中医药治疗肝纤维化的优势与特色

刘俊宏; 李欣瑜; 王淼蕾; 符博雅; 李林蔓; 方慧

doi:10.3969/j.issn.1001-5256.2023.02.003

中医药治疗肝纤维化的优势与特色

DOI: 10.3969/j.issn.1001-5256.2023.02.003

1.
甘肃中医药大学附属医院脾胃病科，兰州 730000
2.
甘肃中医药大学中西医结合学院，兰州 730000
3.
河西学院附属张掖人民医院消化内科，甘肃张掖 734000

基金项目:

国家自然科学基金地区项目 (81660773);

甘肃省组织部重点人才项目 ;

甘肃省科学技术厅临床医学研究中心建设项目 (21JR7RA682)

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：刘俊宏、王淼蕾负责研究选题，终审论文；李欣瑜、符博雅负责设计论文框架，起草论文；李林蔓、方慧负责修订论文。

详细信息

通信作者:
刘俊宏，Lhz8686@163.com(ORCID：0000-0002-5784-5296)

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出版历程
- 收稿日期: 2022-12-03
- 录用日期: 2023-01-14
- 出版日期: 2023-02-20

Advantages and characteristics of traditional Chinese medicine in the treatment of liver fibrosis

1.
Department of Spleen and Stomach Diseases, The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou 730000, China
2.
School of Integrated Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
3.
Department of Gastroenterology, Zhang Ye People's Hospital Affiliated to Hexi University, Zhangye, Gansu 734000, China

Research funding:

Regional Projects of the National Natural Science Foundation of China (81660773);

Key Talent Project of Organization Department of Gansu Province ;

Construction Project of Clinical Medical Research Center, Department of Science and Technology of Gansu Province (21JR7RA682)

More Information

Corresponding author: LIU Junhong, Lhz8686@163.com (ORCID: 0000-0002-5784-5296)

摘要

摘要: 肝纤维化是各种慢性肝病的共同病理过程，与肝脏疾病进展相关，是影响肝脏疾病转归和肝细胞癌风险的关键因素。早期过程可逆，若不及时干预治疗，程度逐渐加重终将发展为肝硬化，甚至肝细胞癌，危及人们健康。因此，积极防治肝纤维化具有重要的意义，而肝纤维化的发病机制复杂，西医治疗单一、局限，尚缺乏疗效确切且公认的抗纤维化药物，治疗存在巨大的医疗需求。随着国内外学者的努力研究，中医药治疗成为了逆转肝纤维化和抗纤维化进展的热点和重要突破点，且发现了多靶点、多途径的优势，本文将从辩证、治法、药物配伍及与现代分子机制结合等方面详细阐述中医药治疗肝纤维化的特色和优势。
- 中草药 /
- 肝纤维化 /
- 治疗学 /
- 医学, 中国传统
Abstract: Hepatic fibrosis (HF) is the common pathological process of various chronic liver diseases and is associated with the progression of liver diseases, and it is also a key factor affecting the outcome of liver diseases and the risk of hepatocellular carcinoma (HCC). The early process of HF is reversible, but without timely intervention and treatment, HF may gradually aggravate and progress to liver cirrhosis and even HCC, which will endanger people's health. Therefore, it is of great significance to actively prevent and treat HF; however, due to the complex pathogenesis of HF, Western medicine treatment is limited and there is still a lack of effective and widely accepted anti-fibrotic drugs, and thus there is a huge demand for medical treatment. With the efforts of scholars in China and globally, traditional Chinese medicine treatment has become a hotspot and a key breakthrough point in reversing HF and preventing its progression, with the advantages of multiple targets and pathways. This article elaborates on the advantages and characteristics of TCM treatment of HF from the aspects of syndrome differentiation, method of treatment, drug compatibility, and modern molecular mechanism.
- Drugs, Chinese Herbal /
- Liver Fibrosis /
- Therapeutics /
- Medicine, Chinese Traditional

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参考文献(38)

