谢晶日教授治疗慢性乙型病毒性肝炎的经验研究
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摘要
慢性乙型病毒性肝炎(chornic hepatitis B,CHB),是临床常见的一种传染病,也是肝硬化、肝癌的重要发病基础。具有传染性强、流行面广、发病率高等特点。在现代医学对慢性乙型肝炎的病因尚无定论,治疗以抗病毒为主,主要药物是干扰素类、核苷类和免疫调节剂等,临床上有一定疗效,但是易复发反弹。本文详细总结了现代医学和祖国医学对慢性乙型病毒性肝炎的病因病机、诊断、治疗等方面的认识与研究进展,通过随诊导师谢晶日教授,研究大量经治的慢性乙型病毒性肝炎病例,并结合中3例进行探讨,从病因病机、辨证、治疗用药等方面总结导师治疗慢性乙型病毒性肝炎的思路。在病因病机上导师认为:(1)湿热疫毒之邪为发病的始动因素;(2)肝郁脾肾亏虚为发病的内在基础;(3)瘀血阻络是重要的病理环节。治疗上以补肾健脾疏肝活血解毒为其基本治疗大法,根据病程病症,疏清化养,有所侧重。
Chronic hepatitis B(CHB) is a kind of common clinical infectious diseases as well as the important incidence base of cirrhosis and liver cancer. It's contagious strong,and prevalence of a wide range of high incidence.In modern medicine the etiology of chronic hepatitis B still hasn't been identified,anti-virus is the mainly treatment with drugs as interferons, nucleoside and immunomodulatory agent.clinical efficacy is effective to some extent but CHB recrudesce easily.This article summarizes the etiology, pathogenesis,diagnosis and treatment of CHB in modern medicine and Chinese medicine.Through research on three CHB patients of professor Xie Jingri,thoughts of therapy of CHB is summarized from etiology,pathogenesis, dialectics and therapeutic medication.From etiology and pathogenesis, professor XIE holds that in the pathogenesis instructors are as follows:the stagnation of liver with the asthenia of spleen and kidney is the immanent cause of CHB,and pathogen invasion with damp-heat and Stagnation is the fundamental cause of CHB.And from therapy,professor XIE holds that the method of invigorating spleen,benefiting kidneys smoothing the liver, removing toxin and activating blood is a fundamental method of treating CHB.
Chronic hepatitis B(CHB) is a kind of common clinical infectious diseases as well as the important incidence base of cirrhosis and liver cancer. It's contagious strong,and prevalence of a wide range of high incidence.In modern medicine the etiology of chronic hepatitis B still hasn't been identified,anti-virus is the mainly treatment with drugs as interferons, nucleoside and immunomodulatory agent.clinical efficacy is effective to some extent but CHB recrudesce easily.This article summarizes the etiology, pathogenesis,diagnosis and treatment of CHB in modern medicine and Chinese medicine.Through research on three CHB patients of professor Xie Jingri,thoughts of therapy of CHB is summarized from etiology,pathogenesis, dialectics and therapeutic medication.From etiology and pathogenesis, professor XIE holds that in the pathogenesis instructors are as follows:the stagnation of liver with the asthenia of spleen and kidney is the immanent cause of CHB,and pathogen invasion with damp-heat and Stagnation is the fundamental cause of CHB.And from therapy,professor XIE holds that the method of invigorating spleen,benefiting kidneys smoothing the liver, removing toxin and activating blood is a fundamental method of treating CHB.
引文
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[1 O].段学章,王福生等.中华医学杂志,2003.5 3(7):548.549
[11].中华医学会传染病与寄生虫病学分会、肝病学分会联合修订.病毒性肝炎防治方案[J].中华传染病杂志,200 1 f 1):5 6-62
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[1 3].中华医学会肝病学分会.慢性乙型肝炎防治指南.柳州医学,2006:1 9(3 1:1 7 8-1 79.
[14].PerilloRP.Current treatment of chronic hepatitis B:benefits and limitations.Semin Liver Dis.2005,25(Suppl 1):20-28
[15].拉米夫定临床应用专家组.2004年拉米夫定临床应用专家共识.中华肝脏病杂志,2004,12(7):425-428
[16].YangHI,Lu SN,Liaw YF,et al.Hepatitis B e antigen and the risk of hepatocellular carcinoma,N Engl J Med.2002,347(3):168-174
[17].Yuen MF,Yuan HJ,Wong DK,et al.Prognostic determinants for chronic hepatitis B in Asians:therapeutic implications.Gut.2005,54(11):1610-1614
[18].Marcellin P,Asselah T,Boyer N.Treatment of chronic hepatitis B.J Viral Hepat.2005,12:333-345
[19].李绍白.慢性乙型肝炎抗病毒药物治疗的评价.临床内科杂志,2002,19(4):251
[20].王耀宗.抗HBV抗HCV感染的研究动态一第51届美国肝病学会年会相关内容概述[J].国外医学·流行病学和传染病学分册,2001,28(1):36.
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[22].Manesis EK,Had Ziyanms SJ Interferon alpha treatment and retreatment of hepatitis B e antigen-negative chronic hepatitis B.Gastroenterology,2001,121:101-109.
[23].毛乾国,骆抗先,傅群芳,等.干扰素对慢性乙型肝炎抗原阴性患者的疗效及影响因素.中华肝脏病杂志,2004,12:582-584.
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