中医药治疗肝硬化研究进展
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摘要
中医药通过辨证论治的个体化诊疗方案,在中医药治疗肝硬化上具有明显优势。作者主要介绍有效治疗肝硬化的中药复方、中成药及相关单味药,指出中医药治疗肝硬化的相关机制及靶点尚不明确,仍需我们进一步去研究。
TCM has obvious advantages in the treatment of liver cirrhosis through the individualized treatment scheme of syndrome differentiation. The author mainly introduces the effective compound Chinese medicine for the treatment of cirrhosis of the liver and related single herbs,traditional Chinese is pointed out that the related mechanism of traditional Chinese medicine treatment of cirrhosis of the liver and the target is not clear,still need us to study further.
TCM has obvious advantages in the treatment of liver cirrhosis through the individualized treatment scheme of syndrome differentiation. The author mainly introduces the effective compound Chinese medicine for the treatment of cirrhosis of the liver and related single herbs,traditional Chinese is pointed out that the related mechanism of traditional Chinese medicine treatment of cirrhosis of the liver and the target is not clear,still need us to study further.
引文
[1] Tsochatzis E A,Bosch J,Burroughs A K. Liver cirrhosis[J].Lancet,2014,383(9930):1749-1761.
[2] Tseng P L,Lu S N,Tung H D,et al. Determinants of early mortality and benefits of lamivudine therapy in patients with hepatitis B virus-related decompensated liver cirrhosis.[J].Journal of Viral Hepatitis,2005,12(4):386-392.
[3] Fasinu P S,Bouic P J,Rosenkranz B. An overview of the evidence and mechanisms of herb-drug interactions[J]. Front Pharmacol,2012,3:69.
[4] Liaw Y F,Leung N,Kao J H,et al. Asian-Pacific consensus statement on the management of chronic hepatitis B:a 2008update[J]. Chinese Journal of Gastroenterology&Hepatology,2012,2(3):263.
[5] Lv G C,Yao J M,Yang Y D,et al. Efficacy of combined therapy in patients with hepatitis B virus-related decompensated cirrhosis[J]. World J Gastroenterol,2013,19(22):3481-3486.
[6] Naveau S,Perlemuter G,Balian A. Epidemiology and natural history of cirrhosis[J]. La Revue Du Praticien,2005,55(14):1527.
[7] Innes HA.Quantifying the fraction of cirrhosis attributable to alcohol among chronic hepatitis C virus patients:implications for treatment cost-effectiveness[J]. Hepatology,2013,57(2):451-460.
[8] Britton R S,Brown K E. Genetic hemochromatosis and Wilson's disease:role for oxidant stress[J]. Hepatology,1995,21(4):1195-1197.
[9] Camaschella C. Treating iron overload[J]. New England Journal of Medicine,2013,368(24):2325-2327.
[10] Deutsch M.Autoimmune Hepatitis or Wilson's Disease a Clinical Dilemma[J]. Hepatitis Monthly,2013,13(5):751.
[11] Wu SJ,Yang YH,Tsuneyama K,et al. Innate immunity and primary biliary cirrhosis:activated invariant natural killer T cells exacerbate murine autoimmune cholangitis and fibrosis[J].Hepatology,2011(53):915-925.
[12] Popov Y. Mouse model of primary biliary cirrhosis with progressive fibrosis:are we there yet[J]. Hepatology,2013,57(2):429-431.
[13] Selmi C,Bowlus CL,Gershwin ME,et al. Primary biliary cirrhosis[J].Lancet,2011,377:1600-1609.
[14] Ji-li Yuan,Hua Zhang,Lei Wang,et al. Biochemical characteristics of traditional Chinese medicine syndromes and their elements in patients with hepatitis B cirrhosis[J]. Journal of Chinese integrative medicine,2011,9(4):374-381.
[15]张琳,吴秀艳,薛晓琳,等.基于现代文献的肝硬化中医证候及证候要素分布特点的研究[J].北京中医药大学学报,2012,35(11):747-751.
[16]张育轩.肝硬化临床诊断、中医辨证和疗效评定标准(试行方案)[J].中国中西医结合杂志,1994(4):237-238.
