中药联合熊去氧胆酸治疗原发性胆汁性肝硬化疗效观察

目的:观察中药复方联合熊去氧胆酸(UDCA)治疗原发性胆汁性肝硬化(PBC)的临床疗效,以明确中药治疗PBC的优势所在并观察其可能存在的不良反应。方法:回顾性分析2010年5月-2013年5月在我院住院的代偿期PBC患者,符合纳入标准者共72人,根据治疗方案不同,分为治疗组(中药复方联合UDCA)35人,对照组(UDCA)37人,观察疗程为24周,观察两组患者治疗后疾病疗效、中医症状好转率及改善情况、肝功能的变化情况。结果:治疗24周后,中药组的治疗好转率显著优于对照组(P<0.05),中医症状改善率显著优于对照组(P<0.05),治疗组在改善患者倦怠乏力、食欲不振、皮肤瘙痒、口干、身目黄染、胸胁胀满方面优于对照组(P<0.05);肝功能总胆红素(TBil)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)等三项指标均较对照组有显著下降(P<0.05)。结论:中药复方联合UDCA治疗PBC在提高疗效、改善症状及肝功能方面优于单用UDCA,有进一步研究的价值。     

Short-Term Efficacy of Treating Hepatitis B Virus-Related Acute-on-Chronic Liver Failure Based on Cold Pattern Differentiation with Hot Herbs: A Randomized Controlled Trial

Objective: To evaluate the clinical efficacy and safety of Yinchen Zhufu Decoction(茵陈术附汤, YCZFD) in the treatment of acute-on-chronic liver failure caused by hepatitis B virus(HBV-ACLF) with cold pattern in Chinese medicine(CM). Methods: This is a multi-center randomized controlled trial of integrative treatment of CM and Western medicine(WM) for the management of HBV-ACLF patients. A total of 200 HBV-ACLF patients with cold pattern were equally randomly assigned to receive YCZFD and WM(integrative treatment) or WM conventional therapy alone respectively for 4 weeks. The primary end point was the mortality for HBV-ACLF patients. Secondary outcome measures included Model for End-Stage Liver disease(MELD) score, liver biochemical function, coagulation function and complications. Adverse events during treatment were reported. Results: The mortality was decreased 14.28% in the integrative treatment group compared with WM group(χ2=6.156, P=0.013). The integrative treatment was found to significantly improve the MELD score(t=2.353, P=0.020). There were statistically significant differences in aspartate transaminase, total bilirubin, indirect bilirubin, direct bilirubin and prothrombin time between the two groups(P0.05 or P0.01). The complications of ascites(χ2=9.033, P=0.003) and spontaneous bacteria peritonitis(χ2=4.194, P=0.041) were improved significantly in the integrative treatment group. No serious adverse event was reported. Conclusions: The integrative treatment of CM and WM was effective and safe for HBV-ACLF patients with cold pattern in CM. The Chinese therapeutic principle "treating cold pattern with hot herbs" remains valuable to the clinical therapy.(Trial registration No. Chi CTR-TRC-10000766)     

TTV在病原学明确的急性肝炎及非甲～戊型急性肝炎患者中的感染状况

作者采用半定量巢式PCR法对121例成人急性肝炎患者血清TTV-DNA进行了检测,其中103例为病原学明确的患者:急性甲型肝炎21例(20.3％)、急性乙型肝炎53例(51.4％)、急性丙型肝炎24例(23.3％)和急性戊型肝炎5例(4.8％),另18例为非甲～戊型急性肝炎患者,该组病例同时     

原发性胆汁性肝硬化的中医治疗现状

原发性胆汁性肝硬化(Primary biliary cirrhosis,PBC)是一种主要发生于肝内小叶间胆管细胞的慢性胆汁淤积性自身免疫性肝病,好发于中年妇女,其发病机制目前尚不完全明了,主要认为与环境及遗传密切相关。其治疗目前尚无特效药物,     

HBx与肝细胞癌的发生机制

在我国,大约80%的肝细胞癌(hepatocellular carcinoma,HCC)与乙型肝炎病毒(HBV)感染有关,乙型肝炎病毒X蛋白(hepatitis B virus X protein,HBx)作为恶性转化肝细胞中惟一表达的蛋白质,与HCC的发生与发展密切相关。本文就HBx的功能与HCC的发生机制之间的关系综述如下。     

187例中草药及其制剂导致肝损伤病例前瞻性临床研究

目的观察中草药及其制剂导致肝损伤(herb-induced liver injury,HILI)的临床特征。方法前瞻性分析2015年9月至2016年6月解放军第三○二医院187例HILI住院患者一般情况、用药史、生化指标、预后、三种诊断方法(整合证据链法iEC、结构化专家意见SEOP、因果关系评分RUCAM)诊断结果差异。结果 137例HILI患者为女性,年龄18~81岁,多发年龄段为40~59岁,中药开始应用至发生肝损伤的平均时间为60d,139例(74.3%)临床分型为肝细胞损伤型;导致HILI的中药治疗疾病排在前5位的有:胃炎(8.0%)、椎间盘突出(5.3%)、失眠(4.8%)、脱发(4.8%)、银屑病(4.3%)。导致HILI中药汤剂及中成药的组方中,含既往有肝毒性报道的前5位中草药:何首乌(n=21)、延胡索(n=10)、大黄(n=9)、柴胡(n=8)、补骨脂(n=7)。29例(15.5%)发生肝硬化,30例(16.0%)形成慢性,死亡3例(1.6%)。187例HILI患者中,iEC法临床诊断率为47.6%,SEOP法临床诊断率为29.9%;HILI/DILI构成比方面,iEC法、RUCAM法及SEOP法结果分别为23.2%、48.7%、14.6%。结论中草药及其制剂可导致肝损伤,应重视中药肝毒性,整合证据链法能够提高HILI临床诊断率,降低HILI/DILI构成比。     

中医药防治埃博拉病毒病的军民融合机制初探

本文通过总结2014年西非国家埃博拉疫情暴发期间,北京地区军地联合抗击埃博拉病毒病过程中中医药的干预治疗情况,初步探索中医药防治埃博拉病毒病的军民融合机制。