加味瓜蒌散治疗肝硬化门脉高压症的临床研究
|
摘要
目的：观察加味瓜蒌散治疗肝炎后肝硬化门脉高压症的临床疗效,并与心得安对照组相比较,评价加味瓜蒌散对乙型肝炎后肝硬化门脉高压症的治疗效果。
方法：选择住院治疗的乙型肝炎后肝硬化门静脉高压症患者97例,分为治疗组(49例)和对照组(48例),治疗组服用中药方剂“加味瓜蒌散”,对照组口服心得安片剂。疗程为3个月。在治疗前后分别观察患者的临床症状、体征、肝功能、肝纤维化指标、血流动力学及血管内皮生长因子的变化,比较两组患者的疗效。
结果：(1)临床症状体征比较：两组患者在治疗后胁痛、乏力、纳差、腹胀、胁下痞块、口干苦、舌象、脉象等主要临床症状、体征均有不同程度好转,总积分值下降。两组病例的总积分前后差异具有显著性(P<0.05)。
(2)肝功能比较：两组病例治疗后ALT、TBIL、ALB三项指标均有不同程度的改善。组间比较,两组病例治疗后在ALT、TBIL方面差异具有统计学意义(P<0.05)。两组治疗后ALB均升高,但治疗组与对照组之间的差异无显著性(P>0.05)。
(3)肝纤维化指标的比较：两组治疗后HA、PCIII、 IVC、LN均有不同程度下降,对照组治疗前后比较差异无统计学意义(P>0.05),治疗组治疗前后差异有显著性(P<0.05或0.01)。
(4)血流动力学结果：治疗组服用加味瓜蒌散3个月后门静脉内径、血流量与用药前比较差异具有显著性(P<0.05),血流速度治疗前后与对照组比较无显著差异(P>0.05)。
(5)血管内皮生长因子改变情况：治疗组服用加味瓜蒌散3个月后血管内皮生长因子与用药前比较差异显著(P<0.05),与对照组比较有显著差异(P<0.05)。
结论：加味瓜蒌散能有效改善乙型肝炎后肝硬化门脉高压患者的临床症状及体征,改善肝功能,降低肝纤维化指标水平,能够使患者门静脉内径缩小,血流速度、血流量减慢或降低,并能有效降低患者血管内皮生长因子水平。其作用机制可能与其抗纤维化,阻止肝硬化形成,降低门脉压力,改善肝脏微循环等有关。
Objective:This research aims to observe the clinical efficacy of the flavored Gualou San treatment of hepatitis, cirrhosis and portal hypertension, and a control group taking propranolol compared to evaluate the efficacy of the flavored Gualou San treatment of hepatitis, cirrhosis and portal hypertension.
Methods:97cases of hepatitis B cirrhosis and portal hypertension in patients hospitalized divided into treatment group (49cases) and control group (48cases), the treatment group taking Chinese medicines the flavored Gualou San,the control group was treated with propranolol. Course of three months. Efficacy observed in patients with clinical symptoms and signs before and after treatment, liver function, liver fibrosis, hemodynamics and vascular endothelial growth factor changes between the two groups.
Results:(1) Clinical signs and symptoms:After treatment, hypochondriac pain, fatigue, anorexia, abdominal distension, Pollution lump in the abdomen, dry mouth, bitter, tongue, pulse, etc. The main clinical symptoms and signs were improved to varying degrees. The total score decreased. The total score before and after the two groups were significantly different (P<0.05).
(2) The liver function:The two groups of patients, theALT, TBIL, ALB, three indicators have improved to varying degrees. Between the two groups, two groups of patients in the ALT, TBIL and aspects of statistical treatment (P<0.05) statistically significant. After treatment, ALB increased,no significant differences between the treatment and control groups (P>0.05).
(3) Liver fibrosis:two groups after treatment of HA, PC III, the IVC, LN decreased, no significant difference in the control group before and after treatment, significant difference (P <0.05or0.01) before treatment.
(4) Hemodynamic results:the treatment group taking the portal vein diameter the flavored Gualou San three months, before the blood flow and drug significantly different (P<0.05), blood flow velocity before and after treatment with the control group showed no significant difference (P>0.05).
(5) Vascular Endothelial Growth Factor: The treatment group was given the flavored Gualou San three months after the vascular endothelial growth factor before treatment difference significant (P<0.05) compared with the control group, significant differences (P<0.05)
Conclusion:the flavored Gualou San can effectively alleviate the clinical symptoms and signs of portal hypertension, can improve liver function, regulating the level of liver fibrosis, enabling patients with portal vein diameter was significantly reduced, blood flow velocity, blood flow to slow down or reduce and vascular endothelial growth factor levels can be reduced effectively. And its mechanism may be related to anti-fibrosis, prevents cirrhosis to reduce portal pressure, improve hepatic microcirculation and so on.
