肝纤维化的中西医结合诊治进展
DOI: 10.3969/j.issn.1001-5256.2023.02.006
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:张雪萍参与起草文章,整理参考文献等;尚小飞对文章进行修改;李秀惠提出文章思路,并对文章进行修改和定稿。
Advances in integrated traditional Chinese and Western medicine diagnosis and treatment of hepatic fibrosis
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摘要: 肝纤维化在慢性肝炎发展到肝硬化甚至肝癌的进程中处于关键环节,可以是一个动态可逆的病理变化。研究表明,中西医结合对肝纤维化具有良好的治疗效果,对于延缓甚至逆转疾病发展具有重要作用。本文在总结肝纤维化发病机制的基础上,从肝纤维化的诊断、中医和西医治疗方法及中西医结合治疗路径等方面进行探讨,以期为中西医结合防治肝纤维化的基础研究及临床应用提供思路。Abstract: Hepatic fibrosis (HF) is a key stage in the progression of chronic hepatitis to liver cirrhosis and even liver cancer, and it is a dynamic and reversible pathological change. Studies have shown that integrated traditional Chinese and Western medicine therapy has a good therapeutic effect on HF and can delay or reverse the progression of this disease. This article summarizes the pathogenesis of HF and discusses the diagnosis of HF, traditional Chinese medicine and Western medicine therapies, and the path of integrated traditional Chinese and Western medicine therapy, so as to provide ideas for the basic research and clinical application of integrated traditional Chinese and western medicine in the prevention and treatment of HF.
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Key words:
- Liver Fibrosis /
- Medicine, Chinese Traditional /
- Integrative Medicine /
- Diagnosis /
- Therapeutics
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[1] LEI JY. Research progress in the diagnosis of liver fibrosis indexes by traditional Chinese and Western medicine[J]. Inner Mongolia J Trad Chin Med, 2020, 39(8): 152-154. DOI: 10.16040/j.cnki.cn15-1101.2020.08.093.雷金艳. 中西医诊断肝纤维化指标的研究进展[J]. 内蒙古中医药, 2020, 39(8): 152-154. DOI: 10.16040/j.cnki.cn15-1101.2020.08.093. [2] AYDIN MM, AKÇALI KC. Liver fibrosis[J]. Turk J Gastroenterol, 2018, 29(1): 14-21. DOI: 10.5152/tjg.2018.17330. [3] SU J, HU YP. Research progress on the initiation and reversal of liver fibrosis[J]. Carcinog Teratogenesis Mutagen, 2022, 34(3): 242-246. DOI: 10.3969/j.issn.1004-616x.2022.03.013.苏静, 胡以平. 肝纤维化发生及逆转途径的研究进展[J]. 癌变·畸变·突变, 2022, 34(3): 242-246. DOI: 10.3969/j.issn.1004-616x.2022.03.013. [4] HE D, CHEN P, LIU F, et al. Research progress on the etiology and mechanism of liver fibrosis[J]. J Kunming Med Univ, 2022, 43(11): 165-171. DOI: 10.12259/j.issn.2095-610X.S20221122.何迪, 陈鹏, 刘锋, 等. 肝纤维化病因与机制研究进展[J]. 昆明医科大学学报, 2022, 43(11): 165-171. DOI: 10.12259/j.issn.2095-610X.S20221122. [5] ROEHLEN N, CROUCHET E, BAUMERT TF. Liver Fibrosis: mechanistic concepts and therapeutic perspectives[J]. Cells, 2020, 9(4): 875. DOI: 10.3390/cells9040875. [6] QIN LJ, ZHANG L, HOU P, et al. Research progress on the pathogenesis of liver fibrosis[J]. J Jilin Med Univ, 2021, 42(5): 369-371. DOI: 10.13845/j.cnki.issn1673-2995.2021.05.019.秦利静, 张露, 侯鹏, 等. 肝纤维化发病机制的研究进展[J]. 吉林医药学院学报, 2021, 42(5): 369-371. DOI: 10.13845/j.cnki.issn1673-2995.2021.05.019 [7] ZUÑIGA-AGUILAR E, RAMÍREZ-FERNÁNDEZ O. Fibrosis and hepatic regeneration mechanism[J]. Transl Gastroenterol Hepatol, 2022, 7: 9. DOI: 10.21037/tgh.2020.02.21 [8] SI J, TANG L, LI CC, et al. Research progress on the pathogenesis of liver fibrosis and its therapeutic drugs[J]. Prog Pharmaceut Sci, 2021, 45(3): 205-211. https://www.cnki.com.cn/Article/CJFDTOTAL-YXJZ202103008.htm司晶, 唐露, 李臣诚, 等. 