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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 9
Sep.  2022
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Article Contents

Integrated traditional Chinese and Western medicine diagnosis and treatment of cirrhotic ascites

DOI: 10.3969/j.issn.1001-5256.2022.09.002
Research funding:

Shandong Province Traditional Chinese Medicine Science and Technology Development Plan Project (2015-098)

More Information
  • Corresponding author: WANG Lei, wanglei.2006@126.com(ORCID: 000-0002-16477-5313)
  • Received Date: 2022-05-31
  • Accepted Date: 2022-06-30
  • Published Date: 2022-09-20
  • Ascites is the most common complication of decompensated liver cirrhosis. Recurrent massive ascites seriously affects the quality of life and prognosis of patients, and therefore, effective control of ascites is an important link in the treatment of liver cirrhosis. Based on the clinical reports in recent years, this article reviews the advances in the integrated traditional Chinese and Western medicine diagnosis of cirrhotic ascites, conventional Western medicine treatment such as salt restriction, diuresis, and albumin supplementation, and the application of transjugular intrahepatic portosystemic shunt, ascites pump, and liver transplantation in the treatment of refractory ascites. In addition, this article introduces the application of integrated traditional Chinese and Western medicine combining disease and syndrome with staged treatment and external treatment methods with traditional Chinese medicine characteristics, as well as the perspectives of future research including real-world study.

     

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  • [1]
    KAPLAN A, ROSENBLATT R. Symptom management in patients with cirrhosis: a practical guide[J]. Curr Treat Options Gastroenterol, 2022, 20(2): 144-159. DOI: 10.1007/s11938-022-00377-y.
    [2]
    HANSEN L, CHANG MF, LEE CS, et al. Physical and mental quality of life in patients with end-stage liver disease and their informal caregivers[J]. Clin Gastroenterol Hepatol, 2021, 19(1): 155-161. DOI: 10.1016/j.cgh.2020.04.014.
    [3]
    DING HG. Road map of the diagnosis and treatment of intractable ascites based on guidelines for the diagnosis and treatment of cirrhotic ascites and related complications[J]. J Clin Hepatol, 2018, 34(1): 31-34. DOI: 10.3969/j.issn.1001-5256.2018.01.006.

    丁惠国. 从《肝硬化腹水及相关并发症的诊疗指南》探讨肝硬化顽固性腹水诊治"路线图"[J]. 临床肝胆病杂志, 2018, 34(1): 31-34. DOI: 10.3969/j.issn.1001-5256.2018.01.006.
    [4]
    Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.

    中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
    [5]
    European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2): 406-460. DOI: 10.1016/j.jhep.2018.03.024.
    [6]
    BIGGINS SW, ANGELI P, GARCIA-TSAO G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases[J]. Hepatology, 2021, 74(2): 1014-1048. DOI: 10.1002/hep.31884.
    [7]
    AITHAL GP, PALANIYAPPAN N, CHINA L, et al. Guidelines on the management of ascites in cirrhosis[J]. Gut, 2021, 70(1): 9-29. DOI: 10.1136/gutjnl-2020-321790.
    [8]
    Branch of Gastrointestinal Diseases, China Association of Chinese Medicine. Expert consensus on TCM diagnosis and treatment of ascites due to cirrhosis (2017)[J]. J Clin Hepatol, 2017, 33(9): 1621-1626. DOI: 10.3969/j.issn.1001-5256.2017.09.002.

    中华中医药学会脾胃病分会. 肝硬化腹水中医诊疗专家共识意见(2017)[J]. 临床肝胆病杂志, 2017, 33(9): 1621-1626. DOI: 10.3969/j.issn.1001-5256.2017.09.002.
    [9]
    KHANDWALLA HE, FASAKIN Y, EL-SERAG HB. The utility of evaluating low serum albumin gradient ascites in patients with cirrhosis[J]. Am J Gastroenterol, 2009, 104(6): 1401-1405. DOI: 10.1038/ajg.2009.117.
    [10]
    WONG CL, HOLROYD-LEDUC J, THORPE KE, et al. Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results?[J]. JAMA, 2008, 299(10): 1166-1178. DOI: 10.1001/jama.299.10.1166.
    [11]
    ABDEL-RAZIK A, ELDARS W, ELHELALY R, et al. C-reactive protein and insulin-like growth factor-1 in differential diagnosis of ascites[J]. J Gastroenterol Hepatol, 2016, 31(11): 1868-1873. DOI: 10.1111/jgh.13386.
    [12]
    European Association for the Study of the Liver. EASL clinical practice guidelines: Liver transplantation[J]. J Hepatol, 2016, 64(2): 433-485. DOI: 10.1016/j.jhep.2015.10.006.
    [13]
    ZHANG C, LIU JT, ZHANG Y, et al. Study on theoretical framework of etiology and pathogenesis of cirrhotic ascites[J]. J Liaoning Univ Tradit Chin Med, 2022, 24(1): 139-143. DOI: 10.13194/j.issn.1673-842x.2022.01.031.

