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

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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

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