肝纤维化的发病机制及其治疗药物研究进展[J]. 药学进展, 2021, 45(3): 205-211. https://www.cnki.com.cn/Article/CJFDTOTAL-YXJZ202103008.htm [9] FU YQ, NONG XX, SU XW, et al. Research progress on anti-liver fibrosis mechanism in traditional Chinese medicine[J]. Henan Trad Chin Med, 2021, 41(8): 1256-1261. DOI: 10.16367/j.issn.1003-5028.2021.08.0285.符燕青, 农小欣, 苏晓文, 等. 中医药抗肝纤维化机制研究进展[J]. 河南中医, 2021, 41(8): 1256-1261. DOI: 10.16367/j.issn.1003-5028.2021.08.0285. [10] XIN X, HU YY. Traditional Chinese medicine's understanding of liver fibrosis[J]. Liver Doctor, 2022, 2: 32. https://www.cnki.com.cn/Article/CJFDTOTAL-GBSH202202012.htm辛鑫, 胡义扬. 中医对肝纤维化的认识[J]. 肝博士, 2022, 2: 32. https://www.cnki.com.cn/Article/CJFDTOTAL-GBSH202202012.htm [11] DAI JH, XIAO Z, MA SP. Discussion on the connotation of traditional Chinese medicine on the molecular biological mechanism of liver fibrosis based on the theory of "yin and yang in the liver body"[J]. Lishizhen Med Materia Medica Res, 2022, 33(1): 169-171. DOI: 10.3969/j.issn.1008-0805.2022.01.44.代静慧, 肖准, 马素平. 基于"肝体阴用阳"理论的肝纤维化分子生物学机制的中医内涵探讨[J]. 时珍国医国药, 2022, 33(1): 169-171. DOI: 10.3969/j.issn.1008-0805.2022.01.44. [12] XIAO Z, YANG FM, DAI JH, et al. Based on the "image analogy" method, the association between hepatocyte iron metabolism disorders and the pathogenesis of liver fibrosis in traditional Chinese medicine was discussed[J]. Modernization Trad Chin Med Materia Medica-World Sci Technol, 2022, 24(3): 1090-1096. DOI: 10.11842/wst.20210513008.肖准, 杨芳明, 代静慧, 等. 基于"取象比类"法探讨肝细胞铁代谢紊乱与肝纤维化中医病机的关联[J]. 世界科学技术-中医药现代化, 2022, 24(3): 1090-1096. DOI: 10.11842/wst.20210513008. [13] 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. [14] BAI YM, LIANG S, ZHOU B. Research progress in the combination of traditional Chinese and Western medicine in the treatment of liver fibrosis[J/OL]. J Pract Trad Chin Inter Med, 2022. [Online ahead of print]白彦铭, 梁爽, 周波. 中西医联合治疗肝纤维化的研究进展[J/OL]. 实用中医内科杂志, 2022. [网络首发] [15] ZHANG N, LI Y. Research progress in traditional Chinese and Western medicine for liver fibrosis[J]. J Hubei Univ Chin Med, 2020, 22(1): 118-121. DOI: 10.3969/j.issn.1008-987x.2020.01.34张娜, 李勇. 肝纤维化的中西医研究进展[J]. 湖北中医药大学学报, 2020, 22(1): 118-121. DOI: 10.3969/j.issn.1008-987x.2020.01.34 [16] SHAN L, WANG F, ZHAI D, et al. New drugs for hepatic fibrosis[J]. Front Pharmacol, 2022, 13: 874408. DOI: 10.3389/fphar.2022.874408 [17] LUO X, QU Y, CAI XB, et al. Effect of antiviral therapy on reversal of liver fibrosis[J]. J Clin Hepatol, 2022, 38(11): 2596-2598. DOI: 10.3969/j.issn.1001-5256.2022.11.032.罗昕, 曲颖, 蔡晓波, 等. 抗病毒治疗对肝纤维化逆转的影响[J]. 临床肝胆病杂志, 2022, 38(11): 2596-2598. DOI: 10.3969/j.issn.1001-5256.2022.11.032. [18] ZHANG H, KONG CF, YANG JL, et al. Traditional Chinese medicine treatment ideas for alcoholic liver fibrosis[J]. Chin J Integr Trad West Med Liver Dis, 2022, 32(2): 167-169. DOI: 10.3969/j.issn.1005-0264.2022.02.016.张欢, 孔晨帆, 杨佳潞, 等. 酒精性肝纤维化的中医治疗思路[J]. 中西医结合肝病杂志, 2022, 32(2): 167-169. DOI: 10.3969/j.issn.1005-0264.2022.02.016. [19] WU FX, WANG XQ, LIU JB. Research progress in the treatment of liver fibrosis by traditional Chinese and Western medicine[J]. Trad Chin Med Res, 2022, 35(8): 87-91. DOI: 10.3969/j.issn.1001-6910.2022.08.21.