一贯煎干预肝硬化作用机制研究进展  

Research Progress on Mechanism of Yiguanjian Intervention in Liver Cirrhosis

作　　者：陈龙 慕永平 张华 王晓柠 陈佳美 刘平 CHEN Long;MU Yong-ping;ZHANG Hua;WANG Xiao-ning;CHEN Jia-mei;LIU Ping(Institute of Interdisciplinary Integrative Medicine Research,Shuguang Hospital,Shanghai Key Laboratory of Traditional Chinese Medicine(TCM),Shanghai University of TCM,Shanghai 201203,China;Institute of Liver Diseases,Key Laboratory of Liver and Kidney Diseases,Ministry of Education,Shanghai Institute of TCM,Shanghai 201203,China)

机构地区：[1]上海中医药大学交叉科学研究院,附属曙光医院,上海市中医临床重点实验室,上海201203 [2]上海市中医药研究院肝病研究所,肝肾疾病病证教育部重点实验室,上海201203

出　　处：《中国实验方剂学杂志》2020年第24期186-192,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(81530101)。

摘　　要：肝硬化是以一种或多种病因反复作用形成的以肝实质弥漫性纤维化、假小叶和再生结节形成,肝内外血管异常以致门静脉高压为特征的病理阶段,进展至失代偿期以肝功能严重损害为特征,出现腹水、胃食管静脉曲张破裂出血、肝性脑病等多种并发症,治疗上多为对症治疗,死亡率高,预后差。对于失代偿期肝硬化,中医药治疗不仅可以有效改善肝功能,且能显著提高患者的5年生存率,提示中医药在防治终末期肝病、促进肝硬化组织重构方面具有潜在优势。现代中医名家认为,肝硬化主要由气阴亏虚(肝、脾、肾)而湿热疫毒内侵,脉络瘀阻所致。肝肾阴虚是失代偿期肝硬化常见的主要证候。中医滋肾养肝方剂一贯煎是现代临床治疗慢性肝病肝肾阴虚证的代表方。由清代名医魏玉璞(魏之琇)所创,载于《续名医类案》。临床研究显示一贯煎可有效改善肝硬化患者的肝功能,促进腹水消退,减少肝性脑病等相关并发症的出现。实验研究提示一贯煎具有多途径、多层次、多靶点综合调节的特征,防治肝硬化的作用机制可能主要与抗氧化应激,改善肝脏炎症、提高肝细胞生物合成以及抑制肝星状细胞活化、减轻胶原沉积、改善肝窦血管化、促进肝细胞再生等有关。文章就近5年来关于一贯煎治疗肝硬化的临床及实验研究作一系统综述,为进一步拓展其临床应用价值提供参考。Liver cirrhosis caused by the repeated action of one or more causes is a pathological stage characterized by diffuse fibrosis of the liver parenchyma,formation of false lobules and regenerative nodules,portal hypertension which caused by abnormal blood vessels inside and outside the liver.The progression of cirrhosis to decompensation is characterized by severe liver damage,with ascites,gastroesophageal varices bleeding,hepatic encephalopathy and other complications,and most of the treatments are symptomatic,with high mortality and poor prognosis.At present,the traditional Chinese medicine treatment of decompensated cirrhosis can not only effectively improve liver function,but also significantly improve the 5-year survival rate of patients,which suggests that Chinese medicine has potential advantages in preventing and treating end-stage liver disease,and promoting liver cirrhosis tissue reconstruction.Modern Chinese medicine doctors believe that liver cirrhosis is mainly caused by Qi Yin deficiency(liver,spleen,kidney),internal invasion of damp-heat epidemic toxin,and collateral stasis.Deficiency of liver and kidney Yin is a common symptom of decompensated cirrhosis.Yiguanjian,one of Kidney-Nourishing and Liver-Replenishing decoction in traditional Chinese medicine,is the representative prescription for modern clinical treatment of chronic liver disease with"deficiency of liver and kidney Yin"syndrome.Yiguanjian,created by WEI Yu-zhen(WEI Zhi-xiu)in the Qing Dynasty,Contained in"Xu Ming Yi Lei An".Clinical studies show that Yiguanjian can effectively improve liver function in patients with liver cirrhosis,promote ascites resolution,and reduce the occurrence of hepatic encephalopathy and other related complications.Experimental research has suggested that Yiguanjian has the characteristics of multi-path,multi-level,and multi-target comprehensive regulation.The mechanism of prevention and treatment of liver cirrhosis may be mainly related to anti-oxidative stress,improving liver inflammation,improving liver cell bi

关 键 词：一贯煎 肝肾阴虚 肝硬化 肝星状细胞 

分 类 号：R2-0[医药卫生—中医学] R289