    张驰, 刘军彤, 张英, 等. 肝硬化腹水(鼓胀)中医病因病机理论框架结构研究[J]. 辽宁中医药大学学报, 2022, 24(1): 139-143. DOI: 10.13194/j.issn.1673-842x.2022.01.031.
    [14]
    KOCKERLING D, NATHWANI R, FORLANO R, et al. Current and future pharmacological therapies for managing cirrhosis and its complications[J]. World J Gastroenterol, 2019, 25(8): 888-908. DOI: 10.3748/wjg.v25.i8.888.
    [15]
    European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease[J]. J Hepatol, 2019, 70(1): 172-193. DOI: 10.1016/j.jhep.2018.06.024.
    [16]
    YOSHIJI H, NAGOSHI S, AKAHANE T, et al. Evidence-based clinical practice guidelines for Liver Cirrhosis 2020[J]. J Gastroenterol, 2021, 56(7): 593-619. DOI: 10.1007/s00535-021-01788-x.
    [17]
    WANG HL, XU SJ, HAN XJ. Diagnostic usefulness of the random urine Na/K ratio in cirrhotic patients with ascites[J]. Modern Prevent Med, 2016, 43(9): 1705-1708. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201609043.htm

    王海龙, 许顺姬, 韩学吉. 肝硬化合并腹水患者随机尿Na/K比值检测在临床诊疗中的应用及其意义[J]. 现代预防医学, 2016, 43(9): 1705-1708. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201609043.htm
    [18]
    EL-BOKL MA, SENOUSY BE, EL-KARMOUTY KZ, et al. Spot urinary sodium for assessing dietary sodium restriction in cirrhotic ascites[J]. World J Gastroenterol, 2009, 15(29): 3631-3635. DOI: 10.3748/wjg.15.3631.
    [19]
    LI M, BI Z, HUANG Z. Impact of vaptans on clinical outcomes in cirrhosis patients: a meta-analysis of randomized controlled trials[J]. Front Pharmacol, 2019, 10: 1365. DOI: 10.3389/fphar.2019.01365.
    [20]
    WANG YF, TANG JT, HAN T, et al. Tolvaptan in Chinese cirrhotic patients with ascites: A randomized, placebo-controlled phase 2 trial[J]. J Dig Dis, 2018, 19(3): 144-154. DOI: 10.1111/1751-2980.12583.
    [21]
    TANG J, WANG Y, HAN T, et al. Tolvaptan therapy of Chinese cirrhotic patients with ascites after insufficient diuretic routine medication responses: a phase Ⅲ clinical trial[J]. BMC Gastroenterol, 2020, 20(1): 391. DOI: 10.1186/s12876-020-01536-0.
    [22]
    BU GK, LIAO JT. The effect of abdominal catheterization in the treatment of refractory ascites and analysis of influencing factors of tube falling[J]. Hebei Med, 2021, 27(9): 1522-1526. DOI: 10.3969/j.issn.1006-6233.2021.09.026.

