摘要
肝硬化是多种慢性肝病进展的病理结局,原因多样,不同阶段的肝硬化病情差异巨大,可严重影响患者预后。祛除病因和对症治疗是目前肝硬化治疗的主要方式,其疗效尚不能满足临床需求。中医药在防治肝硬化及其并发症方面有着长期经验积累,该文从肝纤维化组织学消退、防治肝硬化失代偿及并发症方面综述近年来中医药治疗肝硬化的临床研究进展,旨在为临床治疗提供参考,探讨未来的研究方向。具有抗肝纤维化的常用中成药、常见经验方,不仅有效促进组织学逆转,长期应用还可预防静脉曲张出血,降低肝癌发生率;中西药联合疗法在肝硬化并发症的防治中发挥着重要作用。相关作用机制与抑制星状细胞活化,保护肝细胞损伤与促进肝细胞再生,抑制肝窦毛细血管化,调节肾素-血管紧张素-醛固酮系统,改善胃肠动力等有关。针对肝纤维化、肝再生、肝癌变等主要病理环节,病证结合,进一步加强中医药的临床研究,对提高肝硬化及其并发症的临床疗效具有重要意义。
Liver cirrhosis is the pathological outcome of chronic liver diseases due to a variety of causes.Liver cirrhosis at different stages differs greatly in patients′conditions,which can seriously affect the prognosis of patients.Elimination of the causes and symptomatic treatments are the main ways to treat liver cirrhosis at present.However,the curative effect cannot meet the clinical needs.There is a long-term experience accumulation of traditional Chinese medicine(TCM)in the treatment of liver cirrhosis and its complications.This review focuses on the clinical research progress on the treatment of liver cirrhosis with TCM from the perspectives of histological regression of liver fibrosis and prevention and treatment of decompensated cirrhosis and its complications.The aim is to provide reference for clinical treatment and explore future research directions.The commonly used proprietary Chinese medicines and experience prescriptions with the anti-liver fibrosis effect not only effectively facilitate histological regression but also prevent variceal bleeding and reduce the incidence of hepatocellular carcinoma.The combined therapy integrating traditional Chinese and western medicine plays a crucial role in preventing and treating complications of liver cirrhosis.Its mechanisms are related to inhibiting stellate cell activation,protecting hepatocytes from injury,promoting hepatocyte regeneration,inhibiting hepatic sinusoidal capillarization,regulating renin-angiotensin-aldosterone system,improving gastrointestinal motility,and so on.Aiming at the main pathological processes including liver fibrosis,liver regeneration,and liver cancer,efforts should be made to realize combination of disease and syndrome and further strengthen TCM clinical research,which are of great significance for improving clinical efficacy of liver cirrhosis and its complications.
作者
赵志敏
刘成海
ZHAO Zhi-min;LIU Cheng-hai(Institute of Liver Diseases,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Shanghai Key Laboratory of Traditional Chinese Clinical Medicine,Shanghai 201203,China;Key Laboratory of Liver and Kidney Diseases,Ministry of Education,Shanghai 201203,China)
出处
《中国中药杂志》
北大核心
2025年第15期4178-4189,共12页
China Journal of Chinese Materia Medica
基金
国家自然科学基金项目(82374122,81730109,81473404)
上海市临床重点专科建设项目(shslczdzk01201)。
关键词
肝硬化
肝纤维化
失代偿期
病证结合
临床疗效
liver cirrhosis
liver fibrosis
decompensated cirrhosis
combination of disease and syndrome
clinical efficacy
