primary biliary cirrhosis and inadequate response to ursodeoxycholic acid[J].Gastroenterology, 2015, 148 (4) :751-761.

[16]HOSONUMA K, SATO K, YAMAZAKI Y, et al.A prospective randomized controlled study of long-term combination therapy using ursodeoxycholic acid and bezafibrate in patients with primary biliary cirrhosis and dyslipidemia[J].Am J Gastroenterol, 2015, 110 (3) :423-431.

[17]CORPECHOT C, CHAZOUILLERES O, POUPON R.Early primary biliary cirrhosis:biochemical response to treatment and prediction of long-term outcome[J].J Hepatol, 2011, 55 (6) :1361-1367.

[18]HIRSCHFIELD GM, MASON A, LUKETIC V, et al.Efficacy of obeticholic acid in patients with primary biliary cirrhosis and inadequate response to ursodeoxycholic acid[J].Gastroenterology, 2015, 148 (4) :751-761.

[19]HEMPFLING W, DILGER K, BEUERS U.Systematic review:ursodeoxycholic acid——adverse effects and drug interactions[J].Aliment Pharmacol Ther, 2003, 18 (10) :963-972.

[20]YANG L, LI Y, YUAN XX, et al.Effect of Yangyin Tongluo Decoction on primary biliary cholangitis and its influence on cytokines[J].Chin J Integr Tradit West Med Dig, 2017, 25 (9) :646-650, 655. (in Chinese) 杨磊, 李莹, 袁星星, 等.养阴通络汤对原发性胆汁性胆管炎临床疗效及对细胞因子的影响[J].中国中西医结合消化杂志, 2017, 25 (9) :646-650, 655.

[21]JING HY, LI DG, WANG YG, et al.Clinical efficacy of Huazhuojieduruanganfang combined with ursodeoxycholic acid in treating 60cases with primary biliary cirrhosis[J].Med Res Education, 2013, 30 (1) :57-61. (in Chinese) 靳红燕, 李佃贵, 王彦刚, 等.化浊解毒软肝方联合熊去氧胆酸治疗原发性胆汁性肝硬化[J].医学研究与教育, 2013, 30 (1) :57-61.

[22]ZHAO L, JIN S.Professor Jinshi's experience in the treatment of primary biliary cirrhosis[J].J Sichuan Tradit Chin Med, 2013, 31 (1) :8-9. (in Chinese) 赵琳, 金实.金实教授治疗原发性胆汁性肝硬化的经验[J].四川中医, 2013, 31 (1) :8-9.

[23]FAN XL, ZHU JF, WANG LT.Professor Wang Lingtai’s experience in the treatment of primary biliary cirrhosis (cholangitis) [J].Shanghai J Tradit Chin Med, 2015, 50 (8) :1-3. (in Chinese) 范兴良, 祝峻峰, 王灵台.王灵台论治原发性胆汁性肝硬化 (胆管炎) 经验[J].上海中医药杂志, 2015, 50 (8) :1-3.

[24]DU HB, JIANG YY, XUE YC, et al.Survey on chinese medicine syndrome of 96 patients with primary biliary cirrhosis[J].J Tradit Chin Med, 2017, 4 (58) :575-579. (in Chinese) 杜宏波, 江宇泳, 薛亚春, 等.96例原发性胆汁性肝硬化患者中医证候调查[J].中医杂志, 2017, 4 (58) :575-579.

[25]LU DQ, SHAO M.Distinction and treatment principle of traditional Chinese medicine on primary biliary cirrhosis[J].J Liaoning Univ Tradit Chin Med, 2012, 14 (1) :185-187. (in Chinese) 卢殿强, 邵铭.原发性胆汁性肝硬化中医辨治思路[J].辽宁中医药大学学报, 2012, 14 (1) :185-187.

[26]LIU MT, XUE BY.Analysis of the effect of primary biliary cirrhosis with blood stasis and cholage[J].Heilongjiang J Tradit Chin Med, 2012, 2:4-6. (in Chinese) 刘熳天, 薛博瑜.原发性胆汁性肝硬化化瘀利胆法作用探析[J].黑龙江中医药, 2012, 2:4-6.