    步光奎, 廖江涛. 腹腔置管引流治疗肝硬化顽固性腹水的效果及脱管的影响因素分析[J]. 河北医学, 2021, 27(9): 1522-1526. DOI: 10.3969/j.issn.1006-6233.2021.09.026.
    [23]
    BERNARDI M, ANGELI P, CLARIA J, et al. Albumin in decompensated cirrhosis: new concepts and perspectives[J]. Gut, 2020, 69(6): 1127-1138. DOI: 10.1136/gutjnl-2019-318843.
    [24]
    di PASCOLI M, FASOLATO S, PIANO S, et al. Long-term administration of human albumin improves survival in patients with cirrhosis and refractory ascites[J]. Liver Int, 2019, 39(1): 98-105. DOI: 10.1111/liv.13968.
    [25]
    CARACENI P, RIGGIO O, ANGELI P, et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial[J]. Lancet, 2018, 391(10138): 2417-2429. DOI: 10.1016/S0140-6736(18)30840-7.
    [26]
    LEE TH, KUO G, CHANG CH, et al. Diuretic effect of co-administration of furosemide and albumin in comparison to furosemide therapy alone: An updated systematic review and meta-analysis[J]. PLoS One, 2021, 16(12): e0260312. DOI: 10.1371/journal.pone.0260312.
    [27]
    BUREAU C, THABUT D, OBERTI F, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites[J]. Gastroenterology, 2017, 152(1): 157-163. DOI: 10.1053/j.gastro.2016.09.016.
    [28]
    BUCSICS T, HOFFMAN S, GRVNBERGER J, et al. ePTFE-TIPS vs repetitive LVP plus albumin for the treatment of refractory ascites in patients with cirrhosis[J]. Liver Int, 2018, 38(6): 1036-1044. DOI: 10.1111/liv.13615.
    [29]
    BUREAU C, ADEBAYO D, CHALRET DE RIEU M, et al. Alfapump® system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study[J]. J Hepatol, 2017, 67(5): 940-949. DOI: 10.1016/j.jhep.2017.06.010.
    [30]
    AAGAARD NK, MALAGO M, DE GOTTARDI A, et al. Consensus care recommendations for alfapump® in cirrhotic patients with refractory or recurrent ascites[J]. BMC Gastroenterol, 2022, 22(1): 111. DOI: 10.1186/s12876-022-02173-5.
    [31]
    FU QL, CAO XY, LI FP, et al. Association between TCM syndrome and liver function in patients with tympanites: An analysis of 422 cases[J]. Mod Tradit Chin Med, 2018, 38(6): 36-39. DOI: 10.13424/j.cnki.mtcm.2018.06.014.

    傅琪琳, 曹雪艳, 李粉萍, 等. 422例臌胀病中医证候与肝功相关性研究[J]. 现代中医药, 2018, 38(6): 36-39. DOI: 10.13424/j.cnki.mtcm.2018.06.014.
    [32]
    ZHAO WX. Clinical application of traditional Chinese medicine oral administration and external treatment in cirrhotic ascites[J]. Beijing Med J, 2021, 43(9): 853-855. DOI: 10.15932/j.0253-9713.2021.09.005.

    赵文霞. 中医药内服外治治疗肝硬化腹水的临床应用[J]. 北京医学, 2021, 43(9): 853-855. DOI: 10.15932/j.0253-9713.2021.09.005.
    [33]
    LI L, HU DQ, SUN JG, et al. Ideas and methods of treating hepatitis B virus (HBV)-related cirrhosis with integrated traditional Chinese and western medicine based on concept of "Dispelling Pathogenic Factors First"[J]. Shandong J Tradit Chin Med, 2019, 38(7): 624-628, 637. DOI: 10.16295/j.cnki.0257-358x.2019.07.004.

    李璐, 胡冬青, 孙建光, 等. 基于"祛邪为先"理念探讨中西医结合治疗乙型肝炎肝硬化思路和方法[J]. 山东中医杂志, 2019, 38(7): 624-628, 637. DOI: 10.16295/j.cnki.0257-358x.2019.07.004.
    [34]
    LI XX, HUA Q, HE JH, et al. Meta analysis on invigorating spleen for diuresis therapy combined with western medicine in the treatment of cirrhotic ascites[J]. Chin Med Modern Distance Educ of China, 2019, 17(5): 112-114. DOI: 10.3969/j.issn.1672-2779.2019.05.044.

    李晓晓, 花千, 何佳欢, 等. 健脾利水法联合西药治疗肝硬化腹水的Meta分析[J]. 中国中医药现代远程教育, 2019, 17(5): 112-114. DOI: 10.3969/j.issn.1672-2779.2019.05.044.
    [35]
    MENG YH, LI JT, LIU JH, et al. Meta-analysis on Wulin Powder in treating cirrhotic ascites[J]. Guid J Tradit Chin Med Pharmacol, 2020, 26(3): 43-46. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZB202003014.htm

    孟宇航, 李京涛, 刘佳昊, 等. 五苓散加减治疗肝硬化腹水的Meta分析[J]. 中医药导报, 2020, 26(3): 43-46. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZB202003014.htm
    [36]
    REN XR, ZENG JX, LI HR, et al. Meta-analysis on the treatment of cirrhotic ascites by Yiqi Huoxue Lishui combined with western medicine[J]. Chin J Integr Tradit West Med Liver Dis, 2021, 31(7): 635-639. DOI: 10.3969/j.issn.1005-0264.2021.07.016.

    任小瑞, 曾佳昕, 李浩然, 等. 益气活血利水法联合西医治疗肝硬化腹水患者的Meta分析[J]. 中西医结合肝病杂志, 2021, 31(7): 635-639. DOI: 10.3969/j.issn.1005-0264.2021.07.016.
    [37]
    AI XY, XIE M. Observation of therapeutic effect of Taohe Chengqi Decoction on intractable ascitesdue to cirrhosis[J]. Pract Tradit Chin Intern Med, 2020, 34(9): 9-11. DOI: 10.13729/j.issn.1671-7813.Z20200394.

