慢性乙型肝炎相关肝纤维化中医诊疗进展与思考

萧焕明; 施梅姐; 谢玉宝; 池晓玲

doi:10.3969/j.issn.1001-5256.2023.02.002

慢性乙型肝炎相关肝纤维化中医诊疗进展与思考

DOI: 10.3969/j.issn.1001-5256.2023.02.002

萧焕明^{1, 2},
施梅姐^{1, 2},
谢玉宝^{1, 2},
池晓玲^{1, 2, , ,}

1.
广东省中医院肝病科，广州 510120
2.
广州中医药大学第二附属医院肝病科，广州 510120

基金项目:

国家“十三五”重大传染病专项课题 (2018ZX10725506-003);

国家“十三五”重大传染病专项课题 (2018ZX10725505-004);

广东省中医药局面上项目 (20225022);

广东省中医院院内专项 (YN10101903);

广东省中医院院内专项 (YN2016XP03);

广东省中医院院内专项 (YN2022DB04);

池晓玲国家中医药管理局名老中医药专家传承工作室项目 (Guozhong Pharmaceutical Human Education Letter [2022] No. 75);

第五批全国中医临床优秀人才研修项目 (Guozhong Pharmaceutical Human Education Letter [2022] No. 1)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：萧焕明撰写论文；施梅姐、谢玉宝协助查阅文献；池晓玲提供撰写思路、修改写作框架及审稿。

详细信息

通信作者:
池晓玲，chixiaolingqh@163.com (ORCID：0000-0003-3193-1943)

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出版历程
- 收稿日期: 2022-12-18
- 录用日期: 2023-01-19
- 出版日期: 2023-02-20

Advances and thoughts in traditional Chinese medicine diagnosis and treatment of chronic hepatitis B-related liver fibrosis

Huanming XIAO^{1, 2},
Meijie SHI^{1, 2},
Yubao XIE^{1, 2},
Xiaoling CHI^{1, 2
, ,
,}

1.
Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
2.
The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China

Research funding:

The Thirteenth Five-Year Plan for Major and Special Programs of the National Science and Technologyof China (2018ZX10725506-003);

The Thirteenth Five-Year Plan for Major and Special Programs of the National Science and Technologyof China (2018ZX10725505-004);

The General Project of Guangdong Provincial Bureau of Traditional Chinese Medicine (20225022);

The Science and Technology research project of Traditional Chinese Medicine of Guangdong Provincial Hospital of Chinese Medicine (YN10101903);

The Science and Technology research project of Traditional Chinese Medicine of Guangdong Provincial Hospital of Chinese Medicine (YN2016XP03);

The Science and Technology research project of Traditional Chinese Medicine of Guangdong Provincial Hospital of Chinese Medicine (YN2022DB04);

Chi Xiaoling of Project of Inheritance Workshop of Famous Old Chinese Medicine Experts of State Administration of Traditional Chinese Medicine (Guozhong Pharmaceutical Human Education Letter [2022] No. 75);

The Fifth Batch of National Research and Training Programs for Clinical Talents of traditional Chinese Medicine (Guozhong Pharmaceutical Human Education Letter [2022] No. 1)

More Information

Corresponding author: CHI Xiaoling, chixiaolingqh@163.com (ORCID: 0000-0003-3193-1943)

摘要

摘要: 肝纤维化是慢性乙型肝炎发展至肝硬化、肝癌的必经中间过程。近年来，中医药防治慢性乙型肝炎肝纤维化的研究取得突破性进展。以提高临床疗效为目的，多学科联合开展产学研研究，阐释慢性乙型肝炎肝纤维化中医证候生物学基础、建立与研发中医特色无创诊断模型，优化中医/中西医结合治疗方案并阐释中医治疗的科学内涵能够帮助中医药防治肝纤维化走向国际。
- 乙型肝炎, 慢性 /
- 肝纤维化 /
- 诊断 /
- 治疗学 /
- 医学, 中国传统
Abstract: Liver fibrosis is a necessary intermediate process from the progression of chronic hepatitis B to liver cirrhosis and liver cancer. In recent years, breakthroughs have been made in the research on traditional Chinese medicine (TCM) for the prevention and treatment of chronic hepatitis B liver fibrosis. For the purpose of improving clinical outcome, multidisciplinary industry-university-research studies are conducted to explain the biological basis of TCM syndromes of chronic hepatitis B liver fibrosis, and establishment and development of a non-invasive diagnostic model with TCM characteristics, optimization of TCM/integrated traditional Chinese and Western medicine treatment regimens, and elaboration on the scientific connotation of TCM treatment can help TCM for the prevention and treatment of liver fibrosis to enter the global world.
- Hepatitis B, Chronic /
- Liver Fibrosis /
- Diagnosis /
- Therapeutics /
- Medicine, Chinese Traditional