方法：选择住院治疗的乙型肝炎后肝硬化门静脉高压症患者97例,分为治疗组(49例)和对照组(48例),治疗组服用中药方剂“加味瓜蒌散”,对照组口服心得安片剂。疗程为3个月。在治疗前后分别观察患者的临床症状、体征、肝功能、肝纤维化指标、血流动力学及血管内皮生长因子的变化,比较两组患者的疗效。
结果：(1)临床症状体征比较：两组患者在治疗后胁痛、乏力、纳差、腹胀、胁下痞块、口干苦、舌象、脉象等主要临床症状、体征均有不同程度好转,总积分值下降。两组病例的总积分前后差异具有显著性(P<0.05)。
(2)肝功能比较：两组病例治疗后ALT、TBIL、ALB三项指标均有不同程度的改善。组间比较,两组病例治疗后在ALT、TBIL方面差异具有统计学意义(P<0.05)。两组治疗后ALB均升高,但治疗组与对照组之间的差异无显著性(P>0.05)。
(3)肝纤维化指标的比较：两组治疗后HA、PCIII、 IVC、LN均有不同程度下降,对照组治疗前后比较差异无统计学意义(P>0.05),治疗组治疗前后差异有显著性(P<0.05或0.01)。
(4)血流动力学结果：治疗组服用加味瓜蒌散3个月后门静脉内径、血流量与用药前比较差异具有显著性(P<0.05),血流速度治疗前后与对照组比较无显著差异(P>0.05)。
(5)血管内皮生长因子改变情况：治疗组服用加味瓜蒌散3个月后血管内皮生长因子与用药前比较差异显著(P<0.05),与对照组比较有显著差异(P<0.05)。
结论：加味瓜蒌散能有效改善乙型肝炎后肝硬化门脉高压患者的临床症状及体征,改善肝功能,降低肝纤维化指标水平,能够使患者门静脉内径缩小,血流速度、血流量减慢或降低,并能有效降低患者血管内皮生长因子水平。其作用机制可能与其抗纤维化,阻止肝硬化形成,降低门脉压力,改善肝脏微循环等有关。
Objective:This research aims to observe the clinical efficacy of the flavored Gualou San treatment of hepatitis, cirrhosis and portal hypertension, and a control group taking propranolol compared to evaluate the efficacy of the flavored Gualou San treatment of hepatitis, cirrhosis and portal hypertension.
Methods:97cases of hepatitis B cirrhosis and portal hypertension in patients hospitalized divided into treatment group (49cases) and control group (48cases), the treatment group taking Chinese medicines the flavored Gualou San,the control group was treated with propranolol. Course of three months. Efficacy observed in patients with clinical symptoms and signs before and after treatment, liver function, liver fibrosis, hemodynamics and vascular endothelial growth factor changes between the two groups.
Results:(1) Clinical signs and symptoms:After treatment, hypochondriac pain, fatigue, anorexia, abdominal distension, Pollution lump in the abdomen, dry mouth, bitter, tongue, pulse, etc. The main clinical symptoms and signs were improved to varying degrees. The total score decreased. The total score before and after the two groups were significantly different (P<0.05).
(2) The liver function:The two groups of patients, theALT, TBIL, ALB, three indicators have improved to varying degrees. Between the two groups, two groups of patients in the ALT, TBIL and aspects of statistical treatment (P<0.05) statistically significant. After treatment, ALB increased,no significant differences between the treatment and control groups (P>0.05).
(3) Liver fibrosis:two groups after treatment of HA, PC III, the IVC, LN decreased, no significant difference in the control group before and after treatment, significant difference (P <0.05or0.01) before treatment.
(4) Hemodynamic results:the treatment group taking the portal vein diameter the flavored Gualou San three months, before the blood flow and drug significantly different (P<0.05), blood flow velocity before and after treatment with the control group showed no significant difference (P>0.05).
(5) Vascular Endothelial Growth Factor: The treatment group was given the flavored Gualou San three months after the vascular endothelial growth factor before treatment difference significant (P<0.05) compared with the control group, significant differences (P<0.05)
Conclusion:the flavored Gualou San can effectively alleviate the clinical symptoms and signs of portal hypertension, can improve liver function, regulating the level of liver fibrosis, enabling patients with portal vein diameter was significantly reduced, blood flow velocity, blood flow to slow down or reduce and vascular endothelial growth factor levels can be reduced effectively. And its mechanism may be related to anti-fibrosis, prevents cirrhosis to reduce portal pressure, improve hepatic microcirculation and so on.
