慢性肝炎肝纤维化中西医结合治疗问题

姚希贤; 姚冬梅

慢性肝炎肝纤维化中西医结合治疗问题

河北医科大学第二医院消化内科

详细信息

中图分类号: R575.2
计量
- 文章访问数: 2958
- HTML全文浏览量: 14
- PDF下载量: 780
- 被引次数: 0
出版历程
- 出版日期: 2013-04-20

Combination treatment of Chinese traditional and Western medicine in chronic hepatitis and liver fibrosis

摘要

摘要:
慢性肝炎肝纤维化主要由乙、丙型肝炎所致,合理治疗应包括抗病毒、调节免疫及抗肝纤维化治疗,有效抗病毒是治疗本病的关键,以西药为主辅以中药可提高疗效。当前在所谓的保(护)肝及对肝纤维化治疗方面药物虽多,但迄今尚乏特(有)效药物。研究表明:以"瘀血证"立论,重用丹参配黄芪活血化瘀为主,益气、舒肝、健脾中医中药对肝细胞炎症、坏死及肝纤维化等病变治疗具有良好作用。但面对众多慢性肝炎、肝纤维化患者,可用于临床的抗肝纤维化有效治疗措施仍很有限,而且目前"861"、"益肝康颗粒剂";强肝、扶正化瘀胶囊等有效中药投产者不多,尚需做进一步随机对照、盲法、大样本、多中心临床试验研究,并重视肝组织学治疗前后复查结果,进一步验证疗效。
- 肝炎,慢性 /
- 肝硬化 /
- 中西医结合疗法
Abstract:
A primary complication of chronic viral hepatitis is liver fibrosis.The most effective therapeutic strategies will include agents that exert antiviral, immunomodulatory and anti-fibrotic effects.While several antivirals are currently available in Western medicine, including the widely used pegylated interferons and nucleostde analoges, they are limited by a relatively high incidence of resistance.Therefore, supplementation with traditional Chinese medicines (TCMs) may not only provide the immunomodulatory and anti-fibrotic effects, but also promote the overall curative effect of the antiviral treatment.In this review, we disucss several kinds of the TCMs that are promising candidates for such a liver-targeting integrative therapeutic approach.In particular, Salvia miltiorrhiza (also known as danshen) and various species of the Astragalus genus is known to promote circulation and remove stasis (based on "stasis of blood" theory) .Other TCMs with tonifying Qi provide liver-soothing and strengthen the spleen's immune function, such as ginseng and the Chinese caterpillar fungus (from Ophiocordyceps sinensis) ;these TCMs′ effects on the inflammatory system can ultimately help to reduce necrosis and liver fibrotic lesions.There are still other TCMs exerting direct antifibrotic effects, such as the radix Salviae Miltiorrhizae-based compounds.Use of an integrative medicine approach, combining Western medicines with TCMs, to treat chronic viral hepatitis and liver fibrosis, is still in its infancy.Systematic experimental and clinical studies are necessary to determine the optimal agents, combinations, dosages, and schedules to acheive the optimal efficacy.
- hepatitis /
- chronic /
- liver cirrhosis

HTML全文

参考文献(38)

[1] Chinese Society of Hepatology and Chinese Society of Infec-tious Diseases, Chinese Medical Association.The guideline ofprevention and treatment for chronic hepatitis B (2010 version) [J].J Clin Hepatol, 2011, 27 (1) :Ⅰ-ⅩⅥ. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2010年版) [J].临床肝胆病杂志, 2011, 27 (1) :Ⅰ-ⅩⅥ.

[2]Yao XX, Yao DQ.Clinical problems of antiviral therapy forchronic hepatitis B[J].Mod Digestion Inte, 2012, 17 (5) :276-278. (in Chinese) 姚希贤, 姚冬奇.慢性乙型肝炎的抗病毒治疗问题[J].现代消化及介入诊疗, 2012, 17 (5) :276-278.

[3]Sun KW, Peng JP.Promoting cellular immune response-mechanism of traditional Chinese medicine in treatment ofchronic hepatitis B[J].Chin J Integr Tradit West Med onLiver, 2012, 22 (4) :193-195, 199. (in Chinese) 孙克伟, 彭建平.促进细胞免疫学应答———慢性乙型肝炎中医药治疗的机制[J].中西医结合肝病杂志, 2012, 22 (4) :193-195, 199.