[17]姚树坤,刘成海.肝硬化腹水的中西医结合诊疗共识意见[J].中国中西医结合杂志,2011,31(9):1171-1174.
[18]李毅,刘艳,汶明琦,等.肝硬化的中医辨证分型分析[J].世界科学技术-中医药现代化,2012,14(1):1273-1276.
[19]刘平.肝炎后肝硬化“病证结合”中医证候病机分类与临床疗效评价量表体系[C]//全国中西医结合传染病学术会议.北京:中国中西医结合学会,2012.
[20] Zhang L,Schuppan D. Traditional Chinese Medicine(TCM)for fibrotic liver disease:hope and hype[J]. Journal of Hepatology,2014,61(1):166-168.
[21]梁小立.大黄蛰虫丸治疗病毒性肝炎肝硬化临床观察[J].中外医疗,2009,28(11):129-130.
[22]董昌将,陈向荣.加味下瘀血汤治疗早中期肝硬化120例[J].浙江中医杂志,2001,36(8):339-339.
[23]陈治平.鳖甲煎丸治疗肝炎肝硬化24例[J].中西医结合肝病杂志,2007,17(4):242-243.
[24]赵玉瑶,高天旭.经方桂枝茯苓丸治疗肝硬化32例[J].中国中西医结合脾胃杂志,1998,6(3):190.
[25]孙阳.补阳还五汤治疗肝硬化30例[J].中国民间疗法,2004,12(8):47-48.
[26]赵长青,徐列明.扶正化瘀胶囊/片治疗肝纤维化和肝硬化的临床研究进展[J].世界中医药,2014,(5):561-567.
[27]李佑桥,张亚琳.复方鳖甲软肝片联合恩替卡韦治疗乙肝后肝硬化疗效观察[J].实用中医药杂志,2011,27(7):456-457.
[28]陈国中,徐珊,张永生,等.肝纤维化中医病机与治疗的探讨[J].浙江中医杂志,2011,46(6):395-396.
[29]张向磊.基于中医传承辅助平台的中医药治疗乙肝肝硬化用药规律分析[J].世界中医药,2016,11(10):2160-2163.
[30] Yan-Yan Tao,Cheng-Hai Liu.Progress of research on mechanism of salvia miltiorrhiza and its chemical ingredients against liver fibrosis[J]. Journal of Chinese Integrative Medicine,2004,2(2):145-148.
[31] Hua Y,Xue W,Zhang M,et al. Metabonomics study on the hepatoprotective effect of polysaccharides from different preparations of Angelica sinensis[J]. Journal of Ethnopharmacology,2014,151(3):1090-1099.
[32] Bai G,Yan G,Wang G,et al. Anti-hepatic fibrosis effects of a novel turtle shell decoction by inhibiting hepatic stellate cell proliferation and blocking TGF-β1/Smad signaling pathway in rats[J]. Oncology Reports,2016,36(5):2902.
[33]姜宏伟.单味鳖甲治疗肝炎肝硬化30例[J].临床医学,2007,27(6):93-94.
[34]谢燕华,于泳,陈捷.柴胡对肝硬化大鼠α-肌动蛋白及转化生长因子β1表达的影响[J].陕西中医,2011,32(10):1423-1424.
[35] Hong Xuezhi,Tang Huiqing,Wu Limao,et al. Protective effects of the Alisma orientalis extract on the experimental nonalcoholic fatty liver disease[J]. The Journal of pharmacy and pharmacology,2006,58(10):1391-1398.
[36] Jin M,Zhao K,Huang Q,et al. Structural features and biological activities of the polysaccharides from Astragalus membranaceus[J]. International Journal of Biological Macromolecules,2014,64(2):257.
[37] Wei W,Xiao H T,Bao W R,et al. TLR-4 may mediate signaling pathways of Astragalus polysaccharide RAP induced cytokine expression of RAW264.7 cells[J]. Journal of Ethnopharmacology,2015,179(8):243-252.
[38] Zhao Ming,Zhang Zhao Feng,Ding Ye,et al. Astragalus polysaccharide improves palmitate-induced insulin resistance by inhibiting PTP1 B and NF-κB in C2 C1 2 myotubes[J].Molecules(Basel,Switzerland),2012,17(6):7083-7092.