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参考文献(33)

[1]	ZUO L, CHEN JX, WANG W, et al. TCM informatics and phenomics: genetic mutation of symptoms and biological basis of TCM patterns[J]. J Beijing Univ Chin Med, 2022, 45(2): 140-147. DOI: 10.3969/j.issn.1006-2157.2022.02.007. 左玲, 陈建新, 王伟, 等. 中医信息学与表型组学: 症状的遗传突变与证候的生物学基础初探[J]. 北京中医药大学学报, 2022, 45(2): 140-147. DOI: 10.3969/j.issn.1006-2157.2022.02.007.
[2]	XU JJ, GUO JC, CAI ZB, et al. TGF-β Relationship between gene polymorphism and TCM syndrome types of chronic hepatitis B related liver fibrosis[J]. Zhejiang J Tradit Chin Med, 2014, 49(5): 313-314. DOI: 10.3969/j.issn.0411-8421.2014.05.001. 徐建军, 过建春, 蔡兆斌, 等. TGF-β1基因多态性与慢性乙肝肝纤维化中医证型的相关性探讨[J]. 浙江中医杂志, 2014, 49(5): 313-314. DOI: 10.3969/j.issn.0411-8421.2014.05.001.
[3]	SHI MJ, XIAO HM, XIE YB, et al. Differences in microrna expression in chronic hepatitis B patients with early liver fibrosis based on traditional Chinese medicine syndromes[J]. Evid Based Complement Alternat Med, 2020, 2020: 5956940. DOI: 10.1155/2020/5956940.
[4]	BAO J, OUYANG Y, QIAO L, et al. Serum CHI3L1 as a biomarker for non-invasive diagnosis of liver fibrosis[J]. Discov Med, 2022, 33(168): 41-49.
[5]	LI H, XU X, YI T, et al. Expression of chitinase-3-like protein 1 in different TCM syndromes and its correlation with liver fibrosis[J]. Ann Palliat Med, 2022, 11(1): 217-224. DOI: 10.21037/apm-21-3760.
[6]	KANG NL, RUAN QF, ZHANG DS, et al. Advantages of a novel model for predicting hepatic fibrosis in chronic hepatitis B virus carriers compared with APRI and FIB-4 scores[J]. J Clin Transl Hepatol, 2022, 10(3): 412-419. DOI: 10.14218/JCTH.2022.00098.
[7]	EKIN N, UCMAK F, EBIK B, et al. GPR, King's Score and S-Index are superior to other non-invasive fibrosis markers in predicting the liver fibrosis in chronic Hepatitis B patients[J]. Acta Gastroenterol Belg, 2022, 85(1): 62-68. DOI: 10.51821/85.1.9156.
[8]	LIU X, ZHOU J, ZHU L, et al. Diagnostic accuracy of apparent diffusion coefficient values combined with γ-glutamyl transpeptidase-to-platelet ratio parameters for predicting hepatitis B-related fibrosis[J]. Clin Res Hepatol Gastroenterol, 2022, 46(8): 101968. DOI: 10.1016/j.clinre.2022.101968.
[9]	ZHANG X, ZHU GJ, YE XH, et al. Clinical value of GPR parameter model combined with Fibroscan for evaluating the stage of liver fibrosis in patientes with chronic hepatitis B[J]. Chin Hepatol, 2022, 27(8): 877-880. DOI: 10.3969/j.issn.1008-1704.2022.08.013. 张鑫, 朱桂娟, 叶晓航, 等. GPR参数模型联合Fibroscan对慢性乙型肝炎肝纤维化的诊断效能[J]. 肝脏, 2022, 27(8): 877-880. DOI: 10.3969/j.issn.1008-1704.2022.08.013.