[4]Yokosuka O, Takaguchi K, Fujioka S, et al.Long-term useof entecavir in nucleoside-naive Japanese patients withchronic hepatitis B infection[J].J Hepatol, 2010, 52 (6) :791-799.

[5]Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, et al.Long-term therapy with adefovir dipivoxil for HBeAg-negativechronic hepatitis B[J].N Engl J Med, 2005, 352 (26) :2673-2681.

[6]Tillmann HL, Hadem J, Leifeld L, et al.Safety and efficacyof lamivudine in patients with severe acute or fulminant hepa-titis B, a multicenter experience[J].J Viral Hepat, 2006, 13 (4) :256-263.

[7]Lai MY, Kao JH, Yang PM, et al.Long-term efficacy ofribavirin plus interferon alfa in the treatment of chronic hepati-tis C[J].Gastroenterology, 1996, 111 (5) :1307-1312.

[8]Chuang WL, Yu ML, Dai CY, et al.Treatment of chronichepatitis C in southern Taiwan[J].Intervirology, 2006, 49 (1-2) :99-106.

[9]Liu JP, Qin XK, McIntosh H.Systemic evaluation of randomcontrolled trial on treatment of chronic hepatitis B by Chineseherbal medicine[J].Chin J Integr Tradit West Med, 2002, 22 (1) :58-62, 64. (in Chinese) 刘建平, 秦献魁, McIntosh H.中草药治疗慢性乙型肝炎随机对照试验的系统评价[J].中国中西医结合杂志, 2002, 22 (1) :58-62, 64.

[10]Wan LY, Zhang BH.Effect of matrine in treatment of chronicliver disease[J].Shanxi J Tradit Chin Med, 2009, 25 (1) :44-45. (in Chinese) 万丽艳, 张保红.苦参碱在慢性肝病治疗中的作用[J].山西中医, 2009, 25 (1) :44-45.

[11]Chen B, Sun KW, Chang ZJ, et al.A randomized, double-blind, double-dummy control study on Callicarpa capsules intreating chronic hepatitis B[J].Chin J Integr Tradit WestMed, 2011, 21 (4) :203-206. (in Chinese) 陈斌, 孙克伟, 常占杰, 等.紫珠胶囊治疗慢性乙型肝炎随机、双盲、双模拟对照研究[J].中西医结合肝病杂志, 2011, 21 (4) :203-206.

[12]Yu YY, Wang QH, Zhu LM, et al.A clinical research on oxymatrinefor the treatment of chronic hepatitis B[J].Chin J Hepatol, 2002, 10 (4) :280-282. (in Chinese) 于岩岩, 王勤环, 朱理珉, 等.苦参素治疗慢性乙型肝炎的临床研究[J].中华肝脏病杂志, 2002, 10 (4) :280-282.

[13]Peng JP, Chen C, He F, et al.Effect of tonifying kidney andinvigorating spleen decoctions on dendritic cells in patientswith hepatitis B virus infection in state of immune tolerance[J].Chin J Integr Tradit West Med on Liver, 2010, 20 (4) :221-224. (in Chinese) 彭建平, 陈晨, 何芳, 等.补肾法与健脾法对乙肝病毒感染免疫耐受期患者外周血树突状细胞功能的影响[J].中西医结合肝病杂志, 2010, 20 (4) :221-224.

[14]Liu YH, Zhang YH.Regulating effect of strengthening spleenand tonifying kidney method on Th1/Th2 in peripheral circula-tion dendritic cell of patients with chronic hepatitis B[J].Chin J Tradit Med Sci Technol, 2009, 16 (5) :345-346. (inChinese) 刘肄辉, 张永华.健脾补肾法对拉米夫定治疗慢性乙型肝炎患者外周血树突状细胞调节Th1/Th2的影响[J].中国中医药科技, 2009, 16 (5) :345-346.

[15]Zhang YH, Han Y, Liu YH, et al.Effect of synergy and theinfluence on CD4, CD8 the strengthening spleen and tonifykidney to chronical hepatitis treated by nucleoside analog[J].Chin J Integr Tradit West Med on Liver, 2008, 18 (5) :263-265. (in Chinese) 张永华, 韩颖, 刘肄辉, 等.健脾补肾法对核苷类似物治疗慢性乙型肝炎的增效作用及对CD4、CD8的影响[J].中西医结合肝病杂志, 2008, 18 (5) :263-265.