[27]SU CZ, ZHONG R.The effect on cholestasis indicators of Huazhuo Jiedu Tiaogan decoction to patients with primary biliary cirrhosis[J].Clin J Chin Med, 2011, 3 (5) :58-60. (in Chinese) 苏春芝, 钟锐.化浊解毒调肝方对原发性胆汁性肝硬化患者淤胆指标的影响[J].中医临床研究, 2011, 3 (5) :58-60.

[28]SHI WL, ZHANG XF.Clinical observation on Xixian Erhuang decoction combined with ursodeoxycholic acid for 40 cases of primary biliary cirrhosis[J].J Tradit Chin Med, 2014, 55 (19) :1660-1663. (in Chinese) 史文丽, 张晓锋.豨莶二黄汤联合熊去氧胆酸治疗原发性胆汁性肝硬化患者40例临床观察[J].中医杂志, 2014, 55 (19) :1660-1663.

[29]LYU XF.Clinical study of liver blood stasis therapy combined with ursodeoxycholic acid bear primary biliary cirrhosis[J].Chin J Integr Tradit West Med Liver Dis, 2015, 25 (4) :244-245. (in Chinese) 吕晓峰.养肝化瘀方联合熊去氧胆酸治疗原发性胆汁性肝硬化的临床研究[J].中西医结合肝病杂志, 2015, 25 (4) :244-245.

[30]YANG JL, ZHANG MZ, ZHANG B.The analysis of TCM syndrome and clinical features for 74 cases patients with primary biliary cirrhosis[J].Chin J Integr Tradit West Med Liver Dis, 2015, 25 (4) :209-211. (in Chinese) 杨将领, 张美珠, 张斌.74例原发性胆汁性肝硬化患者中医证型及临床特征分析[J].中西医结合肝病杂志, 2015, 25 (4) :209-211.

[31]DONG ZH, XU HY, QI HB.Study on the law of syndrome differentiation of primary biliary cirrhosis by traditional Chinese medicine:a 74-case report[J].J Med Res, 2011, 40 (5) :83-85. (in Chinese) 董振华, 徐慧媛, 齐贺彬.原发性胆汁性肝硬化74例中医辨证规律的研究[J].医学研究杂志, 2011, 40 (5) :83-85.

[32]JIANG J, HE M.Clinical features of primary biliary cirrhosis and treatment of it by integrated traditional Chinese and western medicine[J].J Chin Integr Med, 2003, 1 (2) :99-102. (in Chinese) 蒋健, 何淼.原发性胆汁性肝硬化的临床特征及中西医结合治疗探讨[J].中西医结合学报, 2003, 1 (2) :99-102.

[33]DU WX, YE Q, LI JK, et al.The effect of TCM syndrome differentiation on primary biliary cirrhosis on regulatory T cells[J].Mod J Integr Tradit Chin West Med, 2017, 26 (33) :3689-3691. (in Chinese) 杜卫星, 叶青, 李金科, 等.中医辨证论治原发性胆汁性肝硬化对于调节性T细胞的影响[J].现代中西医结合杂志, 2017, 26 (33) :3689-3691.

[34]WU SC.Professor Chang Zhanjie's experience of combining traditional Chinese and Western medicine in the treatment of primary biliary cirrhosis[J].Mod Tradit Chin Med, 2011, 31 (5) :9-11. (in Chinese) 吴绍从.常占杰教授中西医结合治疗原发性胆汁性肝硬化的经验[J].现代中医药, 2011, 31 (5) :9-11.

[35]XUAN HP, JIANG XD.Clinical research of strengthening spleen and removing turbid combined with ursodeoxycholic acid to treat primary biliary cirrhosis[J].Chin Arch Tradit Chin Med, 2013, 31 (3) :703-704. (in Chinese) 宣红萍, 蒋雪定.健脾祛浊方联合熊去氧胆酸治疗原发性胆汁性肝硬化的临床研究[J].中华中医药学刊, 2013, 31 (3) :703-704.

[36]ZHANG XY.The clinical study of ursodeoxycholic acid and Tongdan Decoction in the treatment of primary biliary cirrhosis[J].Heilongjiang Med Pharm, 2016, 39 (3) :94-95. (in Chinese) 张晓艳.熊去氧胆酸联合通胆汤治疗原发性胆汁性肝硬化的临床研究[J].黑龙江医药科学, 2016, 39 (3) :94-95.