[10]	XIAO HM, SHI MJ, JIANG JM, et al. Efficacy and safety of AnluoHuaxian pills on chronic hepatitis B with normal or minimally elevated alanine transaminase and early liver fibrosis: A randomized controlled trial[J]. J Ethnopharmacol, 2022, 293: 115210. DOI: 10.1016/j.jep.2022.115210.
[11]	SHI MJ, XIAO HM, XIE YB, et al. Whether Patients in Immune Tolerant Phase of Chronic HBV Infection Should Be Treated: Stratified Analysis of a Clinical Randomized Controlled Trial[J/OL]. Pharmocol Clin Chin Mater Med, 2023, 39(1): 62-66. DOI: 10.13412/j.cnki.zzyl.20220614.001. 施梅姐, 萧焕明, 谢玉宝, 等. 慢性乙型病毒性肝炎免疫耐受期患者应否治疗: 一项临床随机对照试验的分层分析结果[J/OL]. 中药药理与临床, 2023, 39(1): 62-66. DOI: 10.13412/j.cnki.zzyl.20220614.001.
[12]	LIU YQ, ZHANG C, LI JW, et al. An-Luo-Hua-Xian pill improves the regression of liver fibrosis in chronic hepatitis B patients treated with entecavir[J]. J Clin Transl Hepatol, 2023, 11(2): 304-313. DOI: 10.14218/JCTH.2022.00091.
[13]	RONG G, CHEN Y, YU Z, et al. Synergistic effect of Biejia-Ruangan on fibrosis regression in patients with chronic hepatitis B treated with entecavir: A multicenter, randomized, double-blind, placebo-controlled trial[J]. J Infect Dis, 2022, 225(6): 1091-1099. DOI: 10.1093/infdis/jiaa266.
[14]	CUI LY, ZHANG XX, CUI P, et al. Clinical study of yiqi huoxue recipe in the treatment of liver fibrosis of chronic viral hepatitis[J]. Chin J Hepatol, 2020, 28(5): 403-409. DOI: 10.3760/cma.j.cn501113-20190905-00325. 崔璐瑶, 张潇潇, 崔坡, 等. 益气活血方治疗慢性病毒性肝炎肝纤维化的临床研究[J]. 中华肝脏病杂志, 2020, 28(5): 403-409. DOI: 10.3760/cma.j.cn501113-20190905-00325.
[15]	WEI TH, HAO WJ, YANG QJ, et al. Meta-analysis of Activating Blood Circulation and Resolving Stasis Method combined with western drugs in the treatment for liver fibrosis[J]. Chin Tradit Patent Med, 2021, 43(8): 2066-2074. DOI: 10.3969/j.issn.1001-1528.2021.08.017. 魏涛华, 郝文杰, 杨勤军, 等. 活血化瘀法联合西药治疗肝纤维化的Meta分析[J]. 中成药, 2021, 43(8): 2066-2074. DOI: 10.3969/j.issn.1001-1528.2021.08.017.
[16]	HU YK, TANG XJ, TANG ZW, et al. Systematic evaluation of classical prescription from "Treatise on Cold Damage and Miscellaneous Diseases" combined with nucleotide drugs in treatment of chronic hep-atitis B with liver fibrosis[J]. Chin J Integr Tradit West Med Liver Dis, 2021, 31(8): 742-748. DOI: 10.3969/j.issn.1005-0264.2021.08.019. 胡云凯, 唐徐杰, 汤紫薇, 等. 《伤寒杂病论》理气活血类经方联合核苷(酸)类药物治疗慢性乙型肝炎肝纤维化的Meta分析[J]. 中西医结合肝病杂志, 2021, 31(8): 742-748. DOI: 10.3969/j.issn.1005-0264.2021.08.019.
[17]	ZHAO ZM, ZHU CW, HUANG JQ, et al. Efficacy and safety of Fuzheng Huayu tablet on persistent advanced liver fibrosis following 2 years entecavir treatment: A single arm clinical objective performance criteria trial[J]. J Ethnopharmacol, 2022, 298: 115599. DOI: 10.1016/j.jep.2022.115599.