[39] Changping D,Liu J,Qiu F,et al. Effects ofAstragaluspolysaccha rides on memory impairment in a diabetic rat model[J]. Neuropsychiatric Disease&Treatment,2016,12(1):1617-1621.
[40] Jiang J B,Wu C H,Gao H,et al. Effects of astragalus polysaccharides on immunologic function of erythrocyte in chickens infected with infectious bursa disease virus[J].Vaccine,2010,28(34):5614-5616.
[41] Yang B,Xiao B,Sun T. Antitumor and immunomodulatory activity of Astragalus membranaceus polysaccharides in H22tumor-bearing mice[J]. International Journal of Biological Macromolecules,2013,62(11):287.
[42] Sun S.Regulatory Effect of Astragalus Polysaccharides on Intestinal IntraepithelialγδT Cells of Tumor Bearing Mice[J].Molecules,2014,19(9):15224-15236
[43] Han B,Gao Y,Wang Y,et al. Protective effect of a polysaccharide from Rhizoma Atractylodis Macrocephalae on acute liver injury in mice[J]. International journal of biological macromolecules,2016,87:85-91.
[44] Huo Hai Zhong,Wang Bing,Liang Yong Kang,et al.Hepatoprotective and Antioxidant Effects of Licorice Extract against CCl(4)-Induced Oxidative Damage in Rats[J].International journal of molecular sciences,2011,12(10):6529-6543.
[45] Son C G. Compositions for Protecting Liver or for Preventing or Treating Liver Fibrosis or Cirrhosis:US,US 20080260870 A1[P]. 2008-02-06[2008-10-23]. https://www.freshpatents.com/Gro-protect-solutions-dt20081023ptan20080260870.php.
[46]张小霞,吴巧凤,董旭旦,等.猪苓多糖的提取工艺优化及抗氧化活性研究[J].中华中医药学刊,2016,34(8):2025-2028.
[47]刘洪超,杨小龙,王淑英.猪苓药理作用研究进展[J].河南科技大学学报(医学版),2011,29(2):159-160.
[48]张昌菊,郭秀.猪苓多糖抗肿瘤作用的机制研究[J].实用医学进修杂志,1995,23(3):150-152.
[49]高梅,谢蜀生.猪苓多糖对小鼠免疫功能的增强作用[J].中国免疫学杂志,1991,7(3):185-187.
[50] John M Luk,Xiaoling Wang,Ping Liu,et al. Traditional Chinese herbal medicines for treatment of liver fibrosis and cancer from laboratory discovery to clinical evaluation[J]. Liver international,2007,27(7):879-890.
[2] Tseng P L,Lu S N,Tung H D,et al. Determinants of early mortality and benefits of lamivudine therapy in patients with hepatitis B virus-related decompensated liver cirrhosis.[J].Journal of Viral Hepatitis,2005,12(4):386-392.
[3] Fasinu P S,Bouic P J,Rosenkranz B. An overview of the evidence and mechanisms of herb-drug interactions[J]. Front Pharmacol,2012,3:69.
[4] Liaw Y F,Leung N,Kao J H,et al. Asian-Pacific consensus statement on the management of chronic hepatitis B:a 2008update[J]. Chinese Journal of Gastroenterology&Hepatology,2012,2(3):263.
[5] Lv G C,Yao J M,Yang Y D,et al. Efficacy of combined therapy in patients with hepatitis B virus-related decompensated cirrhosis[J]. World J Gastroenterol,2013,19(22):3481-3486.
[6] Naveau S,Perlemuter G,Balian A. Epidemiology and natural history of cirrhosis[J]. La Revue Du Praticien,2005,55(14):1527.
[7] Innes HA.Quantifying the fraction of cirrhosis attributable to alcohol among chronic hepatitis C virus patients:implications for treatment cost-effectiveness[J]. Hepatology,2013,57(2):451-460.
[8] Britton R S,Brown K E. Genetic hemochromatosis and Wilson's disease:role for oxidant stress[J]. Hepatology,1995,21(4):1195-1197.