吴芳霞, 王新群, 刘建斌. 中西医治疗肝纤维化的研究进展[J]. 中医研究, 2022, 35(8): 87-91. DOI: 10.3969/j.issn.1001-6910.2022.08.21. [20] WANG S, FRIEDMAN SL. Hepatic fibrosis: A convergent response to liver injury that is reversible[J]. J Hepatol, 2020, 73(1): 210-211. DOI: 10.1016/j.jhep.2020.03.011. [21] SHE S, WU X, ZHENG D, et al. PSMP/MSMP promotes hepatic fibrosis through CCR2 and represents a novel therapeutic target[J]. J Hepatol, 2020, 72(3): 506-518. DOI: 10.1016/j.jhep.2019.09.033. [22] ZHAO Q, YAN XY, MA Q, et al. Research progress of traditional Chinese medicine in regulating oxidative stress-related signaling pathways in anti-hepatic fibrosis[J/OL]. J Liaoning Univ Trad Chin Med, 2022. [Online ahead of print]赵茜, 颜薛晏, 马琼, 等. 中医药调控氧化应激相关信号通路抗肝纤维化的研究进展[J/OL]. 辽宁中医药大学学报, 2022. [网络首发] [23] LI YJ, JIA KX, LIU RP, et al. Research situation on modern pharmacological effects of five classical prescriptions in treatment of liver fibrosis[J]. Chin Trad Herbal Drugs, 2022, 53(16): 5193-5204. DOI: 10.7501/j.issn.0253-2670.2022.16.029.李依洁, 贾可欣, 刘闰平, 等. 五法经典方辨治肝纤维化的现代药理作用研究概况[J]. 中草药, 2022, 53(16): 5193-5204. DOI: 10.7501/j.issn.0253-2670.2022.16.029. [24] FU L, SHANG GB, CHEN Z, et al. An overview of the study of traditional Chinese medicine to reverse the process of liver fibrosis[J]. Lishizhen Med Materia Medica Res, 2021, 32(4): 944-948. DOI: 10.3969/j.issn.1008-0805.2021.04.51.傅柳, 尚广彬, 陈中, 等. 中药逆转肝纤维化进程的研究概况[J]. 时珍国医国药, 2021, 32(4): 944-948. DOI: 10.3969/j.issn.1008-0805.2021.04.51. [25] LI WQ, LIU WH, QIAN D, et al. Traditional Chinese medicine: An important source for discovering candidate agents against hepatic fibrosis[J]. Front Pharmacol, 2022, 13: 962525. DOI: 10.3389/fphar.2022.962525 [26] PAN FZ, LIU D. Research progress on the mechanism of ligustrazine in anti-liver fibrosis from the method of promoting blood circulation to remove meridian obstruction[J]. China Med Herald, 2021, 18(8): 34-37. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202108009.htm潘富珍, 刘定. 从活血通络法探讨川芎嗪抗肝纤维化的作用机制研究进展[J]. 中国医药导报, 2021, 18(8): 34-37. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202108009.htm [27] WU Z, MA W, ZANG CH, et al. The effect of notoginseng saponin R1 in protecting rats with carbon tetrachloride-induced liver fibrosis in rats[J]. Chin J Tissue Engine Res, 2020, 24(26): 4213. DOI: 10.3969/j.issn.2095-4344.2768.吴朕, 马微, 臧成昊, 等. 三七皂苷R1保护四氯化碳诱导肝纤维化模型大鼠的作用[J]. 中国组织工程研究, 2020, 24(26): 4213. DOI: 10.3969/j.issn.2095-4344.2768. [28] SABERI-KARIMIAN M, KESHVARI M, GHAYOUR-MOBARHAN M, et al. Effects of curcuminoids on inflammatory status in patients with non-alcoholic fatty liver disease: a randomized controlled trial[J]. Complement Ther Med, 2020, 49(3): 102322. DOI: 10.1016/j.ctim.2020.102322. [29] WANG GT, LI JT, WEI HL, et al. Curcumin inhibits human liver astrocyte fibrosis by inhibiting TGF-β/smad2 signaling pathway[J]. Chin J Immunol, 2020, 36(4): 422. DOI: 10.3969/j.issn.1000-484X.2020.04.008.王国泰, 李京涛, 魏海梁, 等. 姜黄素通过抑制TGF-β/smad2信号通路抑制人肝星状细胞纤维化作用研究[J]. 