[18]	CHENG DY, ZHAO ZM, WAN G, et al. Impact of Fuzheng Huayu tablet on antiviral effect of entecavir in patients with hepatitis B cirrhosis[J]. Hepatobiliary Pancreat Dis Int, 2022, 21(5): 479-484. DOI: 10.1016/j.hbpd.2022.03.007.
[19]	SHI K, ZHANG Q, HUANG YY, et al. Effects of anti-liver fibrosis treatment on the occurrence of liver cancer in patients with hepatitis B-related liver cirrhosis[J]. Chin J Hepatol, 2021, 29(7): 685-689. DOI: 10.3760/cma.j.cn501113-20200227-00072. 时克, 张群, 黄云义, 等. 抗肝纤维化治疗对乙型肝炎肝硬化患者发生肝癌的影响[J]. 中华肝脏病杂志, 2021, 29(7): 685-689. DOI: 10.3760/cma.j.cn501113-20200227-00072.
[20]	JI D, CHEN Y, BI J, et al. Entecavir plus Biejia-Ruangan compound reduces the risk of hepatocellular carcinoma in Chinese patients with chronic hepatitis B[J]. J Hepatol, 2022, 77(6): 1515-1524. DOI: 10.1016/j.jhep.2022.07.018.
[21]	WANG G, ZHU Q, CHEN X, et al. Clinical observation of Lishui Xiaogu plaster combined with liver disease therapeutic apparatus on refractory ascites due to hepatitis B cirrhosis[J]. Chin J Exp Med Formul, 2022, 28(22): 123-130. DOI: 10.13422/j.cnki.syfjx.20222292. 王岗, 朱琦, 陈新, 等. 利水消臌膏联合肝病治疗仪治疗乙肝肝硬化顽固性腹水的临床疗效[J]. 中国实验方剂学杂志, 2022, 28(22): 123-130. DOI: 10.13422/j.cnki.syfjx.20222292.
[22]	LI H, SHEN F, WANG XL. Clinical observation of Leihuo moxibustion combined with nose twitching therapy in the treatment of hepatocirrhosis ascites of yang deficiency of spleen and kidney[J]. Chin J Integr Trad West Med Dig, 2020, 28(4): 291-295. DOI: 10.3969/j.issn.1671-038X.2020.04.11. 李辉, 沈峰, 王秀玲. 雷火灸联合搐鼻疗法治疗脾肾阳虚型乙肝肝硬化腹水的疗效观察[J]. 中国中西医结合消化杂志, 2020, 28(4): 291-295. DOI: 10.3969/j.issn.1671-038X.2020.04.11.
[23]	LI J, LUO JC, FU HM, et al. Clinical study on acupuncture plus Si Jun Zi decoction in treating hepatocirrhosis[J]. Shanghai J Acupunct Moxib, 2019, 38(4): 369-373. DOI: 10.13460/j.issn.1005-0957.2019.13.0027. 李菁, 骆劲超, 傅红明, 等. 针刺配合四君子汤治疗肝硬化的临床研究[J]. 上海针灸杂志, 2019, 38(4): 369-373. DOI: 10.13460/j.issn.1005-0957.2019.13.0027.
[24]	GAO H, HUI T. Clinical study of the treatment of Hepatic fibrosis of hepatitis B by acupoint application with Buganshen Cream Ointment and Diamine glycyrrhizinate enteric-coated capsule[J]. Shaanxi J Tradit Chin Med, 2018, 39(12): 1719-1721. DOI: 10.3969/j.issn.1000-7369.2018.12.018. 高慧, 惠桃. 补肝肾膏方穴位贴敷联合甘草酸二胺肠溶胶囊治疗乙肝肝纤维化临床研究[J]. 陕西中医, 2018, 39(12): 1719-1721. DOI: 10.3969/j.issn.1000-7369.2018.12.018.
[25]	ZHANG GQ, LUO LJ, DENG YM, et al. Effect of traditional Chinese medicine characteristic chronic disease management on patients with hepatitis B cirrhosis and malnutrition[J]. Chin J Integr Tradit West Med Liver Dis, 2021, 31(2): 120-124. DOI: 10.3969/j.issn.1005-0264.2021.02.006. 张广清, 罗利娟, 邓燕妹, 等. 中医特色慢病管理对乙型肝炎肝硬化营养不良患者的影响[J]. 中西医结合肝病杂志, 2021, 31(2): 120-124. DOI: 10.3969/j.issn.1005-0264.2021.02.006.