引文
1.李校天,姚希贤,白文元,等.丹参对肝硬化犬门脉压力及胃粘膜血流的影响[J].中国中西医结合脾胃杂志,1997,5(1)：29.
2.谭友文,殷玉梅,于学军,等.丹参、黄芪对肝硬化门脉高压血流动力学的影响[J]_上海医药,2000,2l(11)：30-32.
3.胡乃中,孔德润,许建明,等.丹参对肝硬化门脉高压血流动力学影响的临床研究[J].中华消化杂志,2004,24(10)：625-626.
4.孔德润,胡乃中,许建明,等.丹参对肝硬化门脉高压血流动力学及血管活性物质影响的相关性[J].安徽医科大学学报,2006,41(2)：166-168.
5.谭友文,殷玉梅,於学军,等.丹参对肝硬化门脉高压血液动力学及血流变性的影响[J].中国微循环,2001,5(4)：281-283.
6.谭友文.丹参、黄芪对肝硬化微循环及肝纤维化指标的影响[J].中西医结合肝病杂志,1999,9(2)：41.
7.姚希贤,李校天,李迎武,等.丹参等活血化瘀中药对门脉高压血流动力学影响的临床与实验研究[J].中华消化杂志,1998,18(1)：24.
8.黄自平,梁扩寰.当归对正常及肝硬化犬血浆胰高血糖素水平的影响[J].中国病理生理杂志,1994,10(1)：32.
9.徐列明,刘平,刘成.桃仁提取物抗实验性肝纤维化的作用观察[J].中国中药杂志,1994,19(8)：491.
10.刘成海,扶正化瘀方对肝星状细胞胶原生成的抑制作用[J].中华肝脏病杂志,1998,6(11)：4.
11.李延昌,孙玉风.赤芍抗肝纤维化的实验研究[J].中国中西医结合杂志,2003,23(10)：767-768.
12.万志强,邹晓雅.桃仁提取物合冬虫夏草治疗肝纤维化的疗效观察[J].中华腹部疾病杂志,2005,5(12)：881-882.
13.曾芬.黄芪、丹参对肝硬化门静脉高压患者血流动力学及肝纤维化指标的影响[J].江西中医药,2004,35(9)：24-25.
14.冯志杰,姚希贤.泽泻对肝硬化门脉高压大鼠离体血管的扩张效应.中华实用医学[J],2000,2(6)：7.
15.冯志杰,姚希贤.泽泻对肝硬化门脉高压大鼠血流动力学的影响[J].中国中西医结合消化杂志,2001,9(4)：218-220.
16.吴德峰,陈璇,秦玉成.灯盏细辛注射液治疗肝硬化54例临床观察[J].医学信息,2011,24(5)：145.146.
17.赵治友,姚真敏,钟庆平,等.中药鳖甲煎丸抗肝纤维化作用的临床实验研究[J].中西医结合肝病杂志,2001,11(3)：136-139..
18.孟胜喜.鳖甲煎丸治疗早期肝硬化门脉高压症63例[J].辽宁中医药大学学报,2009,11(6)：155-156.
19.林寿宁,黄贵华,王振常.壮肝逐瘀煎对大鼠星状细胞活化的影响[J].北京中医药大学学报,2004,27(5)：36-38.
20.林寿宁,黄贵华,王振常.壮肝逐瘀煎抗大鼠肝纤维化的实验研究[J].中国中西医结合脾胃病,2005,28(1)：42-45.
21.王振常,毛德文,王丽,等.壮肝逐瘀煎对肝硬化门脉高压患者血流动力学的影响[J].辽宁中医杂志,2008,35(7)：1045-1046.
22.邓鑫,吴发胜,梁健.肝宁方对肝硬化门脉高压生物力学的影响[J].医学信息,2011,3：928-929.
23.夏小芳.扶正化瘀胶囊治疗肝硬化门静脉高压症临床观察[J].中国中医急症,20l0,19(7)：1119一1120.
24.吕荣华.孙秉华老中医治疗治疗肝病的经验[J].新疆中医药,1994,1：46-47.
25.张丽慧,张文生.张志华主任医师治肝病经验[J].河北中医,1997,19(4)：26-27.
26.张娴文,李凤贤,李辉.三七皂苷抗肝纤维化作用的现状[J].中国新药杂志,2007,16(4)：260-263.
27.李佩,向芙蓉,潘惠敏,等.三七粉对肝纤维化干预作用的实验研究[J].右江民族医学院学报,2009,5：779-781.