[1]	SHIHA G, IBRAHIM A, HELMY A, et al. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: A 2016 update[J]. Hepatol Int, 2017, 11(1): 1-30. DOI: 10.1007/s12072-016-9760-3.
[2]	ELPEK GÖ. Cellular and molecular mechanisms in the pathogenesis of liver fibrosis: An update. World J Gastroenterol, 2014, 20(23): 7260-7276. DOI: 10.3748/wjg.v20.i23.7260.
[3]	ZHOU WC, ZHANG QB, QIAO L. Pathogenesis of liver cirrhosis[J]. World J Gastroenterol, 2014, 20(23): 7312-7324. DOI: 10.3748/wjg.v20.i23.7312.
[4]	FUKUI H, SAITO H, UENO Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015[J]. J Gastroenterol, 2016, 51(7): 629-650. DOI: 10.1007/s00535-016-1216-y.
[5]	DU WT, REN WL, HU DD, et al. Research progress on reversible animal model of liver fibrosis[J/CD]. Chin J Liver Dis (Electronic Version), 2022, 14(3): 18-21. DOI: 10.3969/j.issn.1674-7380.2022.03.005. 杜文涛, 任万雷, 胡豆豆, 等. 肝纤维化可逆转动物模型研究进展[J/CD]. 中国肝脏病杂志(电子版), 2022, 14(3): 18-21. DOI: 10.3969/j.issn.1674-7380.2022.03.005.
[6]	ZHANG QZ. Research on Name of disease of hepatic fibrosis in the traditional historical literature of TCM[J]. Nei Mongol J Tradit Chin Med, 2016, 35(4): 132-134. DOI: 10.16040/j.cnki.cn15-1101.2016.04.127. 张轻舟. 肝纤维化病名中医传统历史文献研究[J]. 内蒙古中医药, 2016, 35(4): 132-134. DOI: 10.16040/j.cnki.cn15-1101.2016.04.127.
[7]	HUANG YY. Core theory of four sages[M]. Beijing: China Pharmaceutical Science and Technology Press, 2016: 81-82. 黄元御. 四圣心源[M]. 北京: 中国医药科技出版社, 2016: 81-82.
[8]	WEN B, HE SQ, LUO XR, et al. Discussion on the mechanism of anti-hepatic fibrosis by clearing heat and removing dampness[J]. Jiangsu J Tradit Chin Med, 2007, 39(11): 76-78. DOI: 10.3969/j.issn.1672-397X.2007.11.046. 文彬, 贺松其, 罗显荣, 等. 清热祛湿法抗肝纤维化的作用机理探讨[J]. 江苏中医药, 2007, 39(11): 76-78. DOI: 10.3969/j.issn.1672-397X.2007.11.046.
[9]	HUANG T, NIU HY, ZHANG Q, et al. Current status and outlook ofresearch on integrated Chinese and western medicine treatment of hepatitis B cirrhosis[J]. J Changchun Univ Chin Med, 2023, 39(1): 113-117. DOI: 10.13463/j.cnki.cczyy.2023.01.025. 黄涛, 牛宏垚, 张倩, 等. 乙型肝炎肝硬化的中西医治疗研究现状及展望[J]. 长春中医药大学学报, 2023, 39(1): 113-117. DOI: 10.13463/j.cnki.cczyy.2023.01.025.
[10]	HUANG LP, XU YH, DENG MZ, et al. Research progress on chemical constituents, pharmacological mechanism and clinical application of Artemisiae Scopariae Herba[J]. Nat Prod Res Dev, 2021, 33(4): 676-690. DOI: 10.16333/j.1001-6880.2021.4.018. 黄丽平, 许远航, 邓敏贞, 等. 茵陈的化学成分、药理作用机制与临床应用研究进展[J]. 天然产物研究与开发, 2021, 33(4): 676-690. DOI: 10.16333/j.1001-6880.2021.4.018.
[11]	DENG Y, LIU H, WU XY, et al. Research progress on the hepatoprotective effects of polydatin[J]. Chin J Comp Med, 2021, 31(9): 136-140. DOI: 10.3969/j.issn.1671-7856.2021.09.021. 邓艳, 刘洪, 吴新玉, 等. 虎杖苷的保肝作用研究进展[J]. 中国比较医学杂志, 2021, 31(9): 136-140. DOI: 10.3969/j.issn.1671-7856.2021.09.021.