[26]	DENG XJ, LEI YY, CAO GX, et al. Research progress in the proteomics of traditional Chinese medical syndrome for chronic viral hepatitis B[J]. World Sci Technol Modern Tradit Chin Med, 2021, 23(4): 1228-1234. DOI: 10.11842/wst.20200728004. 邓晓靖, 雷亚云, 曹贵霞, 等. 慢性乙型病毒性肝炎中医证候蛋白质组学研究进展[J]. 世界科学技术-中医药现代化, 2021, 23(4): 1228-1234. DOI: 10.11842/wst.20200728004.
[27]	ZHOU W, ZHAN LB, ZHANG L. Systems biology and visceral manifestations of spleen[J]. J Tradit Chin Med, 2022, 63(3): 206-211. DOI: 10.13288/j.11-2166/r.2022.03.002. 周雯, 战丽彬, 章玲. 关于脾藏象研究的系统生物学思考[J]. 中医杂志, 2022, 63(3): 206-211. DOI: 10.13288/j.11-2166/r.2022.03.002.
[28]	YU L, ZENG Z, TAN H, et al. Significant metabolic alterations in patients with hepatitis B virus replication observed via serum untargeted metabolomics shed new light on hepatitis B virus infection[J]. J Drug Target, 2022, 30(4): 442-449. DOI: 10.1080/1061186X.2021.2009841.
[29]	WANG Q, HU Q, YING Y, et al. Using next-generation sequencing to identify novel exosomal miRNAs as biomarkers for significant hepatic fibrosis[J]. Discov Med, 2021, 31(164): 147-159.
[30]	CHI XL, XIAO HM. Traditional Chinese medicine prevention and treatment of liver fibrosis under the new situation of prevention and treatment of viral hepatitis[J]. J Clin Hepatol, 2018, 34(4): 694-697. DOI: 10.3969/j.issn.1001-5256.2018.04.003. 池晓玲, 萧焕明. 病毒性肝炎防治新形势下对中医药防治肝纤维化的思考[J]. 临床肝胆病杂志, 2018, 34(4): 694-697. DOI: 10.3969/j.issn.1001-5256.2018.04.003.
[31]	ZHANG CZ, LIN SS, XIAO HM, et al. Lingnan famous doctor Chi Xiaoling's chronic hepatitis B management thought of traditional Chinese medicine[J]. Chin J Integr Tradit West Med Liver Dis, 2021, 31(8): 749-751. DOI: 10.3969/j.issn.1005-0264.2021.08.020. 张朝臻, 林姗姗, 萧焕明, 等. 岭南名医池晓玲慢性乙型肝炎中医慢病管理思想[J]. 中西医结合肝病杂志, 2021, 31(8): 749-751. DOI: 10.3969/j.issn.1005-0264.2021.08.020.
[32]	ZHANG CZ, CHEN YR, XIAO HM, et al. Analysis on the application of traditional Chinese medicine thinking in'talk therapy'technology of multidimensional stereo series of liver disease therapy system[J]. China J Tradit Chin Med Pharma, 2021, 36(8): 4507-4511. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202108023.htm 张朝臻, 陈沿任, 萧焕明, 等. 中医思维在肝病多维立体系列疗法体系"话疗"技术中的应用探析[J]. 中华中医药杂志, 2021, 36(8): 4507-4511. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202108023.htm
[33]	ZHANG CZ, XIAO HM, SHI MJ, et al. A preliminary study on the TCM model of chronic disease management of chronic hepatitis B[J]. Chin J Integr Tradit West Med Liver Dis, 2016, 26(3): 181-182, 184. DOI: 10.3969/j.issn.1005-0264.2016.03.021. 张朝臻, 萧焕明, 施梅姐, 等. 慢性乙型肝炎慢病管理中医模式初探[J]. 中西医结合肝病杂志, 2016, 26(3): 181-182, 184. DOI: 10.3969/j.issn.1005-0264.2016.03.021.