[16]Gao YQ, Zheng YJ, Wang LT.Effect of spleen-invigoratingprescription on dendritic cell function in patients with chronichepatitis B of TCM Pi-deficiency syndrome type[J].Chin JIntegr Tradit West Med, 2007, 27 (4) :300-302. (in Chinese) 高月求, 郑亚江, 王灵台.健脾方对脾虚型慢性乙型肝炎患者树突细胞功能的影响[J].中国中西医结合杂志, 2007, 27 (4) :300-302.

[17]Gao YQ.Immune regulation by traditional Chinese medicineas a superior link in treatment of chronic hepatitis B[J].ChinJ Integr Tradit West Med on Liver, 2010, 20 (3) :129-130. (in Chinese) 高月求.中医药调控免疫是治疗慢性乙型肝炎优势环节[J].中西医结合肝病杂志, 2010, 20 (3) :129-130.

[18] Xiao SD, Xu GM.Chinese Gastroenterology[M].Beijing:People’s Medical Publishing House, 2008:617-648. (inChinese) 萧树东, 许国铭.中华胃肠病学[M].北京:人民卫生出版社, 2008:617-648.

[19]Tian LY, Lu LG.Role of hepatoprotectants in treatment offatty liver disease[J].J Clin Hepatol, 2010, 26 (3) :253-254. (in Chinese) 田丽艳, 陆伦根.保肝药在脂肪性肝病治疗中的地位[J].临床肝胆病杂志, 2010, 26 (3) :253-254.

[20]Yao XX, Xu KC.Basic and Clinical Research of Liver Cirrhosis[M].Shanghai:Shanghai Scientific and Technological Edu-cation Publishing House, 2003:85-98. (in Chinese) 姚希贤, 徐克成.肝纤维化的基础与临床[M].上海:上海科技教育出版社, 2003:85-98.

[21]Yao XX.Viral Hepatitis[M].Heibei:Heibei People's Publish-ing House, 1980:234-239. (in Chinese) 姚希贤.病毒性肝炎[M].河北:河北人民出版社, 1980:234-239.

[22]Yao XX.Clinical Gastroenterology[M].Tianjin:Tianjin Sci-ence and Technology Press, 1999:995-1009. (in Chinese) 姚希贤.临床消化病学[M].天津:天津科学技术出版社, 1999:995-1009.

[23]Wang BE, Zhao HT, Wang TL, et al.Histopathological evalua-tion of the therapeutic effect of herbal Cpd.861 on liver fibrosis[J].Chin J Hepatol, 1997, 5 (2) :77-78. (in Chinese) 王宝恩, 赵洪涛, 王泰玲, 等.复方861对肝炎肝纤维化疗效的病理组织学分析[J].中华肝脏病杂志, 1997, 5 (2) :77-78.

[24]Yao HS, Yao XX, Yao DM, et al.Efficacy of Yigankang ther-apy in 365 chronic hepatitis B patients with liver fibrosis[J].Clin Focus, 2009, 24 (8) :690-693. (in Chinese) 姚洪森, 姚希贤, 姚冬梅, 等.益肝康治疗慢性乙型肝炎肝纤维化365例疗效观察[J].临床荟萃, 2009, 24 (8) :690-693.

[25]Yao XX, Fu YL, Li XL, et al.Therapeutic efficacy of Yigangranules in treatment of chronic hepatitis:a multicenter stud-y of 324 cases[J].J Hebei Med Univ, 1989, 10 (4) :231-233. (in Chinese) 姚希贤, 傅玉玲, 李秀兰, 等.“益肝冲剂”治疗慢性肝炎324例的多中心疗效观察[J].河北医学院学报, 1989, 10 (4) :231-233.

[26]Yao XX, Tang YW, Yao DM, et al.Effects of Yigan Decoc-tion on proliferation and apoptosis of hepatic stellate cells[J].World J Gastroenterol, 2002, 8 (3) :511-514.

[27]Tang YW, Yao XX, Yao HS.Protective effect of yigankangon hepatocytes of rats with experimental hepatic fibrosis andultrastructural observation[J].Chin J Integr Traditi WestMed Digest, 2002, 10 (2) :76-78. (in Chinese) 唐有为, 姚希贤, 姚洪森.益肝康对实验性肝纤维化大鼠肝细胞的保护作用及超微结构观察[J].中国中西医结合消化杂志, 2002, 10 (2) :76-78.