[12]	SHEN X, GUO QQ, CAO W, et al. Research progress of amarogentin[J]. Prog Mod Biomed, 2015, 15(2): 365-367, 346. DOI: 10.13241/j.cnki.pmb.2015.02.042. 沈歆, 郭倩倩, 曹蔚, 等. 苦龙胆酯苷的研究进展[J]. 现代生物医学进展, 2015, 15(2): 365-367, 346. DOI: 10.13241/j.cnki.pmb.2015.02.042.
[13]	QIU ZC, CHEN YX, ZHOU RL. Experimental study on anti-immune hepatic fibrosis of rats by total flavonoids of Lonicera japonica Thunb[J]. J Chin Med Mater, 2010, 33(6): 974-976. DOI: 10.13863/j.issn1001-4454.2010.06.046. 丘志春, 陈玉兴, 周瑞玲. 金银花总黄酮抗大鼠免疫性肝纤维化的实验研究[J]. 中药材, 2010, 33(6): 974-976. DOI: 10.13863/j.issn1001-4454.2010.06.046.
[14]	PENG Y, YANG T, HUANG K, et al. Salvia miltiorrhiza ameliorates liver fibrosis by activating hepatic natural killer cells in vivo and in vitro[J]. Front Pharmacol, 2018, 9: 762. DOI: 10.3389/fphar.2018.00762.
[15]	HAN SQ, CAO WF, HE J, et al. Effect of Danshen-containing serum on expression of Smo and α-SMA proteins of hedgehog signaling pathway in HSCs[J]. Pharmacol Clin Chin Mater Med, 2015, 31(5): 79-82. DOI: 10.13412/j.cnki.zyyl.2015.05.023. 韩仕庆, 曹文富, 何娟, 等. 丹参含药血清对HSCs中Smo和α-SMA表达的影响[J]. 中药药理与临床, 2015, 31(5): 79-82. DOI: 10.13412/j.cnki.zyyl.2015.05.023.
[16]	JIANG H, GAO JR, WANG YZ, et al. Panax notoginseng saponins ameliorates experimental hepatic fibrosis and hepatic stellate cell proliferation by inhibiting the Jak2/Stat3 pathways[J]. J Tradit Chin Med, 2016, 36(2): 217-224. DOI: 10.1016/S0254-6272(16)30030-9.
[17]	ZHANG RH, MOU FX, BAI GP, et al. Effects of panax notoginseng saponins on the expression of type Ⅰ and type Ⅲ collagen mRNA in liver tissue of rats with liver fibrosis[C]//Proceedings of the 30th national conference on digestive system diseases of integrated traditional Chinese and Western Medicine. Zhengzhou, 2018: 357-358. 张荣华, 牟方翔, 柏干苹, 等. 三七总皂苷对肝纤维化大鼠肝组织Ⅰ、Ⅲ型胶原mRNA表达的影响[C]//第三十届全国中西医结合消化系统疾病学术会议论文集. 郑州, 2018: 357-358.
[18]	LI GY. Curcumol alleviates liver fibrosis with blood-stasis syndrome in rats and LSEC ultrastructure changes in vivo and in vitro[D]. Nanning: Guangxi University of Chinese Medicine, 2017. 黎桂玉. 莪术醇干预大鼠血瘀型肝纤维化及LSEC超微结构的实验研究[D]. 南宁: 广西中医药大学, 2017.
[19]	XIONG S, GAO JR, HU ZL, et al. Effect of carapax trionycis in inhibiting activation of rat hepatic stellate cell induced by TGF-β[J]. Chin J Exp Tradit Med Formulae, 2017, 23(19): 155-159. DOI: 10.13422/j.cnki.syfjx.2017190155. 熊莎, 高建蓉, 胡祖良, 等. 鳖甲提取物对抑制TGF-β诱导的大鼠肝星状细胞活化的影响[J]. 中国实验方剂学杂志, 2017, 23(19): 155-159. DOI: 10.13422/j.cnki.syfjx.2017190155.
[20]	HU CL, PENG XZ, TANG YP, et al. Synthesis of peptides of Carapax Trionycis and their inhibitory effects on TGF-β1-induced hepatic stellate cells[J]. Drug Discov Ther, 2013, 7(6): 248-253. DOI: 10.5582/DDT.2013.v7.6.248.
[21]	LI G, DONG ST, DONG ZJ. General situation of natural products for improving liver fibrosis based on antioxidant stress[J]. China Pharm, 2019, 30(19): 2731-2736. DOI: 10.6039/j.issn.1001-0408.2019.19.27. 李桂, 董松涛, 董占军. 基于抗氧化应激作用改善肝纤维化的天然产物的研究概况[J]. 中国药房, 2019, 30(19): 2731- 2736. DOI: 10.6039/j.issn.1001-0408.2019.19.27.