28.邹廷英.红花联合黄芪注射液治疗肝硬化失代偿期40例[J].中国民族民间医药,2008,45(3)：45.
29.原皓,冯玉光,孙秀菊,等.红花注射液联合苦参素治疗乙肝失代偿期肝硬化的疗效观察[J].中外医疗,2008,12：1-2.
30.赵文丽,姜庆久,吴影.红花对实验性大鼠肝纤维化的抑制作用[J].黑龙江医药科学,2004,27(4)：4-5.
31.兰凤英,何静春,赵颖,等.郁金抗四氯化碳致小鼠急性肝损伤的作用[J].中国康复理论与实践,2007,13(5)：446.
32.黄小鸥,秦华珍,李彬.广西桂郁金对肝纤维化大鼠血清学指标的影响[J].广西中医药,2009,32(3)：59-61.
33. LEE H S, HUANG G T, CHEN C H, et al. Less reversal of liver fibrosis after prolonged carbon tetraehloride injection[J]. Hepatogastroenterology,2001,48:1312-1315.
34. BRIRDSALL T C. Therapeutic applications of taurine[J]. Altern Med Rev,1998,3:128-136.
35.张博,张翠萍,田字彬,等.牡蛎提取物治疗乙醇性肝病的临床效果[J].青岛大学医学院学报,2010,42(2)：122-124.
36.徐强,桑希生,梁伟.牡蛎汤对四氯化碳所致实验性肝损伤的影响[J].中医药信息,2007,24(2)：57-58.
37.徐强,李庆云,吕凤娟,等.牡蛎汤对免疫性肝损伤小鼠血清ALT、AST和肝组织TNF-α的影响[J].中国中医基础医学杂志,2008,14(2)：104-105.
38.陆再英,钟南山主编.内科学第7版[M].北京.人民卫生出版社.2008.1.446.
39. Reynaert H, Urbain D, Geerts A.Regulation ofsinusoidal perfusion in portal hypertension[J].Anat Rec (Hoboken),2008,291:693.
40.徐道振主编.病毒性肝炎临床实践[M].北京.人民卫生出版社.2006.9.370-371.
41.李建生,刘文斌.肝炎肝硬化门脉高压症的治疗现状[J].实用肝脏病杂志,2006.9(6)：375-377.
42.史多琦,姜德清.肝硬化门脉高压症的外科治疗[J].安徽医学,2011.32(5)：686-688.
43.刘澍,张文,张凯旋.门静脉高压症的研究和介入治疗现况[J].中外医疗,2010.27-181.
44. Baik SK, Jeong PH, J iSW, et al. Acute hemodynamic effects of octreotide and terlip ressin in patientswith cirrhosi: a randomizedcomparison. Am J Gastroenterol,2005,100:631.
45. Corley DA, Cello JP, AdkissonW, et al. Octreotide for acute esophageal variceal bleeding: a meta-analysis [J]. Gastroenterology,2001,120:946-954.
46. Liu TB, Lin HC, Huang YT, et al. Portal hypotensive effects of tetrandrine and verapamil in portal hypertensive rats[J]. Pharm Pharmacol,1997,49:85.
47. Park DH, Baik SK, Choi YH, et al. Inhibitory effect of angiotensin blockade on hepatic fibrosis in common bile duct-ligated rats[J]. Korean J Hepatol,2007,13:61.
48. Moller S, Henriksen JH. Cirrhotic cardiomyopathy:a pathophysiogical review of circulatory dysfunction in liver disease[J]. Heart,2002,87:9-15.
49.徐克群,陆建云,蒋利峰,等.β受体阻滞剂联合小剂量利尿剂预防肝硬化门脉高压性再出血疗效观察[J].实用临床医学,2005,10：39-41.
50.王大冰,苏言辉,张素侠,等.p受体阻滞剂联合螺内酯对肝硬化患者心功能的影响[J].临床研究,2008,28(1)：82-84.
51.孔庆钻.普萘洛尔联合消心痛预防肝硬化上消化道再出血的前瞻性研究[J].临床肝胆病杂志,2008,24(6)：456.
52. Sarin SK, Wadhawan M, Gup ta R, et al. Evaluation of endoscopic variceal ligation (EVL) versus propanolol plus isosorbide mononitrate /nadolol (ISMN) in the prevention of variceal rebleeding: comparison of cirrhotic and noncirrhotic patients [J]. Dig Dis Sci,2005,50:1538-1547.
53.史付力.联合应用治疗肝硬化门脉高压出血的临床治疗观察[J]_中国实用医药,2010,5(28)：142-143.