[28]Yao X, Xiu HM, Zhang YZ.Blood-activating and stasis-eliminating effects of concentrated Yigan decoction of Chi-nese herb on hepatic fibrosis in rats[J].World Chin J Dig, 2002, 10 (5) :544-548. (in Chinese) 姚欣, 修贺明, 张玉琢.活血化淤中药益肝浓缩煎剂对大鼠肝纤维化的作用[J].世界华人消化杂志, 2002, 10 (5) :544-548.

[29]Yao XX, Jiang SL, Tang YW, et al.Efficacy of Chinese med-icine Yi-gan-kang granule in prophylaxis and treatment ofliver fibrosis in rats[J].World J Gastroenterol, 2005, 11 (17) :2583-2590.

[30]Yao XX, Xiu HM, Song M, Experimental study of concentratedYigan decoction as well as other blood-activatin and stasis-e-liminating drugs on hepatic fibrosis in rats[J].Chin J Gastroen-terol Hepatol, 2001, 10 (3) :217-222. (in Chinese) 姚希贤, 修贺明, 宋梅.“益肝浓缩煎剂”等活血化淤药抗大鼠肝纤维化作用实验研究[J].胃肠病学和肝病学杂志, 2001, 10 (3) :217-222.

[31]Yao XX, Tang YW, Yao DM, et al.Effect of Yigan Decoctionon the expression of typeⅠ, Ⅲcollagen proteins in experi-mental hepatic fibrosis in rats[J].World Chin J Dig, 2001, 9 (3) :263-267. (in Chinese) 姚希贤, 唐有为, 姚冬梅, 等.益肝煎剂对实验性肝纤维化大鼠Ⅰ, Ⅲ型胶原蛋白表达的影响[J].世界华人消化杂志, 2001, 9 (3) :263-267.

[32]Yao XX, Lv T.Effects of pharmacological serum from normaland liver fibrotic rats on HSCs[J].World J Gastroenterol, 2005, 11 (16) :2444-2449.

[33]Jiang SL, Yao XX, Lv T.Inhibitory effect of Danshen on lipidperoxidation in mitochondria of hepatic fibrosis in rats[J].World Chin J Dig, 2002, 10 (11) :1253-1256. (in Chinese) 蒋树林, 姚希贤, 吕涛.丹参抑制大鼠肝纤维化线粒体脂质过氧化[J].世界华人消化杂志, 2002, 10 (11) :1253-1256.

[34]Fang HM, Yao XX, Yao JF, et al, Seropharmacological effectsof Yigankang and its separated recipe on activation and prolifera-tion of hepatic stellate cells[J].World Chin J Dig, 2005, 13 (16) :1970-1973. (in Chinese) 房红梅, 姚希贤, 姚金峰, 等.拆方益肝康的两种药物血清对HSC活化增殖的影响[J].世界华人消化杂志, 2005, 13 (16) :1970-1973.

[35]Yao XX, Fang HM, Wang JM.Effects of Yigankang and itsseparated recipe on expression of platelet-derived growthfactor and its receptor in hepatic stellate cells[J].WorldChin J Dig, 2005, 13 (12) :1412-1416. (in Chinese) 姚希贤, 房红梅, 王军民.拆方益肝康与药物血清对肝星状细胞PDGF及受体表达的影响[J].世界华人消化杂志, 2005, 13 (12) :1412-1416.

[36]Yang DG, Wang LJ.Comparison of pre-and post-treatmentalhepatohistology with heavy dosage of paeonia rubra on chronicactive hepatitis caused liver fibrosis[J].Chin J Integr TraditWest Med, 1994, 14 (4) :207-209. (in Chinese) 杨大国, 王林杰.重用赤芍治疗慢性肝炎纤维化前后肝穿组织学的比较[J].中国中西医结合杂志, 1994, 14 (4) :207-209.

[37]Chen XL, Li XA.The research on medical treatment of liverfibrosis[J].Chin J Gastroenterol Hepatol, 2010, 19 (1) :93-95. (in Chinese) 陈鲜兰, 李小安.肝纤维化内科治疗的研究[J].胃肠病学和肝病学杂志, 2010, 19 (1) :93-95.

[38]Yao X, Song M, Yin L.Effects of prevention and treatmentof Qianggan capsule on experimental liver fibrosis in rats[J].Chin J Gastroenterol Hepatol, 2001, 10 (3) :223-226. (inChinese) 姚欣, 宋梅, 尹雷.强肝胶囊对大鼠实验性肝纤维化防治作用[J].胃肠病学和肝病学杂志, 2001, 10 (3) :223-226.

施引文献

资源附件(0)

访问统计