[22]	QI L, LI S, XU J, et al. Acupuncture for the treatment of liver cirrhosis: A meta-analysis[J]. Gastroenterol Res Pract, 2020, 2020: 4054781. DOI: 10.1155/2020/4054781.
[23]	LI ZL, CAO HC, YAO M, et al. Effect of acupuncture combined with Shenqi Yigan Decoction on liver function and T cell subsets in patients with HBV-induced liver fibrosis[J]. Am J Transl Res, 2021, 13(4): 3409-3417.
[24]	HUANG J, ZHANG C, ZHAN F, et al. Effects of astragalan on liver fibrosis rat in TGF-β1/Smads signal pathway[J]. China J Tradit Chin Med Pharm, 2015, 30(6): 2184-2186. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201506098.htm 黄进, 张晨, 詹菲, 等. 黄芪多糖对肝纤维化大鼠TGF-β1/Smads信号通路的影响[J]. 中华中医药杂志, 2015, 30(6): 2184-2186. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201506098.htm
[25]	CHEN MF, HUANG CC, LIU PS, et al. Saikosaponin a and saikosaponin d inhibit proliferation and migratory activity of rat HSC-T6 cells[J]. J Med Food, 2013, 16(9): 793-800. DOI: 10.1089/jmf.2013.2762.
[26]	ZHENG Y, LIANG TJ, WANG JH, et al. Experimental study on effect of curcumin on MAPK signaling pathway in hepatic sinusoidal endothelial cells[J]. Chin Arch Tradit Chin Med, 2021, 39(1): 57-61. DOI: 10.13193/j.issn.1673-7717.2021.01.016. 郑洋, 梁天坚, 王佳慧, 等. 莪术醇对肝窦内皮细胞MAPK信号通路作用的实验研究[J]. 中华中医药学刊, 2021, 39(1): 57-61. DOI: 10.13193/j.issn.1673-7717.2021.01.016.
[27]	GAO Y, CHU SF, CHEN NH. Anti-inflammatory function of ginsenoside Rg1 on alcoholic hepatitis through glucocorticoid receptor related nuclear factor-kappa B pathway[J]. J Hunan Univ Chin Med, 2015, 35(12): 1-4. DOI: 10.3969/j.issn.1674-070X.2015.12.001. 高岩, 楚世峰, 陈乃宏. 人参皂苷Rg1通过糖皮质激素受体相关NF-κB信号通路发挥抗炎作用抵抗酒精性肝炎研究[J]. 湖南中医药大学学报, 2015, 35(12): 1-4. DOI: 10.3969/j.issn.1674-070X.2015.12.001.
[28]	Liver Disease Committee, Chinese Association of Integrative Medicine. Guidelines for the diagnosis and treatment of liver fibrosis in integrative medicine practice (2019)[J]. J Clin Hepatol, 2019, 35(7): 1444-1449. DOI: 10.3969/j.issn.1001-5256.2019.07.007. 中国中西医结合学会肝病专业委员会. 肝纤维化中西医结合诊疗指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(7): 1444-1449. DOI: 10.3969/j.issn.1001-5256.2019.07.007.
[29]	ZHAO ZM, LIU CH. The main mechanism and the substantial basis of FZHY recipe in the treatment of hepatic fibrosis[J]. Shanghai Med Pharm J, 2016, 37(13): 13-16. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY201613004.htm 赵志敏, 刘成海. 扶正化瘀方抗肝纤维化的主要作用机制与效应物质[J]. 上海医药, 2016, 37(13): 13-16. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY201613004.htm
[30]	WANG RQ, MI HM, LI H, et al. Modulation of IKKβ/NF-κB and TGF-β1/Smad via Fuzheng Huayu recipe involves in prevention of nutritional steatohepatitis and fibrosis in mice[J]. Iran J Basic Med Sci, 2015, 18(4): 404-411.
