中医药论治HBeAg阴性慢性乙型肝炎的现状与展望
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摘要
HBeAg阴性慢性乙型肝炎(CHB)是CHB中的特殊临床类型,是近年来CHB研究领域的热点之一。中医药在防治HBeAg阴性CHB方面进行着积极有益的探索并取得不少进展。CHB中医学的总体病因病机已基本达成共识,但针对HBeAg阴性CHB的病因病机学探讨仍需细化; HBeAg阴性CHB中医证候研究主要涉及中医证候规律及证候生物学基础等方面; HBeAg阴性CHB的中医治疗主要涉及基于中医辨证的中药复方论治以及基于抗病毒治疗的中西医结合治疗两方面。HBeAg阴性CHB治疗疗程长、具体疗程不明确、停药后复发率高,目前尚无可预见的新药物在近年上市,因此基于循证医学证据的大数据中医诊疗资料,努力探索适宜的HBeAg阴性CHB中医中药或中西医结合诊疗方案作为必要补充,具有重要意义。
HBe Ag-negative chronic hepatitis B( CHB),a special clinical types in CHB,is one of the hot research fields in CHB. The TCM treatment of HBe Ag-negative CHB has been carried on the positive beneficial exploration and achieved a lot of progress. Based on the principle of TCM,the overall etiology and pathogenesis of CHB has been reached a consensus,which need to be further refined in HBe Ag-negative CHB. As to the syndrome differentiation of TCM in HBe Agnegative CHB,the law of the syndrome or the biological basis of the syndrome has been studied. Both the treatment of chinese medicine compound based on the syndrome differentiation of TCM and the therapy combined with chinese medicine and western medicine based on the antiviral treatment have been involved.With a long and unclear course of treatment and a high rate of relapse after drug withdrawal,there is no foreseeable new drug for the treatment of HBe Ag-negative CHB in recent years. As a necessary supplement in the diagnosis and treatment of HBe Ag-negative CHB,it will be of great significance that a suitable TCM scheme or the therapy combined with Chinese medicine and western medicine should be tried to explore based on the large and evidence-based medical data of TCM.
HBe Ag-negative chronic hepatitis B( CHB),a special clinical types in CHB,is one of the hot research fields in CHB. The TCM treatment of HBe Ag-negative CHB has been carried on the positive beneficial exploration and achieved a lot of progress. Based on the principle of TCM,the overall etiology and pathogenesis of CHB has been reached a consensus,which need to be further refined in HBe Ag-negative CHB. As to the syndrome differentiation of TCM in HBe Agnegative CHB,the law of the syndrome or the biological basis of the syndrome has been studied. Both the treatment of chinese medicine compound based on the syndrome differentiation of TCM and the therapy combined with chinese medicine and western medicine based on the antiviral treatment have been involved.With a long and unclear course of treatment and a high rate of relapse after drug withdrawal,there is no foreseeable new drug for the treatment of HBe Ag-negative CHB in recent years. As a necessary supplement in the diagnosis and treatment of HBe Ag-negative CHB,it will be of great significance that a suitable TCM scheme or the therapy combined with Chinese medicine and western medicine should be tried to explore based on the large and evidence-based medical data of TCM.
引文
[1]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015更新版)[J].中华肝脏病杂志,2015,23(12):888-905.
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[4]胡九东,邢练军,张玮,等.HBeAg阴性的慢性乙型肝炎[J].中西医结合肝病杂志,2012,22(1):56-57.
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[7] LAMPERTICO P,SOFFREDINI R,VIGANO M,et al.5-yearentecavirtreatment in NUC-naive,field-practice patients withchronic hepatitis B showed excellent viral suppression and safetyprofile but no prevention of HCC in cirrhosis[J]. Journal ofhepatology,2013,58:S306.
[8] SETO WK,HUI AJ,WONG VW,et al. Treatment cessation ofentecavir in Asian patients with hepatitis B e antigen negativechronic hepatitis B:a multicentre prospective study[J]. Gut,2015,64(4):667-672.
[9] BRAHMANIA M,FELD J,ARIF A,et al.New therapeutic agentsfor chronic hepatitis B[J]. The Lancet infectious diseases,2016,16(2):e10-21.
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[11]谷灿立,张振强,付月箫,等.中西医结合治疗HBe Ag阴性慢性乙型肝炎的临床研究[J].世界中医药,2008,3(4):204-206.
[12]蒋开平,陶银,胡洪涛,等.温阳活血解毒法治疗HBeAg阴性慢性乙型肝炎的临床研究[J].北京中医药大学学报:中医临床版,2009,16(4):9-12.