中国免疫学杂志, 2020, 36(4): 422. DOI: 10.3969/j.issn.1000-484X.2020.04.008. [30] CAO L, GUO RW, GAO YQ, et al. Research progress of integrated traditional Chinese and Western medicine in the treatment of chronic hepatitis B liver fibrosis[J]. China Med Herald, 2019, 16(25): 37-40. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201925009.htm曹林, 郭若闻, 高月求, 等. 中西医结合治疗慢性乙型肝炎肝纤维化的研究进展[J]. 中国医药导报, 2019, 16(25): 37-40. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201925009.htm [31] WANG W, CHEN HH, WANG K. Research progress in the treatment of liver fibrosis by traditional Chinese medicine[J]. Henan Trad Chin Med, 2021, 41(1): 137-140. DOI: 10.16367/j.issn.1003-5028.2021.01.0034.王伟, 陈翰翰, 王凯. 中医药治疗肝纤维化研究进展[J]. 河南中医, 2021, 41(1): 137-140. DOI: 10.16367/j.issn.1003-5028.2021.01.0034. [32] AI DD, LUO WS. Overview of traditional Chinese medicine research on liver fibrosis[J]. Hunan J Trad Chin Med, 2020, 36(9): 188-189. DOI: 10.16808/j.cnki.issn1003-7705.2020.09.071.艾丁丁, 罗伟生. 肝纤维化的中医药研究概况[J]. 湖南中医杂志, 2020, 36(9): 188-189. DOI: 10.16808/j.cnki.issn1003-7705.2020.09.071. [33] YANG SL. Clinical efficacy of traditional Chinese medicine of Kang Xian Fang in the treatment of liver fibrosis of hepatitis[J]. Chin Communit Doctors, 2018, 34(31): 82-84. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS201831051.htm杨顺林. 中药抗纤方治疗肝炎肝纤维化的临床疗效[J]. 中国社区医师, 2018, 34(31): 82-84. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS201831051.htm [34] SHUAI CN, ZHANG YT, LIU M, et al. Research progress of proprietary Chinese medicine against chronic hepatitis B liver fibrosis[J]. J Med Informat, 2022, 35(8): 38-42. DOI: 10.3969/j.issn.1006-1959.2022.08.010.帅苍南, 张玉亭, 刘敏, 等. 抗慢性乙型肝炎肝纤维化中成药研究进展[J]. 医学信息, 2022, 35(8): 38-42. DOI: 10.3969/j.issn.1006-1959.2022.08.010. [35] 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 Trad 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. [36] JIANG FQ, ZHANG QX, SUN FX, et al. Effect of Huangqi Huaxian decoction on liver function and liver fibrosis index among chronic hepatitis B patients[J]. World Chin Med, 2022, 17(1): 104-107. DOI: 10.3969/j.issn.1673-7202.2022.01.018.姜付泉, 张秋香, 孙凤霞, 等. 黄芪化纤汤对慢性乙型肝炎患者肝功能与肝纤维化指标的影响[J]. 世界中医药, 2022, 17(1): 104-107. DOI: 10.3969/j.issn.1673-7202.2022.01.018. [37] LU F, GENG J, ZHANG J, et al. Effect of entecavir plus Ganshuang granule on fibrosis and cirrhosis in patients with chronic hepatitis B[J]. J Tradit Chin Med, 2021, 41(4): 624-629. DOI: 10.19852/j.cnki.jtcm.2021.04.012. [38] CHEN WL, LIANG F, ZHANG YC, et al. Efficacy of Zhenggan Huayu Recipe combined with Entecavir in the treatment of hepatitis B fibrosis and its effect on IL-6 and TNF-α[J]. Chin Arch Trad Chin Med, 2022, 40(8): 209-212. DOI: 10.13193/j.issn.1673-7717.2022.08.050.陈文林, 梁芳, 张云城, 等. 正肝化瘀方联合恩替卡韦治疗乙肝肝纤维化疗效及对IL-6、TNF-α的影响[J]. 中华中医药学刊, 2022, 40(8): 209-212. DOI: 10.13193/j.issn.1673-7717.2022.08.050 [39] ZHAO H. Treatment with Anluo Huaxian Pill helps reduce the degree of liver fibrosis in patients with chronic hepatitis B[J]. Liver Doctor, 2022, 2: 42-43. https://www.cnki.com.cn/Article/CJFDTOTAL-GBSH202202017.htm赵鸿. 安络化纤丸治疗有助于降低慢乙肝患者肝纤维化程度[J]. 肝博士, 2022, 2: 42-43. https://www.cnki.com.cn/Article/CJFDTOTAL-GBSH202202017.htm
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