[31]	ZHU XD, DI XS, YANG JL, et al. Mechanism of Yinchenhao Decoction in treating hepatic fibrosis based on network pharmacology[J]. Acta Chin Med Pharmacol, 2021, 49(6): 29-36. DOI: 10.19664/j.cnki.1002-2392.210134. 朱晓东, 邸学士, 杨佳潞, 等. 基于网络药理学探讨茵陈蒿汤治疗肝纤维化的作用机制[J]. 中医药学报, 2021, 49(6): 29-36. DOI: 10.19664/j.cnki.1002-2392.210134.
[32]	DING MP, WEI LX, WANG ZW, et al. Study on anti-hepatic fibrosis mechanism of Biejiajian pill based on network pharmacology[J]. Chin Tradit Pat Med, 2021, 43(10): 2874-2878. DOI: 10.3969/j.issn.1001-1528.2021.10.053. 丁茂鹏, 韦凌霞, 王志旺, 等. 基于网络药理学研究鳖甲煎丸抗肝纤维化的作用机制[J]. 中成药, 2021, 43(10): 2874-2878. DOI: 10.3969/j.issn.1001-1528.2021.10.053.
[33]	JIANG C, SONG HF, WANG D, et al. Study on the mechanism of Qijia Rougan Prescription in anti-hepatic fibrosis based on IKKβ/NF-κB pathway[J]. China J Tradit Chin Med Pharm, 2022, 37(8): 4805-4809. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202208115.htm 姜岑, 宋虹霏, 王东, 等. 基于IKKβ/NF-κB通路研究芪甲柔肝方抗肝纤维化作用机制[J]. 中华中医药杂志, 2022, 37(8): 4805-4809. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202208115.htm
[34]	XU XG, HUANG Y, HUANG YJ. Yiqi Huoxue Jiedu Decoction in the treatment of chronic viral hepatitis B fibrosis[J]. Shaanxi J Tradit Chin Med, 2015, 36(11): 1450-1452. DOI: 10.3969/j.issn.1000-7369.2015.11.004. 徐学刚, 黄毓, 黄玉娟. 益气活血解毒方治疗慢性病毒性乙型肝炎肝纤维化的临床研究[J]. 陕西中医, 2015, 36(11): 1450-1452. DOI: 10.3969/j.issn.1000-7369.2015.11.004.
[35]	LIU YJ. Rougan soup treated liver fibrosis and cirrhosis randomized controlled study[J]. J Pract Tradit Chin Intern Med, 2015, 29(9): 50-51. DOI: 10.13729/j.issn.1671-7813.2015.09.22. 刘云杰. 柔肝汤治疗肝纤维化和肝硬化随机平行对照研究[J]. 实用中医内科杂志, 2015, 29(9): 50-51. DOI: 10.13729/j.issn.1671-7813.2015.09.22.
[36]	WANG T, JIN W, HUANG QQ, et al. Clinical efficacy and safety of eight traditional Chinese medicine combined with entecavir in the treatment of chronic hepatitis B liver fibrosis in adults: A network meta-analysis[J]. Evid Based Complement Alternat Med, 2020, 2020: 7603410. DOI: 10.1155/2020/7603410.
[37]	AN JH, NI W, QIAO J. Therapeutic efficacy and quality of life investigation of traditional Chinese medicine-based therapy of chronic hepatitis B-related liver fibrosis[J]. Chin J Hepatol, 2014, 22(1): 30-32. DOI: 10.3760/cma.j.issn.1007-3418.2014.01.007. 安纪红, 倪文, 乔杰. 中药治疗慢性乙型肝炎肝纤维化的疗效观察及生存质量研究[J]. 中华肝脏病杂志, 2014, 22(1): 30-32. DOI: 10.3760/cma.j.issn.1007-3418.2014.01.007.
[38]	CHEN J, ZHANG TH, WAN XM, et al. Clinical effects syndrome differentiation in stages, acupuncture therapy and heart intervention on hepatitis B liver fibrosis[J]. Chin Arch Tradit Chin Med, 2017, 35(7): 1687-1690. DOI: 10.13193/j.issn.1673-7717.2017.07.014. 陈婧, 张天洪, 万雪梅, 等. 分阶段辨证联合针灸、心理干预治疗慢性乙型肝炎肝纤维化疗效观察[J]. 中华中医药学刊, 2017, 35(7): 1687-1690. DOI: 10.13193/j.issn.1673-7717.2017.07.014.