54.唐有为,姚希贤.中药防治肝硬化门脉高压的研究进展[J]_中国中西医结合消化杂志,200l,(02)：124-126.
55.汪朝晖.中西医结合治疗慢性乙型肝炎早期肝硬化30例临床研究[J].江苏中医药,2010,42(9)：22-23.
56.赵永忠,肖绪华,覃理灵,等.肝硬化患者外周血中血管内皮生长因子的变化及其临床意义[J].华夏医学,2010,23(1)：28-29.
57. Brodsky SV, Mendelev N, Melamed M, et al. Vascular density and VEGF expression in hepatic lesions[J]. J Gastrointestin Liver Dis,2007,16(4):373-377.
58. Ye CH, Liu XY. Intravenous injection of vascular endothelial growth factor in treatment of hepatic cirrhosis with portal hypertension in rats[J]. China Medical Engineering,2005,13(3):232-235.
59. Xu H, Shi BM, Lu XF, et al. Vascular endothelial growth factor attenuates hepatic sinusoidal capillarization in thioacetamideinduced cirrhotic rats[J]. world J Gastroenterol,2008,14(15):2349-2357..
60.蒋伟伟,赵金满,于良立,等.外源性血管内皮生长因子对肝硬化大鼠肝组织血管的影响[J].世界华人消化杂志,2011,19(10)：1009-1014.
61. Thabut D, Shah V. Intrahepatic angiogenesis and sinusoidal remodeling in chronic liver disease:new targets for the treatment of portal hypertension. Hepatol 2010,53:976-980.
62.徐珊珊,赵金满,杨思贤,等.门脉高压肝脏小叶间动脉与小叶间静脉血管内皮生长因子受体的分布[J].世界华人消化杂志,2010.18(17)：1756-1760.
63. Poordad FF, Sigal SH, Brown RS. Pathophysiologic basis for the medical management of Portal hypertension[J]. Expert Opin Pharmacother 2009,10:453-467.
64.赵永忠,肖绪华,覃理灵,等.肝硬化患者外周血中血管内皮生长因子的变化及其临床意义[J].华夏医学,2010.23(1)：28-29.
65. JAROSZEWICZ J, JANUSZKIEWICZ M. FLISIAK R, etal. Circulating vascular endothelial growth factor and its soluble receptors in patients with liver cirrhosis:possible association with hepatic function impairment[J]. Cytokine,2008,44(1):14-17.
66. RIBATFI D. The crucial role of vascular permeability factor/vascular endothelial growth factor in angiogenesis:a historical review[J]. Br J Hematol,2005,128(3):303-309.
67.邹美银,章幼奕,赵云,等.失代偿期肝硬化患者血清血管内皮生长因子水平检测的临床意义木[J].实用肝脏病杂志,2009,12(5)：359-361.
68.杨牧祥,张一昕,于文涛,等.柔肝消癥饮对肝硬化大鼠肝组织VEGF表达的影响[J].中医研究,2010,23(10)：16.18.
69.郭艳萍,杨广英,王建君.转化生长因子p一1及VEGF在肝纤维化中的表达[J].中华实用诊断与治疗杂志,2008,22：724-725.
70. Yoshiji H, Kuriyama S, Yoshii, et al. Vascular endothelial growth factor and receptor interaction is a prerequisite for murine hepatic fibrogenesis[J]. Gut,2003,52(9):1347-1354.
71.商中华,刘浔阳,黄飞舟,等.门静脉高压症胃黏膜血管内皮生长因子变化的研究[J].中华普通外科杂志,2004,19(3)：136-137.
72.商中华,张波,陈海云,等VEGF及其受体在门静脉高压性胃病中的作用[J].山西医科大学学报,2008,39(1)：55-57.
73.白云,路新卿.门静脉高压大鼠胃黏膜血管内皮生长因子的表达[J].临床合理用药,2010,3(13)：1-2.
74.任习芳,龚发良,姚佶华.血管内皮生长因子和Ⅳ型胶原、Ⅲ型前胶原、透明质酸、层黏连蛋白在恶性腹水中的诊断及意义探讨[J].临床荟萃,2009,24(7)：623-624.
75.危北海,张万岱,陈治水,等.肝硬化中西医结合诊治方案(草案)[J].中国中西医结合杂志,2004,24(10)：869-871.
76.血瘀证研究国际会议.血瘀证诊断参考标准.实用中西医结合杂志,1989,2(1)：7.
77.李民,顾尔莉,章幼奕,等.加味瓜萎散对PHT患者胃肠激素及肝纤维化指标的影响[J].江苏中医药,2009,41(1)：30-31.