[13]肖倩.慢性乙型肝炎HBeAg阴性患者乙肝病毒变异与中医辨证分型的关系[J].中医杂志,2006,47(6):454-455.
[14]陈培琼,张金珍,田广俊,等.HBeAg阴性慢性乙型肝炎中医证型分布及与HBVDNA、肝纤四项关系的研究[J].中国中医药信息杂志,2009,16(11):15-18.
[15]罗俊华,曹秋实. HBeAg阴性慢性乙型肝炎中医证型与T淋巴细胞亚群及IL-4、IFN-γ相关性研究[J].云南中医学院学报,2014,37(4):1-3.
[16] LEI WANG,LI ZHANG,XIAOXIA FENG,et al. The FunctionalDifference of Dendritic Cells in HBe Ag Negative Chronic Hepatitis BPatients with Three Different Spleen Deficiency Syndromes and theTherapeutic Evaluation of Chinese Medicine Intervention Based onSyndrome Differentiation[J]. Evidence-Based Complementary andAlternative Medicine,2014,2014,1-10.
[17]刘业方,张传涛,黄群,等.基于microiRNA调控的HBeAg(-)轻度慢性乙型肝炎脾胃湿热证发生的分子机制研究[J].辽宁中医杂志,2016,43(9):1803-1806.
[18]李洁,赵晓东,史美育,等.慢性乙型肝炎中医证型临床文献研究[J].中国中医基础医学杂志,2006,12(1):57-58.
[19]叶永安,田德录,李晓林,等.疏肝理脾方治HBeAg阴性慢性乙型肝炎的临床研究[J].中西医结合肝病杂志,2006,16(6):325-326.
[20]陈典发,杨创国,邓国雄.疏肝理脾合剂治疗HBeAg阴性慢性乙型肝炎肝纤维化63例总结[J].湖南中医杂志,2010,26(5):22-25.
[21]徐礼通,周全胜.清热养阴化湿方治疗HBeAg阴性慢性乙型肝炎30例[J].中西医结合肝病杂志,2010,20(5):304-305.
[22]张兴宏.八珍涤痰汤治疗HBeAg阴性慢性乙型肝炎76例疗效观察[J].中国中医药科技,2012,19(4):357-358.
[23]雷陵,刘志勇,夏启芝,等.扶正益肝颗粒对HBeAg阴性慢性乙型肝炎病毒低水平复制的影响[J].中西医结合肝病杂志,2013,23(4):199-202.
[24]叶峥嵘,杜卫星,吴琳.加味柴平汤对HBeAg阴性慢性乙型肝炎的临床研究[J].中国中药杂志,2016,41(20):3875-3880.
[25]李小科,叶永安,杜宏波.基于2015年版慢性乙型肝炎防治指南谈中医药治疗的机遇与挑战[J].世界中医药,2016,11(2):364-367.
[26]杨华升.加味真武汤联合干扰素治疗HBeAg阴性慢性乙型肝炎临床研究[J].中西医结合肝病杂志,2007,17(4):200-202.
[27]蒲朝晖,丁天玉,薛文翰,等.中药强肝合剂联合拉米夫定治疗HBeAg阴性慢性乙型肝炎临床研究[J].中华中医药学刊,2008,26(6):1205-1207.
[28]万凌峰,高加齐,邵铭,等.益气健脾清肝方联合拉米夫定治疗HBeAg阴性慢性乙型病毒性肝炎脾虚湿热证37例临床观察[J].河北中医,2011,33(10):1510-1511.
[29]江堤,扬光,罗万蓉.阿德福韦联合苦参素治疗HBe Ag阴性慢性乙肝效果研究[J].现代预防医学,2009,36(8):1587-1590.
[30]付修文,李玉平.双虎清肝颗粒联合阿德福韦酯治疗HBeAg阴性的慢性乙型肝炎35例疗效观察[J].中国中医基础医学杂志,2009,15(11):876-877.
[31]高淑俊,常丽萍.六味五灵片联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎[J].传染病信息,2011,24(1):49-51.
[32]张志沛.复方鳖甲软肝片联合阿德福韦酯胶囊治疗HBeAg阴性慢性乙型肝炎36例[J].河南预防医学杂志,2012,23(3):23-244.
[33]江杰,李丽,王利红,等.安络化纤丸联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎对血清肝纤维化指标的影响[J].实用肝脏病杂志,2013,16(6):539-540.
[34]王彬,马利,龙远雄,等.中药联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎的系统评价[J].湖北中医药大学学报,2015,17(4):111-115.