    艾香英, 谢敏. 桃核承气汤联合西药治疗肝硬化顽固性腹水疗效观察[J]. 实用中医内科杂志, 2020, 34(9): 9-11. DOI: 10.13729/j.issn.1671-7813.Z20200394.
    [38]
    ZHOU Y, XING F, ZHAO CQ, et al. Clinical observation on treatment of refractory ascites in liver cirrhosis by modified Tuduzi Buqi Decoction combined with western medicine conventional therapy[J]. Shanghai J Tradit Chin Med, 2021, 55(5): 67-69, 76. DOI: 10.16305/j.1007-1334.2021.2011059.

    周扬, 邢枫, 赵长青, 等. 徒都子补气汤加减联合西医常规疗法治疗肝硬化顽固性腹水的临床观察[J]. 上海中医药杂志, 2021, 55(5): 67-69, 76. DOI: 10.16305/j.1007-1334.2021.2011059.
    [39]
    LIU W, GONG R. Meta analysis on integrated traditional Chinese and western medicine in the treatment of cirrhosis ascites[J]. Chin Med Modern Distance Educ of China, 2017, 15(16): 152-156. DOI: 10.3969/j.issn.1672-2779.2017.16.065.

    刘汶, 龚然. 中西医结合治疗肝硬化腹水的Meta分析[J]. 中国中医药现代远程教育, 2017, 15(16): 152-156. DOI: 10.3969/j.issn.1672-2779.2017.16.065.
    [40]
    WANG XY, LI X, MEN JZ, et al. A Meta-analysis of efficacy and safety of the compound TCM preparation of the Wenyang Jianpi type plus conventional western medicine on liver cirrhosis ascites[J]. Clin J Chin Med, 2019, 11(34): 1-7. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY201934002.htm

    王晓勇, 李霞, 门九章, 等. 温阳健脾类中药复方制剂联合西医常规治疗肝硬化腹水疗效和安全性的Meta分析[J]. 中医临床研究, 2019, 11(34): 1-7. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY201934002.htm
    [41]
    LUO XL, GUAN W, GOU CY, et al. Clinical observation of nourishing kidney and softening liver in treating refractory ascites due to liver and kidney yin deficiency[J]. Chin J Integr Tradit West Med Liver Dis, 2019, 29(3): 214-216. DOI: 10.3969/j.issn.1005-0264.2019.03.007.

    罗晓岚, 关伟, 勾春燕, 等. 滋肾柔肝法治疗肝肾阴虚型肝硬化顽固性腹水临床观察[J]. 中西医结合肝病杂志, 2019, 29(3): 214-216. DOI: 10.3969/j.issn.1005-0264.2019.03.007.
    [42]
    LI Y, WANG L, SU C, et al. Clinical observation on the treatment of chronic severe hepatitis B by retention enema with Huchang Jiedu Decoction[J]. Chin J Integr Med, 2010, 16(4): 348-352. DOI: 10.1007/s11655-010-0519-8.
    [43]
    WU ZL, TAN WJ, LIAN BT, et al. Systematic review of umbilical therapy of traditional Chinese medicine in treating ascites due to liver cirrhosis[J]. Chin J Exp Med Formul, 2016, 22(17): 177-181. DOI: 10.13422/j.cnki.syfjx.2016170177.

    吴驻林, 谭婉君, 连宝涛, 等. 中药敷脐辅助治疗肝硬化腹水的系统评价[J]. 中国实验方剂学杂志, 2016, 22(17): 177-181. DOI: 10.13422/j.cnki.syfjx.2016170177.
    [44]
    YANG X, RU S, LUO L, et al. Efficacy and safety of umbilical therapy with the traditional Chinese medicine formulation Lishui Xiaogu cataplasm for cirrhotic ascites: protocol for a randomized controlled trial[J]. Trials, 2019, 20(1): 127. DOI: 10.1186/s13063-019-3221-y.
    [45]
    FU Y, SHAO MY, YAN SX, et al. Real world study and clinical efficacy evaluation of traditional Chinese medicine[J]. J Tradit Chin Med, 2019, 60(7): 546-550. DOI: 10.13288/j.11-2166/r.2019.07.002.

    符宇, 邵明义, 燕树勋, 等. 真实世界研究与中医临床疗效评价[J]. 中医杂志, 2019, 60(7): 546-550. DOI: 10.13288/j.11-2166/r.2019.07.002.
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