78.李民,顾尔莉,章幼奕,等.加味瓜萎散对门静脉高压症大鼠门静脉压力、肝纤维化指标的影响[J].中西医结合肝病杂志,2007,17(6)：356.357.
2.谭友文,殷玉梅,于学军,等.丹参、黄芪对肝硬化门脉高压血流动力学的影响[J]_上海医药,2000,2l(11)：30-32.
3.胡乃中,孔德润,许建明,等.丹参对肝硬化门脉高压血流动力学影响的临床研究[J].中华消化杂志,2004,24(10)：625-626.
4.孔德润,胡乃中,许建明,等.丹参对肝硬化门脉高压血流动力学及血管活性物质影响的相关性[J].安徽医科大学学报,2006,41(2)：166-168.
5.谭友文,殷玉梅,於学军,等.丹参对肝硬化门脉高压血液动力学及血流变性的影响[J].中国微循环,2001,5(4)：281-283.
6.谭友文.丹参、黄芪对肝硬化微循环及肝纤维化指标的影响[J].中西医结合肝病杂志,1999,9(2)：41.
7.姚希贤,李校天,李迎武,等.丹参等活血化瘀中药对门脉高压血流动力学影响的临床与实验研究[J].中华消化杂志,1998,18(1)：24.
8.黄自平,梁扩寰.当归对正常及肝硬化犬血浆胰高血糖素水平的影响[J].中国病理生理杂志,1994,10(1)：32.
9.徐列明,刘平,刘成.桃仁提取物抗实验性肝纤维化的作用观察[J].中国中药杂志,1994,19(8)：491.
10.刘成海,扶正化瘀方对肝星状细胞胶原生成的抑制作用[J].中华肝脏病杂志,1998,6(11)：4.
11.李延昌,孙玉风.赤芍抗肝纤维化的实验研究[J].中国中西医结合杂志,2003,23(10)：767-768.
12.万志强,邹晓雅.桃仁提取物合冬虫夏草治疗肝纤维化的疗效观察[J].中华腹部疾病杂志,2005,5(12)：881-882.
13.曾芬.黄芪、丹参对肝硬化门静脉高压患者血流动力学及肝纤维化指标的影响[J].江西中医药,2004,35(9)：24-25.
14.冯志杰,姚希贤.泽泻对肝硬化门脉高压大鼠离体血管的扩张效应.中华实用医学[J],2000,2(6)：7.
15.冯志杰,姚希贤.泽泻对肝硬化门脉高压大鼠血流动力学的影响[J].中国中西医结合消化杂志,2001,9(4)：218-220.
16.吴德峰,陈璇,秦玉成.灯盏细辛注射液治疗肝硬化54例临床观察[J].医学信息,2011,24(5)：145.146.
17.赵治友,姚真敏,钟庆平,等.中药鳖甲煎丸抗肝纤维化作用的临床实验研究[J].中西医结合肝病杂志,2001,11(3)：136-139..
18.孟胜喜.鳖甲煎丸治疗早期肝硬化门脉高压症63例[J].辽宁中医药大学学报,2009,11(6)：155-156.
19.林寿宁,黄贵华,王振常.壮肝逐瘀煎对大鼠星状细胞活化的影响[J].北京中医药大学学报,2004,27(5)：36-38.
20.林寿宁,黄贵华,王振常.壮肝逐瘀煎抗大鼠肝纤维化的实验研究[J].中国中西医结合脾胃病,2005,28(1)：42-45.
21.王振常,毛德文,王丽,等.壮肝逐瘀煎对肝硬化门脉高压患者血流动力学的影响[J].辽宁中医杂志,2008,35(7)：1045-1046.
22.邓鑫,吴发胜,梁健.肝宁方对肝硬化门脉高压生物力学的影响[J].医学信息,2011,3：928-929.
23.夏小芳.扶正化瘀胶囊治疗肝硬化门静脉高压症临床观察[J].中国中医急症,20l0,19(7)：1119一1120.
24.吕荣华.孙秉华老中医治疗治疗肝病的经验[J].新疆中医药,1994,1：46-47.
25.张丽慧,张文生.张志华主任医师治肝病经验[J].河北中医,1997,19(4)：26-27.
26.张娴文,李凤贤,李辉.三七皂苷抗肝纤维化作用的现状[J].中国新药杂志,2007,16(4)：260-263.
27.李佩,向芙蓉,潘惠敏,等.三七粉对肝纤维化干预作用的实验研究[J].右江民族医学院学报,2009,5：779-781.
28.邹廷英.红花联合黄芪注射液治疗肝硬化失代偿期40例[J].中国民族民间医药,2008,45(3)：45.