[37]WU Y, YAO DK, ZHU L, et al.Clinical observation on the safety and efficacy of ursodeoxycholic acid and Fuzheng Huayu capsule in the treatment of primary biliary cirrhosis[J].Chin J Integr Trad West Med, 2012, 32 (11) :1477-1482. (in Chinese) 吴颖, 姚定康, 朱樑, 等.熊去氧胆酸联合扶正化瘀胶囊治疗原发性胆汁性肝硬化临床观察[J].中国中西医结合杂志, 2012, 32 (11) :1477-1482.

[38]LI ZQ, WU D.Clinical observation of anoxy chemical fiber pill combined with ursodeoxycholic acid in the treatment of primary biliary cirrhosis[J].Chin J Integr Tradit West Med Liver Dis, 2013, 23 (5) :277-278. (in Chinese) 李之清, 吴东.安络化纤丸联合熊去氧胆酸治疗原发性胆汁性肝硬化临床观察[J].中西医结合肝病杂志, 2013, 23 (5) :277-278.

[39]WANG HL, CUI WF, YANG XP.Clinical observation of meteorism tablets combined with ursodeoxycholic acid in the treatment of primary biliary cirrhosis[J].Chin J Inf Tradit Chin Med, 2013, 20 (2) :77-78. (in Chinese) 王会丽, 崔伟锋, 杨小平.臌胀片联合熊去氧胆酸治疗原发性胆汁性肝硬化临床观察[J].中国中医药信息杂志, 2013, 20 (2) :77-78.

[40]DU HH, LI QM, WANG L, et al.Primary biliary cirrhosis and hepatic stasis syndrome[J].Chin J Integr Tradit West Med Liver Dis, 2012, 22 (3) :136-139, 157. (in Chinese) 杜慧慧, 李青梅, 王磊, 等.原发性胆汁性肝硬化与肝血瘀证[J].中西医结合肝病杂志, 2012, 22 (3) :136-139, 157.

[41]ZHANG W.Application of supplementing deficiency and removing stasis in chronic liver disease[J].Chin J Integr Tradit West Med Liver Dis, 2014, 24 (6) :321-323. (in Chinese) 张玮.补虚化瘀法在慢性肝病中的运用[J].中西医结合肝病杂志, 2014, 24 (6) :321-323.

[42]ZHANG LH, ZHANG W.Pathogenesis of traditional Chinese Medicine and Western Medicine of Primary biliary cirrhosis[J].Chin J Integr Tradit West Med Liver Dis, 2014, 24 (2) :111-113. (in Chinese) 张丽慧, 张玮.原发性胆汁性肝硬化中西医病机探讨[J].中西医结合肝病杂志, 2014, 24 (2) :111-113.

[43]ZHANG W, JI G, WANG YQ, et al.Clinical observation of“TianmianⅠDecoction”in treating autoimmune hepatitis[J].Shanghai J Tradit Chin Med, 2002, 36 (10) :13-15. (in Chinese) 张玮, 季光, 王育群, 等.调免Ⅰ号治疗自身免疫性肝炎的临床观察[J].上海中医药杂志, 2002, 36 (10) :13-15.

[44]ZHANG W, LIU YB, WANG LQ, et al.Clinico bservation of 45cases of autoimmune hepatitis treated by TiaomianⅠcombining ursodeoxycholic acid[J].Chin J Integr Tradit West Med Liver Dis, 2009, 19 (2) :78-80. (in Chinese) 张玮, 刘一博, 王俐琼, 等.调免Ⅰ号联合熊去氧胆酸胶囊治疗自身免疫性肝炎的临床观察[J].中西医结合肝病杂志, 2009, 19 (2) :78-80.

[45]WANG L, DU H, LIU Y, et al.Chinese medicine bu xu hua yu recipe for the regulation of treg/th17 ratio imbalance in autoimmune hepatitis[J].Evid Based Complement Alternat Med, 2015, 2015 (3) :1-14.

施引文献

资源附件(0)

访问统计