[35]黄春红,余会元,万谟彬,等.替比夫定联合双虎清肝颗粒治疗慢性乙型肝炎的初步疗效[J].上海医学,2011,34(3):228-230.
[36]罗俊华,巴元明,曹秋实.地五养肝方治疗HBeAg阴性慢性乙型肝炎的疗效及肝脏瞬时弹性变化的意义[J].时珍国医国药,2014,25(11):2692-2694.
[37]罗俊华,曹秋实.地五养肝方对HBeAg阴性慢性乙型肝炎患者外周血T淋巴细胞亚群和细胞因子的影响[J].中国中医急症,2014,23(8):1505-1507.
[38]王闻婧,巴元明.补肾驱邪法对HBe Ag阴性慢性乙型肝炎患者生存质量的影响[J].时珍国医国药,2016,27(10):2441-2443.
[39]李秀慧,杨华升,李丰农,等.病毒性肝炎中医辨证标准[J].临床肝胆病杂志,2017,33(10):1839-1846.
[40] LOK AS,ZOULIM F,DUSHEIKO G,et al. Hepatitis B cure:From discovery to regulatory approval[J]. Hepatology,2017,66(4):1296-1313.
[2] EUROPEAN ASSOCIATION FOR THE STUDY OF THE LIVER.EASL 2017 Clinical Practice Guidelines on the management ofhepatitis B virus infection. Journal of hepatology[J]. 2017,67(2):370-398.
[3] HADZIYANNIS SJ.Natural history of chronic hepatitis B in Euro-Mediterranean and African countries[J]. Journal of hepatology,2011,55(1):183-191.
[4]胡九东,邢练军,张玮,等.HBeAg阴性的慢性乙型肝炎[J].中西医结合肝病杂志,2012,22(1):56-57.
[5]杨创国,于乐成,陈金军,等.1686例慢性乙型肝炎中HBeAg阴性与阳性患者临床和病学特点比较分析[J].中华内科杂志,2005,44(9):648-651.
[6] CAI G,YIN W.Methodological considerations in studying naturalhistory of HBeAg-negative and-positive chronic hepatitis B[J].Liver international,2012,32(4):689-690.
[7] LAMPERTICO P,SOFFREDINI R,VIGANO M,et al.5-yearentecavirtreatment in NUC-naive,field-practice patients withchronic hepatitis B showed excellent viral suppression and safetyprofile but no prevention of HCC in cirrhosis[J]. Journal ofhepatology,2013,58:S306.
[8] SETO WK,HUI AJ,WONG VW,et al. Treatment cessation ofentecavir in Asian patients with hepatitis B e antigen negativechronic hepatitis B:a multicentre prospective study[J]. Gut,2015,64(4):667-672.
[9] BRAHMANIA M,FELD J,ARIF A,et al.New therapeutic agentsfor chronic hepatitis B[J]. The Lancet infectious diseases,2016,16(2):e10-21.
[10]中华中医药学会内科肝胆病学组,世界中医药联合学会肝病专业委员会,中国中西医结合学会肝病组.慢性乙型肝炎中医诊疗专家共识(2012年1月)[J].临床肝胆病杂志,2012,28(3):164-168.
[11]谷灿立,张振强,付月箫,等.中西医结合治疗HBe Ag阴性慢性乙型肝炎的临床研究[J].世界中医药,2008,3(4):204-206.
[12]蒋开平,陶银,胡洪涛,等.温阳活血解毒法治疗HBeAg阴性慢性乙型肝炎的临床研究[J].北京中医药大学学报:中医临床版,2009,16(4):9-12.
[13]肖倩.慢性乙型肝炎HBeAg阴性患者乙肝病毒变异与中医辨证分型的关系[J].中医杂志,2006,47(6):454-455.
[14]陈培琼,张金珍,田广俊,等.HBeAg阴性慢性乙型肝炎中医证型分布及与HBVDNA、肝纤四项关系的研究[J].中国中医药信息杂志,2009,16(11):15-18.
[15]罗俊华,曹秋实. HBeAg阴性慢性乙型肝炎中医证型与T淋巴细胞亚群及IL-4、IFN-γ相关性研究[J].云南中医学院学报,2014,37(4):1-3.
[16] LEI WANG,LI ZHANG,XIAOXIA FENG,et al. The FunctionalDifference of Dendritic Cells in HBe Ag Negative Chronic Hepatitis BPatients with Three Different Spleen Deficiency Syndromes and theTherapeutic Evaluation of Chinese Medicine Intervention Based onSyndrome Differentiation[J]. Evidence-Based Complementary andAlternative Medicine,2014,2014,1-10.