29.原皓,冯玉光,孙秀菊,等.红花注射液联合苦参素治疗乙肝失代偿期肝硬化的疗效观察[J].中外医疗,2008,12：1-2.
30.赵文丽,姜庆久,吴影.红花对实验性大鼠肝纤维化的抑制作用[J].黑龙江医药科学,2004,27(4)：4-5.
31.兰凤英,何静春,赵颖,等.郁金抗四氯化碳致小鼠急性肝损伤的作用[J].中国康复理论与实践,2007,13(5)：446.
32.黄小鸥,秦华珍,李彬.广西桂郁金对肝纤维化大鼠血清学指标的影响[J].广西中医药,2009,32(3)：59-61.
33. LEE H S, HUANG G T, CHEN C H, et al. Less reversal of liver fibrosis after prolonged carbon tetraehloride injection[J]. Hepatogastroenterology,2001,48:1312-1315.
34. BRIRDSALL T C. Therapeutic applications of taurine[J]. Altern Med Rev,1998,3:128-136.
35.张博,张翠萍,田字彬,等.牡蛎提取物治疗乙醇性肝病的临床效果[J].青岛大学医学院学报,2010,42(2)：122-124.
36.徐强,桑希生,梁伟.牡蛎汤对四氯化碳所致实验性肝损伤的影响[J].中医药信息,2007,24(2)：57-58.
37.徐强,李庆云,吕凤娟,等.牡蛎汤对免疫性肝损伤小鼠血清ALT、AST和肝组织TNF-α的影响[J].中国中医基础医学杂志,2008,14(2)：104-105.
38.陆再英,钟南山主编.内科学第7版[M].北京.人民卫生出版社.2008.1.446.
39. Reynaert H, Urbain D, Geerts A.Regulation ofsinusoidal perfusion in portal hypertension[J].Anat Rec (Hoboken),2008,291:693.
40.徐道振主编.病毒性肝炎临床实践[M].北京.人民卫生出版社.2006.9.370-371.
41.李建生,刘文斌.肝炎肝硬化门脉高压症的治疗现状[J].实用肝脏病杂志,2006.9(6)：375-377.
42.史多琦,姜德清.肝硬化门脉高压症的外科治疗[J].安徽医学,2011.32(5)：686-688.
43.刘澍,张文,张凯旋.门静脉高压症的研究和介入治疗现况[J].中外医疗,2010.27-181.
44. Baik SK, Jeong PH, J iSW, et al. Acute hemodynamic effects of octreotide and terlip ressin in patientswith cirrhosi: a randomizedcomparison. Am J Gastroenterol,2005,100:631.
45. Corley DA, Cello JP, AdkissonW, et al. Octreotide for acute esophageal variceal bleeding: a meta-analysis [J]. Gastroenterology,2001,120:946-954.
46. Liu TB, Lin HC, Huang YT, et al. Portal hypotensive effects of tetrandrine and verapamil in portal hypertensive rats[J]. Pharm Pharmacol,1997,49:85.
47. Park DH, Baik SK, Choi YH, et al. Inhibitory effect of angiotensin blockade on hepatic fibrosis in common bile duct-ligated rats[J]. Korean J Hepatol,2007,13:61.
48. Moller S, Henriksen JH. Cirrhotic cardiomyopathy:a pathophysiogical review of circulatory dysfunction in liver disease[J]. Heart,2002,87:9-15.
49.徐克群,陆建云,蒋利峰,等.β受体阻滞剂联合小剂量利尿剂预防肝硬化门脉高压性再出血疗效观察[J].实用临床医学,2005,10：39-41.
50.王大冰,苏言辉,张素侠,等.p受体阻滞剂联合螺内酯对肝硬化患者心功能的影响[J].临床研究,2008,28(1)：82-84.
51.孔庆钻.普萘洛尔联合消心痛预防肝硬化上消化道再出血的前瞻性研究[J].临床肝胆病杂志,2008,24(6)：456.
52. Sarin SK, Wadhawan M, Gup ta R, et al. Evaluation of endoscopic variceal ligation (EVL) versus propanolol plus isosorbide mononitrate /nadolol (ISMN) in the prevention of variceal rebleeding: comparison of cirrhotic and noncirrhotic patients [J]. Dig Dis Sci,2005,50:1538-1547.
53.史付力.联合应用治疗肝硬化门脉高压出血的临床治疗观察[J]_中国实用医药,2010,5(28)：142-143.
54.唐有为,姚希贤.中药防治肝硬化门脉高压的研究进展[J]_中国中西医结合消化杂志,200l,(02)：124-126.