[9] Camaschella C. Treating iron overload[J]. New England Journal of Medicine,2013,368(24):2325-2327.
[10] Deutsch M.Autoimmune Hepatitis or Wilson's Disease a Clinical Dilemma[J]. Hepatitis Monthly,2013,13(5):751.
[11] Wu SJ,Yang YH,Tsuneyama K,et al. Innate immunity and primary biliary cirrhosis:activated invariant natural killer T cells exacerbate murine autoimmune cholangitis and fibrosis[J].Hepatology,2011(53):915-925.
[12] Popov Y. Mouse model of primary biliary cirrhosis with progressive fibrosis:are we there yet[J]. Hepatology,2013,57(2):429-431.
[13] Selmi C,Bowlus CL,Gershwin ME,et al. Primary biliary cirrhosis[J].Lancet,2011,377:1600-1609.
[14] Ji-li Yuan,Hua Zhang,Lei Wang,et al. Biochemical characteristics of traditional Chinese medicine syndromes and their elements in patients with hepatitis B cirrhosis[J]. Journal of Chinese integrative medicine,2011,9(4):374-381.
[15]张琳,吴秀艳,薛晓琳,等.基于现代文献的肝硬化中医证候及证候要素分布特点的研究[J].北京中医药大学学报,2012,35(11):747-751.
[16]张育轩.肝硬化临床诊断、中医辨证和疗效评定标准(试行方案)[J].中国中西医结合杂志,1994(4):237-238.
[17]姚树坤,刘成海.肝硬化腹水的中西医结合诊疗共识意见[J].中国中西医结合杂志,2011,31(9):1171-1174.
[18]李毅,刘艳,汶明琦,等.肝硬化的中医辨证分型分析[J].世界科学技术-中医药现代化,2012,14(1):1273-1276.
[19]刘平.肝炎后肝硬化“病证结合”中医证候病机分类与临床疗效评价量表体系[C]//全国中西医结合传染病学术会议.北京:中国中西医结合学会,2012.
[20] Zhang L,Schuppan D. Traditional Chinese Medicine(TCM)for fibrotic liver disease:hope and hype[J]. Journal of Hepatology,2014,61(1):166-168.
[21]梁小立.大黄蛰虫丸治疗病毒性肝炎肝硬化临床观察[J].中外医疗,2009,28(11):129-130.
[22]董昌将,陈向荣.加味下瘀血汤治疗早中期肝硬化120例[J].浙江中医杂志,2001,36(8):339-339.
[23]陈治平.鳖甲煎丸治疗肝炎肝硬化24例[J].中西医结合肝病杂志,2007,17(4):242-243.
[24]赵玉瑶,高天旭.经方桂枝茯苓丸治疗肝硬化32例[J].中国中西医结合脾胃杂志,1998,6(3):190.
[25]孙阳.补阳还五汤治疗肝硬化30例[J].中国民间疗法,2004,12(8):47-48.
[26]赵长青,徐列明.扶正化瘀胶囊/片治疗肝纤维化和肝硬化的临床研究进展[J].世界中医药,2014,(5):561-567.
[27]李佑桥,张亚琳.复方鳖甲软肝片联合恩替卡韦治疗乙肝后肝硬化疗效观察[J].实用中医药杂志,2011,27(7):456-457.
[28]陈国中,徐珊,张永生,等.肝纤维化中医病机与治疗的探讨[J].浙江中医杂志,2011,46(6):395-396.
[29]张向磊.基于中医传承辅助平台的中医药治疗乙肝肝硬化用药规律分析[J].世界中医药,2016,11(10):2160-2163.
[30] Yan-Yan Tao,Cheng-Hai Liu.Progress of research on mechanism of salvia miltiorrhiza and its chemical ingredients against liver fibrosis[J]. Journal of Chinese Integrative Medicine,2004,2(2):145-148.
[31] Hua Y,Xue W,Zhang M,et al. Metabonomics study on the hepatoprotective effect of polysaccharides from different preparations of Angelica sinensis[J]. Journal of Ethnopharmacology,2014,151(3):1090-1099.
[32] Bai G,Yan G,Wang G,et al. Anti-hepatic fibrosis effects of a novel turtle shell decoction by inhibiting hepatic stellate cell proliferation and blocking TGF-β1/Smad signaling pathway in rats[J]. Oncology Reports,2016,36(5):2902.
[33]姜宏伟.单味鳖甲治疗肝炎肝硬化30例[J].临床医学,2007,27(6):93-94.
[34]谢燕华,于泳,陈捷.柴胡对肝硬化大鼠α-肌动蛋白及转化生长因子β1表达的影响[J].陕西中医,2011,32(10):1423-1424.
[35] Hong Xuezhi,Tang Huiqing,Wu Limao,et al. Protective effects of the Alisma orientalis extract on the experimental nonalcoholic fatty liver disease[J]. The Journal of pharmacy and pharmacology,2006,58(10):1391-1398.
[36] Jin M,Zhao K,Huang Q,et al. Structural features and biological activities of the polysaccharides from Astragalus membranaceus[J]. International Journal of Biological Macromolecules,2014,64(2):257.
[37] Wei W,Xiao H T,Bao W R,et al. TLR-4 may mediate signaling pathways of Astragalus polysaccharide RAP induced cytokine expression of RAW264.7 cells[J]. Journal of Ethnopharmacology,2015,179(8):243-252.
[38] Zhao Ming,Zhang Zhao Feng,Ding Ye,et al. Astragalus polysaccharide improves palmitate-induced insulin resistance by inhibiting PTP1 B and NF-κB in C2 C1 2 myotubes[J].Molecules(Basel,Switzerland),2012,17(6):7083-7092.
[39] Changping D,Liu J,Qiu F,et al. Effects ofAstragaluspolysaccha rides on memory impairment in a diabetic rat model[J]. Neuropsychiatric Disease&Treatment,2016,12(1):1617-1621.
[40] Jiang J B,Wu C H,Gao H,et al. Effects of astragalus polysaccharides on immunologic function of erythrocyte in chickens infected with infectious bursa disease virus[J].Vaccine,2010,28(34):5614-5616.
[41] Yang B,Xiao B,Sun T. Antitumor and immunomodulatory activity of Astragalus membranaceus polysaccharides in H22tumor-bearing mice[J]. International Journal of Biological Macromolecules,2013,62(11):287.
[42] Sun S.Regulatory Effect of Astragalus Polysaccharides on Intestinal IntraepithelialγδT Cells of Tumor Bearing Mice[J].Molecules,2014,19(9):15224-15236
[43] Han B,Gao Y,Wang Y,et al. Protective effect of a polysaccharide from Rhizoma Atractylodis Macrocephalae on acute liver injury in mice[J]. International journal of biological macromolecules,2016,87:85-91.
[44] Huo Hai Zhong,Wang Bing,Liang Yong Kang,et al.Hepatoprotective and Antioxidant Effects of Licorice Extract against CCl(4)-Induced Oxidative Damage in Rats[J].International journal of molecular sciences,2011,12(10):6529-6543.
[45] Son C G. Compositions for Protecting Liver or for Preventing or Treating Liver Fibrosis or Cirrhosis:US,US 20080260870 A1[P]. 2008-02-06[2008-10-23]. https://www.freshpatents.com/Gro-protect-solutions-dt20081023ptan20080260870.php.
[46]张小霞,吴巧凤,董旭旦,等.猪苓多糖的提取工艺优化及抗氧化活性研究[J].中华中医药学刊,2016,34(8):2025-2028.
[47]刘洪超,杨小龙,王淑英.猪苓药理作用研究进展[J].河南科技大学学报(医学版),2011,29(2):159-160.
[48]张昌菊,郭秀.猪苓多糖抗肿瘤作用的机制研究[J].实用医学进修杂志,1995,23(3):150-152.
[49]高梅,谢蜀生.猪苓多糖对小鼠免疫功能的增强作用[J].中国免疫学杂志,1991,7(3):185-187.
[50] John M Luk,Xiaoling Wang,Ping Liu,et al. Traditional Chinese herbal medicines for treatment of liver fibrosis and cancer from laboratory discovery to clinical evaluation[J]. Liver international,2007,27(7):879-890.