[17]刘业方,张传涛,黄群,等.基于microiRNA调控的HBeAg(-)轻度慢性乙型肝炎脾胃湿热证发生的分子机制研究[J].辽宁中医杂志,2016,43(9):1803-1806.
[18]李洁,赵晓东,史美育,等.慢性乙型肝炎中医证型临床文献研究[J].中国中医基础医学杂志,2006,12(1):57-58.
[19]叶永安,田德录,李晓林,等.疏肝理脾方治HBeAg阴性慢性乙型肝炎的临床研究[J].中西医结合肝病杂志,2006,16(6):325-326.
[20]陈典发,杨创国,邓国雄.疏肝理脾合剂治疗HBeAg阴性慢性乙型肝炎肝纤维化63例总结[J].湖南中医杂志,2010,26(5):22-25.
[21]徐礼通,周全胜.清热养阴化湿方治疗HBeAg阴性慢性乙型肝炎30例[J].中西医结合肝病杂志,2010,20(5):304-305.
[22]张兴宏.八珍涤痰汤治疗HBeAg阴性慢性乙型肝炎76例疗效观察[J].中国中医药科技,2012,19(4):357-358.
[23]雷陵,刘志勇,夏启芝,等.扶正益肝颗粒对HBeAg阴性慢性乙型肝炎病毒低水平复制的影响[J].中西医结合肝病杂志,2013,23(4):199-202.
[24]叶峥嵘,杜卫星,吴琳.加味柴平汤对HBeAg阴性慢性乙型肝炎的临床研究[J].中国中药杂志,2016,41(20):3875-3880.
[25]李小科,叶永安,杜宏波.基于2015年版慢性乙型肝炎防治指南谈中医药治疗的机遇与挑战[J].世界中医药,2016,11(2):364-367.
[26]杨华升.加味真武汤联合干扰素治疗HBeAg阴性慢性乙型肝炎临床研究[J].中西医结合肝病杂志,2007,17(4):200-202.
[27]蒲朝晖,丁天玉,薛文翰,等.中药强肝合剂联合拉米夫定治疗HBeAg阴性慢性乙型肝炎临床研究[J].中华中医药学刊,2008,26(6):1205-1207.
[28]万凌峰,高加齐,邵铭,等.益气健脾清肝方联合拉米夫定治疗HBeAg阴性慢性乙型病毒性肝炎脾虚湿热证37例临床观察[J].河北中医,2011,33(10):1510-1511.
[29]江堤,扬光,罗万蓉.阿德福韦联合苦参素治疗HBe Ag阴性慢性乙肝效果研究[J].现代预防医学,2009,36(8):1587-1590.
[30]付修文,李玉平.双虎清肝颗粒联合阿德福韦酯治疗HBeAg阴性的慢性乙型肝炎35例疗效观察[J].中国中医基础医学杂志,2009,15(11):876-877.
[31]高淑俊,常丽萍.六味五灵片联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎[J].传染病信息,2011,24(1):49-51.
[32]张志沛.复方鳖甲软肝片联合阿德福韦酯胶囊治疗HBeAg阴性慢性乙型肝炎36例[J].河南预防医学杂志,2012,23(3):23-244.
[33]江杰,李丽,王利红,等.安络化纤丸联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎对血清肝纤维化指标的影响[J].实用肝脏病杂志,2013,16(6):539-540.
[34]王彬,马利,龙远雄,等.中药联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎的系统评价[J].湖北中医药大学学报,2015,17(4):111-115.
[35]黄春红,余会元,万谟彬,等.替比夫定联合双虎清肝颗粒治疗慢性乙型肝炎的初步疗效[J].上海医学,2011,34(3):228-230.
[36]罗俊华,巴元明,曹秋实.地五养肝方治疗HBeAg阴性慢性乙型肝炎的疗效及肝脏瞬时弹性变化的意义[J].时珍国医国药,2014,25(11):2692-2694.
[37]罗俊华,曹秋实.地五养肝方对HBeAg阴性慢性乙型肝炎患者外周血T淋巴细胞亚群和细胞因子的影响[J].中国中医急症,2014,23(8):1505-1507.
[38]王闻婧,巴元明.补肾驱邪法对HBe Ag阴性慢性乙型肝炎患者生存质量的影响[J].时珍国医国药,2016,27(10):2441-2443.
[39]李秀慧,杨华升,李丰农,等.病毒性肝炎中医辨证标准[J].临床肝胆病杂志,2017,33(10):1839-1846.
[40] LOK AS,ZOULIM F,DUSHEIKO G,et al. Hepatitis B cure:From discovery to regulatory approval[J]. Hepatology,2017,66(4):1296-1313.