55.汪朝晖.中西医结合治疗慢性乙型肝炎早期肝硬化30例临床研究[J].江苏中医药,2010,42(9)：22-23.
56.赵永忠,肖绪华,覃理灵,等.肝硬化患者外周血中血管内皮生长因子的变化及其临床意义[J].华夏医学,2010,23(1)：28-29.
57. Brodsky SV, Mendelev N, Melamed M, et al. Vascular density and VEGF expression in hepatic lesions[J]. J Gastrointestin Liver Dis,2007,16(4):373-377.
58. Ye CH, Liu XY. Intravenous injection of vascular endothelial growth factor in treatment of hepatic cirrhosis with portal hypertension in rats[J]. China Medical Engineering,2005,13(3):232-235.
59. Xu H, Shi BM, Lu XF, et al. Vascular endothelial growth factor attenuates hepatic sinusoidal capillarization in thioacetamideinduced cirrhotic rats[J]. world J Gastroenterol,2008,14(15):2349-2357..
60.蒋伟伟,赵金满,于良立,等.外源性血管内皮生长因子对肝硬化大鼠肝组织血管的影响[J].世界华人消化杂志,2011,19(10)：1009-1014.
61. Thabut D, Shah V. Intrahepatic angiogenesis and sinusoidal remodeling in chronic liver disease:new targets for the treatment of portal hypertension. Hepatol 2010,53:976-980.
62.徐珊珊,赵金满,杨思贤,等.门脉高压肝脏小叶间动脉与小叶间静脉血管内皮生长因子受体的分布[J].世界华人消化杂志,2010.18(17)：1756-1760.
63. Poordad FF, Sigal SH, Brown RS. Pathophysiologic basis for the medical management of Portal hypertension[J]. Expert Opin Pharmacother 2009,10:453-467.
64.赵永忠,肖绪华,覃理灵,等.肝硬化患者外周血中血管内皮生长因子的变化及其临床意义[J].华夏医学,2010.23(1)：28-29.
65. JAROSZEWICZ J, JANUSZKIEWICZ M. FLISIAK R, etal. Circulating vascular endothelial growth factor and its soluble receptors in patients with liver cirrhosis:possible association with hepatic function impairment[J]. Cytokine,2008,44(1):14-17.
66. RIBATFI D. The crucial role of vascular permeability factor/vascular endothelial growth factor in angiogenesis:a historical review[J]. Br J Hematol,2005,128(3):303-309.
67.邹美银,章幼奕,赵云,等.失代偿期肝硬化患者血清血管内皮生长因子水平检测的临床意义木[J].实用肝脏病杂志,2009,12(5)：359-361.
68.杨牧祥,张一昕,于文涛,等.柔肝消癥饮对肝硬化大鼠肝组织VEGF表达的影响[J].中医研究,2010,23(10)：16.18.
69.郭艳萍,杨广英,王建君.转化生长因子p一1及VEGF在肝纤维化中的表达[J].中华实用诊断与治疗杂志,2008,22：724-725.
70. Yoshiji H, Kuriyama S, Yoshii, et al. Vascular endothelial growth factor and receptor interaction is a prerequisite for murine hepatic fibrogenesis[J]. Gut,2003,52(9):1347-1354.
71.商中华,刘浔阳,黄飞舟,等.门静脉高压症胃黏膜血管内皮生长因子变化的研究[J].中华普通外科杂志,2004,19(3)：136-137.
72.商中华,张波,陈海云,等VEGF及其受体在门静脉高压性胃病中的作用[J].山西医科大学学报,2008,39(1)：55-57.
73.白云,路新卿.门静脉高压大鼠胃黏膜血管内皮生长因子的表达[J].临床合理用药,2010,3(13)：1-2.
74.任习芳,龚发良,姚佶华.血管内皮生长因子和Ⅳ型胶原、Ⅲ型前胶原、透明质酸、层黏连蛋白在恶性腹水中的诊断及意义探讨[J].临床荟萃,2009,24(7)：623-624.
75.危北海,张万岱,陈治水,等.肝硬化中西医结合诊治方案(草案)[J].中国中西医结合杂志,2004,24(10)：869-871.
76.血瘀证研究国际会议.血瘀证诊断参考标准.实用中西医结合杂志,1989,2(1)：7.
77.李民,顾尔莉,章幼奕,等.加味瓜萎散对PHT患者胃肠激素及肝纤维化指标的影响[J].江苏中医药,2009,41(1)：30-31.
78.李民,顾尔莉,章幼奕,等.加味瓜萎散对门静脉高压症大鼠门静脉压力、肝纤维化指标的影响[J].中西医结合肝病杂志,2007,17(6)：356.357.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |