蓝青强老中医治疗乙型肝炎肝硬化学术经验整理与研究
|
摘要
一、指导老师学术思想和临床经验的整理与研究
通过跟随蓝青强教授学习、实时采集病例、临床病例回顾、数据挖掘方法,总结归纳了蓝青强教授治疗乙型肝炎肝硬化的经验。蓝教授认为肝硬化的病因病机主要在于虚损生积、毒损肝络、血瘀脉络,脏腑虚损是肝硬化发生的内在原因,毒邪外袭是本病发生的重要条件,血瘀脉络是本病的中心环节；总结了仲景实脾、疏肝、温通、退黄、和胃辨治乙型肝炎的方法；总结了清热利湿、疏肝理气、柔肝、和胃、化瘀方法治疗乙型肝炎的用药心得体会；总结出基于疏肝健脾,清热利湿为主的治疗慢性乙肝炎经验方一个；总结了肝肾同源治疗肝纤维的基本方法；总结了肝硬化清热除湿、柔肝健脾、益气疏肝、补血化瘀的基本治疗方法；提出了肝硬化门脉高压补虚为主,攻补兼施,肝肾同治,勿忘化瘀基本治疗原则；总结了肝硬化腹水证治心得。
二、指导老师学术经验的临床研究
目的：评价蓝青强教授治疗肝硬化门脉高压临床疗效；方法：将70例肝硬化门脉高压患者随机分成治疗组和对照组各35例,治疗组根据蓝青强教授经验进行加减辩证治疗,对照组采用心得安治疗；评价临床疗效,观察治疗前后临床症状,肝功能、肝纤维、血流动力学、影像学指标,生存质量的变化；结果：治疗组总有效率85.72%,对照组总有效率71.43%,治疗组总有效率显著优于对照组(P<0.05)；治疗组胁肋疼痛、乏力、呆症症状积分治疗后较治疗前相比,积分显著降低(P<0.01或PPart1Academic thoughts and clinical experience of Professor Qing-qiang Lan
The experience of Prof. Lan in treating chronic liver disease is summarized. He believes that, in the realm of traditional Chinese medicine, the development of chronic liver disease is associated with visceral deficiency, blood stasis, phlegm congealing, and pathogen invasion. Therefore, the principles for treating chronic liver disease are to soothe the liver, harmonize the stomach, tonify the kidney, replenish qi and nourish blood to expel water and resolve stasis. Based on these principles, he developed an empirical therapy which was found to produce good efficacy for the treatment of chronic liver disease.
Part2Clinical translation of Professor Qing-qiang Lan's academic thoughts
Objective:To assess the efficacy of an empirical therapy developed by Professor Lan for the treatment of portal hypertension (PH). Methods:Seventy five patients with PH were randomized to receive the empirical therapy or propranolol. Patients were observed for changes in symptoms, liver function, hepatic fibrosis, hemodynamics, imaging, and quality of life.
Results:Overall, a significantly higher proportion of patients responded to the empirical therapy than to propranolol (85.34%vs.66.35%, P<0.05). The scores of flank pain, fatigue and sluggishness were significantly decreased after initiation of the empirical therapy (P<0.01or P<0.05). The empirical therapy was more effective than propranolol in improving fatigue (P<0.05). The empirical therapy was associated with significantly decreased IV-IC (P<0.05), significantly increased ALB (P<0.05) and significantly reduced DSV, PVF and SVF (P<0.01). Compared with patients on propranolol, those treated empirically had significantly lower DSV, PVF and SVF (P<0.01or P<0.05). In patients treated with the empirical therapy, there was a significant decrease in the diameter of the portal vein and the splenic vein (P<0.05), and a significant increase in the physical, psychological, social relationship, environmental domain and total scores (P<0.01or P<0.05) after the start of the treatment. Patients receiving the empirical therapy showed significantly greater improvement in the physical and psychological domains compared with those receiving propranolol (P<0.05).
Conclusions:The empirical therapy developed by Professor Lan appears to be efficacious for the treatment portal hypertension due to cirrhosis.
通过跟随蓝青强教授学习、实时采集病例、临床病例回顾、数据挖掘方法,总结归纳了蓝青强教授治疗乙型肝炎肝硬化的经验。蓝教授认为肝硬化的病因病机主要在于虚损生积、毒损肝络、血瘀脉络,脏腑虚损是肝硬化发生的内在原因,毒邪外袭是本病发生的重要条件,血瘀脉络是本病的中心环节；总结了仲景实脾、疏肝、温通、退黄、和胃辨治乙型肝炎的方法；总结了清热利湿、疏肝理气、柔肝、和胃、化瘀方法治疗乙型肝炎的用药心得体会；总结出基于疏肝健脾,清热利湿为主的治疗慢性乙肝炎经验方一个；总结了肝肾同源治疗肝纤维的基本方法；总结了肝硬化清热除湿、柔肝健脾、益气疏肝、补血化瘀的基本治疗方法；提出了肝硬化门脉高压补虚为主,攻补兼施,肝肾同治,勿忘化瘀基本治疗原则；总结了肝硬化腹水证治心得。
二、指导老师学术经验的临床研究
目的：评价蓝青强教授治疗肝硬化门脉高压临床疗效；方法：将70例肝硬化门脉高压患者随机分成治疗组和对照组各35例,治疗组根据蓝青强教授经验进行加减辩证治疗,对照组采用心得安治疗；评价临床疗效,观察治疗前后临床症状,肝功能、肝纤维、血流动力学、影像学指标,生存质量的变化；结果：治疗组总有效率85.72%,对照组总有效率71.43%,治疗组总有效率显著优于对照组(P<0.05)；治疗组胁肋疼痛、乏力、呆症症状积分治疗后较治疗前相比,积分显著降低(P<0.01或P
The experience of Prof. Lan in treating chronic liver disease is summarized. He believes that, in the realm of traditional Chinese medicine, the development of chronic liver disease is associated with visceral deficiency, blood stasis, phlegm congealing, and pathogen invasion. Therefore, the principles for treating chronic liver disease are to soothe the liver, harmonize the stomach, tonify the kidney, replenish qi and nourish blood to expel water and resolve stasis. Based on these principles, he developed an empirical therapy which was found to produce good efficacy for the treatment of chronic liver disease.
Part2Clinical translation of Professor Qing-qiang Lan's academic thoughts
Objective:To assess the efficacy of an empirical therapy developed by Professor Lan for the treatment of portal hypertension (PH). Methods:Seventy five patients with PH were randomized to receive the empirical therapy or propranolol. Patients were observed for changes in symptoms, liver function, hepatic fibrosis, hemodynamics, imaging, and quality of life.
Results:Overall, a significantly higher proportion of patients responded to the empirical therapy than to propranolol (85.34%vs.66.35%, P<0.05). The scores of flank pain, fatigue and sluggishness were significantly decreased after initiation of the empirical therapy (P<0.01or P<0.05). The empirical therapy was more effective than propranolol in improving fatigue (P<0.05). The empirical therapy was associated with significantly decreased IV-IC (P<0.05), significantly increased ALB (P<0.05) and significantly reduced DSV, PVF and SVF (P<0.01). Compared with patients on propranolol, those treated empirically had significantly lower DSV, PVF and SVF (P<0.01or P<0.05). In patients treated with the empirical therapy, there was a significant decrease in the diameter of the portal vein and the splenic vein (P<0.05), and a significant increase in the physical, psychological, social relationship, environmental domain and total scores (P<0.01or P<0.05) after the start of the treatment. Patients receiving the empirical therapy showed significantly greater improvement in the physical and psychological domains compared with those receiving propranolol (P<0.05).
Conclusions:The empirical therapy developed by Professor Lan appears to be efficacious for the treatment portal hypertension due to cirrhosis.
引文
[1]陆再英,钟南山,谢毅等.内科学-第七版[M].北京：人民卫生出版社,2008：446.
[2]孔颖达.周易正义[M].北京：中国书店出版社,1985,170.
[3]清.尤怡撰.金匮要略心典[M].辽宁：辽宁科学技术出版社,1997,22.
[4]沈洪瑞,梁秀清,主编.中国历代名医医话大观[M].山西：山西科学技术出版社,1996,853-876.
[5]张秋云,刘绍能.慢性乙型肝炎“毒邪论”[J].中国中医药信息杂志.2006,18(08)：82-83.
[6]南京中医学院编著.诸病源候论校释[M].北京：人民卫生出版社,2009,566.
[7]明.张介宾著.孙玉信,朱平生校注.景岳全书[M].上海：第二军医大学出版社,2006,220.
[8]战国.佚名编著.樊德春,李泰然点校.皇帝内经.灵枢[M].上海,第二军医大学出版社,2005,203.
[9]侯宪聚.“解毒通络法”治疗慢性乙肝浅析[c].海峡两岸中医药发展大会.北京：国家中医药管理局.2009：314-315.
[10]明.李中梓.医宗必读[M].太原：山西科学技术出版社,2006：24.
[11]汉.张仲景著.宋林亿校正.金匮要略[M].北京：学苑出版社,金匮要略.2007,1.
[12]田熹海,龚婕宁.浅论慢性乙肝的中医“补攻之法”[J].浙江中医药大学学报2009,33(01)：25-27.
[13]沈仲奎.“肝硬化中医治疗三得”读后研讨[J].辽宁中医杂志.1983,(07)：47.
[14]慕永平,王磊.谨守病机权衡邪正主次燮理脏腑重视处方配伍—刘平教授治疗肝硬化经验浅析[J].上海中医药大学学报2004,18,(03)：29-32.
[15]吕荣华,孙秉华.老中医治疗肝病的经验[J].新疆中医药杂志1994,(01)：46-47.
[1]中华医学会传染病与寄生虫病学分会、中华医学会肝病学分会.病毒性肝炎防治方案[J].中华内科杂志,2001,1(1)：62-68.
[2]Bruha R, Petrtyl J, Urbanek P, et al. Long term pharmacological treatment of portal hypertension[J].Cas Lek Cesk,2005,144(Suppl 1):63-66.
[3]Hassoun Z, Pomier Layrargues G. The transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension [J]. Eur J Gastroenterol Hepatol, 2004,16(1):1-4.
[4]谢玉宝,蔡高术,萧焕明.古代中医对肝硬化晚期症状体征的认识[J].中医文献杂志,2010,6：20-22.
[5]刘衡如校.灵枢经.水胀第五十七[M].北京：人民卫生出版社,1956,218.
[6]汉.张仲景.金匮要略.水气病脉证并治篇[M].北京：人民卫生出版社,1963：70.
[7]许浚.东医宝鉴.杂病篇卷八[M].北京：人民卫生出版社,1955：491.
[8]明.龚廷贤.寿世保元.水肿[M].北京：人民卫生出版社,1994：195.
[9]清.喻嘉言.医门法律.胀病论[M].北京：人民卫生出版社,2007：238.
[10]清.陈士铎.辩证录.臌胀门[M].北京：人民卫生出版社,1989：285.
[11]隋.巢元方.诸病源候论.盅毒病诸候[M].北京：人民卫生出版社,1955：308.
[12]清.胡增彬.经验选秘.臌胀[M].北京：中医古籍出版社,2004,118.
[13]李普治疗乙肝肝硬化腹水验案举隅[J].四川中医,2009,27(4)：3.
[14]吴智兵,邹立华.彭胜权教授治疗肝硬化经验介绍[J].新中医,2004,36(5)：9-10.
[15]晏军,王煦.王绵之教授治疗早期肝硬化的经验[J].北京中医药大学学报,2001,24(4)：56—57.
[16]何浩,张玉亮,严义忠,等.乙型肝炎后肝纤维化的中医防治[J].新中医,2003,35(4)： 75.
[17]叶放,薛博瑜,周珉,等.论湿热瘀毒与肝纤维化[J].南京中医药大学学报,2005,3(6)：346—349.
[18]唐雪梅.浊邪及其致病机理探讨[J].辽宁中医杂志,2006,33(11)：1416-1418.
[19]李佃贵,李刚,刘金里,等.李佃贵以“浊毒”立论治疗肝硬化经验[J].陕西中医,2006,27(11)：1394—1395.
[20]武嫣斐,孙健民.慢性乙型肝炎致早期肝硬化辨证治疗体会[J].中医药研究,2002,18(2)： 18.
[21]徐光福.络病的内涵及其外延释义[J].中医药学刊,2005,7(1)：96—98.
[22]任继学.“伏邪”探微[J].中国中医药现代远程教育,2003,6(2)：8—9.
[23]邝卫红.许鑫梅教授治疗慢性乙型肝炎经验介绍[J].新中医,2006,38(9)：13-14.
[24]陈园,刘成海.络病理论在慢性肝病中的应用[J].中华中医药学刊,2007,25(9)：1860--1892.
[25]姚泽民,杨必金.肝硬化的辨证施治[J].湖北中医杂志,2003,25(12)：37.
[26]郭利平.浅谈肝硬化的中医辨证论治[J].内蒙古中医药,2007,26(1)：45.
[27]雷芳,王海燕,冯亚红.肝硬化腹水辨证施护46例[J].陕西中医,2008,29(5)：566-567.
[28]于泓,贺松其,康金兰,等.肝炎后肝硬化的证治规律及用药原则探讨[J].新中医,2009,41(4)：1-2.
[29]郑保平,姚乃礼,陶夏平,等.乙型肝炎肝硬化中医病机认识概况[J].辽宁中医杂志,2010,37(6)：1021-1022.
[30]葛香芹.肝炎后肝硬化的中医辨证论治体会[J].中国实用医药,2008,3(26)：160-161.
[31]王奕,张玮,王磊,等.大黄蛰虫丸治疗慢性肝炎后肝硬化47例临床观察[J].山西中医,2010,26(10)：16-17.
[32]韩小平,王守智.辨证分型治疗肝硬化36例临床观察[J].新疆中医药,2008,26(3)：55-56.
[33]陈帅.辨证分型敷脐治疗肝硬化腹水临床体会[J].江苏中医药,2003,24(11)：19-20.
[34]王晓.中医外治治疗肝硬化双下肢乏力疗效观察[J].医药论坛杂志,2008,29(19)：84-85.
[35]胡东辉,张建军.肝硬化中医外治法的研究现状和展望[J].中西医结合肝病杂志,2009,19(3)：191-192.
[36]施维群,倪伟.中药脐部贴敷对肝硬化内毒血症影响的临床研究[J].中华中医药杂志,2010,3(25)：452-455.
[37]孙妩弋,魏伟.中药和天然药物治疗肝纤维化的研究[J].中国药理学通报,2004,20(7)：741-745.
[38]施维群.肝硬化治疗的中医特色优势及展望[J].浙江中医药大学学报,2010,34(4)：618-619.
[39]Moller S, Hobolth L, Winkler C, et al. Determinants of the hyperdynamic circulation and central hypovolaemia in cirrhosis[J]. Gut,2011 1254-1259.
[40]Park S, Kim S, Ropella G, et al. Trancing Multiscale Mechanisms of Drug Disposition in Normal and Diseased Livers[J]. J Pharmacol Exp Ther.2010, 334,124-136.
[41]Rossle M, Gerbes A. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax:a critical update[J]. Gut, 2010,59:988-1000.
[42]Kim YK, kim YK, shim SS. Thoracic Complications of Liver Cirrhosis: Radiologic Findingsl[J]. RadioGraphics,2009,29:825-837
[43]Montano LZ, Meza JJ. Pathogenesis of portal hypertension[J]. Rev Invest Clin, 2005,57(4):596-607.
[44]Groszmann RJ, Abraldes JG. Portal hypertension:from bed side to bench. J Clin Gastroenterol,2005,39(4Supol 2):125-130.
[45]邓旦,廖明松,李树森,等.能量多普勒应用于肝硬化进程中肾脏血流动力学观测的价值[J].中国超声医学杂志,2003,19(3)：190-192.
[46]张静,郭小兵,王润兰,等.彩色多普勒超声对肝硬化患者眼血流动力学研究[J].中国实验诊断学,2010,14(5)：720-721.
[47]乔伟,王楠,鲁建国,等.肝硬化大鼠原位肝移植血流动力学改变.西安交通大学学报(医学版)[J].2009,30(6)：80-682.
[48]谢建亮,陈旭鹏.肝硬化门静脉系统血流动力学变化与食管静脉曲张出血的关系[J].中国全科医学,2007,10(5)：374-375.
[49]Huang CT, Du RY, Leng XS. Humoral mechanism in pathogenesis of portal hypertension[J].Chin Med J Egnl.1982,95:409-416.
[50]Defects in cGMP-PKG pathway contribute to impaired NO-dependent responses in hepatic stellate cells upon activation[J]. Am J Physiol Gastrointest Liver Physiol,2006,290,535-542.
[51]陈卫刚,李睿,张宁,等.iNOS/NO体系在慢性肝炎患者及肝硬化患者中的表达比较[J].中华肝脏病杂志,2009,10(9)：256-258.
[52]张初民,韩盛玺,沈通良.肝硬化患者血浆前列环素与门脉高压的关系[J].医学科技,2001,9(3)：13-15.
[53]黑子清,罗晨芳,黎尚荣,等.肝硬化患者肝移植围手术期血浆TXA2和PGI2水平变化[J].中国病理生理杂志,2006,22(8)：1650-1653.
[54]Kuddus RH, Nalesnik MA, Subbotin VM, et al. Enhanced synthesis and reduced metabolism of endothelin-1 (ET-1) by hepatocytes—an important mechanism of increased endogenous levels of ET-1 in liver cirrhosis[J]. J Hepatol, 2000,33(5):725-732.
[55]Noguchi N, Teramoto K, Ochiai T, et al. The close participation of ET-1 and NO in human hepatic hemodynamics[J]. Hepatol Res,2006,36(2):86-93
[56]李瑞珍,肖际东,周平,等.肝硬化门脉系统血流动力学与血浆内皮素关系的研究[J].医学临床研究,2004,21(9)：973-975.
[57]唐承薇,李肖.肝硬化门静脉高压治疗策略[J].中国实用内科杂志,2011,31(1)：79-80.
[58]李雯雯,李强,王晶波,等.乙肝肝炎肝硬化患者生存质量研究[J].中华肝脏病杂志,2007,15(4)：312-313.
[59]梁茹,刘序友,张惠琴,等.肝炎后肝硬化患者生存质量现状调查[J].现代预防医学,2011,38(10)：1884-1885.
[2]孔颖达.周易正义[M].北京：中国书店出版社,1985,170.
[3]清.尤怡撰.金匮要略心典[M].辽宁：辽宁科学技术出版社,1997,22.
[4]沈洪瑞,梁秀清,主编.中国历代名医医话大观[M].山西：山西科学技术出版社,1996,853-876.
[5]张秋云,刘绍能.慢性乙型肝炎“毒邪论”[J].中国中医药信息杂志.2006,18(08)：82-83.
[6]南京中医学院编著.诸病源候论校释[M].北京：人民卫生出版社,2009,566.
[7]明.张介宾著.孙玉信,朱平生校注.景岳全书[M].上海：第二军医大学出版社,2006,220.
[8]战国.佚名编著.樊德春,李泰然点校.皇帝内经.灵枢[M].上海,第二军医大学出版社,2005,203.
[9]侯宪聚.“解毒通络法”治疗慢性乙肝浅析[c].海峡两岸中医药发展大会.北京：国家中医药管理局.2009：314-315.
[10]明.李中梓.医宗必读[M].太原：山西科学技术出版社,2006：24.
[11]汉.张仲景著.宋林亿校正.金匮要略[M].北京：学苑出版社,金匮要略.2007,1.
[12]田熹海,龚婕宁.浅论慢性乙肝的中医“补攻之法”[J].浙江中医药大学学报2009,33(01)：25-27.
[13]沈仲奎.“肝硬化中医治疗三得”读后研讨[J].辽宁中医杂志.1983,(07)：47.
[14]慕永平,王磊.谨守病机权衡邪正主次燮理脏腑重视处方配伍—刘平教授治疗肝硬化经验浅析[J].上海中医药大学学报2004,18,(03)：29-32.
[15]吕荣华,孙秉华.老中医治疗肝病的经验[J].新疆中医药杂志1994,(01)：46-47.
[1]中华医学会传染病与寄生虫病学分会、中华医学会肝病学分会.病毒性肝炎防治方案[J].中华内科杂志,2001,1(1)：62-68.
[2]Bruha R, Petrtyl J, Urbanek P, et al. Long term pharmacological treatment of portal hypertension[J].Cas Lek Cesk,2005,144(Suppl 1):63-66.
[3]Hassoun Z, Pomier Layrargues G. The transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension [J]. Eur J Gastroenterol Hepatol, 2004,16(1):1-4.
[4]谢玉宝,蔡高术,萧焕明.古代中医对肝硬化晚期症状体征的认识[J].中医文献杂志,2010,6：20-22.
[5]刘衡如校.灵枢经.水胀第五十七[M].北京：人民卫生出版社,1956,218.
[6]汉.张仲景.金匮要略.水气病脉证并治篇[M].北京：人民卫生出版社,1963：70.
[7]许浚.东医宝鉴.杂病篇卷八[M].北京：人民卫生出版社,1955：491.
[8]明.龚廷贤.寿世保元.水肿[M].北京：人民卫生出版社,1994：195.
[9]清.喻嘉言.医门法律.胀病论[M].北京：人民卫生出版社,2007：238.
[10]清.陈士铎.辩证录.臌胀门[M].北京：人民卫生出版社,1989：285.
[11]隋.巢元方.诸病源候论.盅毒病诸候[M].北京：人民卫生出版社,1955：308.
[12]清.胡增彬.经验选秘.臌胀[M].北京：中医古籍出版社,2004,118.
[13]李普治疗乙肝肝硬化腹水验案举隅[J].四川中医,2009,27(4)：3.
[14]吴智兵,邹立华.彭胜权教授治疗肝硬化经验介绍[J].新中医,2004,36(5)：9-10.
[15]晏军,王煦.王绵之教授治疗早期肝硬化的经验[J].北京中医药大学学报,2001,24(4)：56—57.
[16]何浩,张玉亮,严义忠,等.乙型肝炎后肝纤维化的中医防治[J].新中医,2003,35(4)： 75.
[17]叶放,薛博瑜,周珉,等.论湿热瘀毒与肝纤维化[J].南京中医药大学学报,2005,3(6)：346—349.
[18]唐雪梅.浊邪及其致病机理探讨[J].辽宁中医杂志,2006,33(11)：1416-1418.
[19]李佃贵,李刚,刘金里,等.李佃贵以“浊毒”立论治疗肝硬化经验[J].陕西中医,2006,27(11)：1394—1395.
[20]武嫣斐,孙健民.慢性乙型肝炎致早期肝硬化辨证治疗体会[J].中医药研究,2002,18(2)： 18.
[21]徐光福.络病的内涵及其外延释义[J].中医药学刊,2005,7(1)：96—98.
[22]任继学.“伏邪”探微[J].中国中医药现代远程教育,2003,6(2)：8—9.
[23]邝卫红.许鑫梅教授治疗慢性乙型肝炎经验介绍[J].新中医,2006,38(9)：13-14.
[24]陈园,刘成海.络病理论在慢性肝病中的应用[J].中华中医药学刊,2007,25(9)：1860--1892.
[25]姚泽民,杨必金.肝硬化的辨证施治[J].湖北中医杂志,2003,25(12)：37.
[26]郭利平.浅谈肝硬化的中医辨证论治[J].内蒙古中医药,2007,26(1)：45.
[27]雷芳,王海燕,冯亚红.肝硬化腹水辨证施护46例[J].陕西中医,2008,29(5)：566-567.
[28]于泓,贺松其,康金兰,等.肝炎后肝硬化的证治规律及用药原则探讨[J].新中医,2009,41(4)：1-2.
[29]郑保平,姚乃礼,陶夏平,等.乙型肝炎肝硬化中医病机认识概况[J].辽宁中医杂志,2010,37(6)：1021-1022.
[30]葛香芹.肝炎后肝硬化的中医辨证论治体会[J].中国实用医药,2008,3(26)：160-161.
[31]王奕,张玮,王磊,等.大黄蛰虫丸治疗慢性肝炎后肝硬化47例临床观察[J].山西中医,2010,26(10)：16-17.
[32]韩小平,王守智.辨证分型治疗肝硬化36例临床观察[J].新疆中医药,2008,26(3)：55-56.
[33]陈帅.辨证分型敷脐治疗肝硬化腹水临床体会[J].江苏中医药,2003,24(11)：19-20.
[34]王晓.中医外治治疗肝硬化双下肢乏力疗效观察[J].医药论坛杂志,2008,29(19)：84-85.
[35]胡东辉,张建军.肝硬化中医外治法的研究现状和展望[J].中西医结合肝病杂志,2009,19(3)：191-192.
[36]施维群,倪伟.中药脐部贴敷对肝硬化内毒血症影响的临床研究[J].中华中医药杂志,2010,3(25)：452-455.
[37]孙妩弋,魏伟.中药和天然药物治疗肝纤维化的研究[J].中国药理学通报,2004,20(7)：741-745.
[38]施维群.肝硬化治疗的中医特色优势及展望[J].浙江中医药大学学报,2010,34(4)：618-619.
[39]Moller S, Hobolth L, Winkler C, et al. Determinants of the hyperdynamic circulation and central hypovolaemia in cirrhosis[J]. Gut,2011 1254-1259.
[40]Park S, Kim S, Ropella G, et al. Trancing Multiscale Mechanisms of Drug Disposition in Normal and Diseased Livers[J]. J Pharmacol Exp Ther.2010, 334,124-136.
[41]Rossle M, Gerbes A. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax:a critical update[J]. Gut, 2010,59:988-1000.
[42]Kim YK, kim YK, shim SS. Thoracic Complications of Liver Cirrhosis: Radiologic Findingsl[J]. RadioGraphics,2009,29:825-837
[43]Montano LZ, Meza JJ. Pathogenesis of portal hypertension[J]. Rev Invest Clin, 2005,57(4):596-607.
[44]Groszmann RJ, Abraldes JG. Portal hypertension:from bed side to bench. J Clin Gastroenterol,2005,39(4Supol 2):125-130.
[45]邓旦,廖明松,李树森,等.能量多普勒应用于肝硬化进程中肾脏血流动力学观测的价值[J].中国超声医学杂志,2003,19(3)：190-192.
[46]张静,郭小兵,王润兰,等.彩色多普勒超声对肝硬化患者眼血流动力学研究[J].中国实验诊断学,2010,14(5)：720-721.
[47]乔伟,王楠,鲁建国,等.肝硬化大鼠原位肝移植血流动力学改变.西安交通大学学报(医学版)[J].2009,30(6)：80-682.
[48]谢建亮,陈旭鹏.肝硬化门静脉系统血流动力学变化与食管静脉曲张出血的关系[J].中国全科医学,2007,10(5)：374-375.
[49]Huang CT, Du RY, Leng XS. Humoral mechanism in pathogenesis of portal hypertension[J].Chin Med J Egnl.1982,95:409-416.
[50]Defects in cGMP-PKG pathway contribute to impaired NO-dependent responses in hepatic stellate cells upon activation[J]. Am J Physiol Gastrointest Liver Physiol,2006,290,535-542.
[51]陈卫刚,李睿,张宁,等.iNOS/NO体系在慢性肝炎患者及肝硬化患者中的表达比较[J].中华肝脏病杂志,2009,10(9)：256-258.
[52]张初民,韩盛玺,沈通良.肝硬化患者血浆前列环素与门脉高压的关系[J].医学科技,2001,9(3)：13-15.
[53]黑子清,罗晨芳,黎尚荣,等.肝硬化患者肝移植围手术期血浆TXA2和PGI2水平变化[J].中国病理生理杂志,2006,22(8)：1650-1653.
[54]Kuddus RH, Nalesnik MA, Subbotin VM, et al. Enhanced synthesis and reduced metabolism of endothelin-1 (ET-1) by hepatocytes—an important mechanism of increased endogenous levels of ET-1 in liver cirrhosis[J]. J Hepatol, 2000,33(5):725-732.
[55]Noguchi N, Teramoto K, Ochiai T, et al. The close participation of ET-1 and NO in human hepatic hemodynamics[J]. Hepatol Res,2006,36(2):86-93
[56]李瑞珍,肖际东,周平,等.肝硬化门脉系统血流动力学与血浆内皮素关系的研究[J].医学临床研究,2004,21(9)：973-975.
[57]唐承薇,李肖.肝硬化门静脉高压治疗策略[J].中国实用内科杂志,2011,31(1)：79-80.
[58]李雯雯,李强,王晶波,等.乙肝肝炎肝硬化患者生存质量研究[J].中华肝脏病杂志,2007,15(4)：312-313.
[59]梁茹,刘序友,张惠琴,等.肝炎后肝硬化患者生存质量现状调查[J].现代预防医学,2011,38(10)：1884-1885.