自身免疫性肝炎合并代谢相关脂肪性肝病的中西医结合诊治探讨  

Exploration of integrative Chinese and western medicine diagnosis and treatment on autoimmune hepatitis combined with metabolism-related steatohepatopathy

作　　者：苟悦 邢枫 刘成海 GOU Yue;XING Feng;LIU Chenghai(Institute of Liver Diseases,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院肝病研究所,上海201203

出　　处：《北京中医药》2024年第6期600-605,共6页Beijing Journal of Traditional Chinese Medicine

基　　金：上海市临床重点专科建设项目(shslczdzk01201);山西中医药大学科技创新团队项目(2022TD2003)。

摘　　要：代谢相关脂肪性肝病(metabolic dysfunction-associated steatotic liver disease,MASLD)的患病率居肝病之首,自身免疫性肝炎(autoimmune hepatitis, AIH)与MASLD合并致病临床常见。这2种肝病虽临床表现相似,但病理机制与诊疗均有显著区别,相兼出现后病情复杂、治疗困难,目前尚缺乏研究与诊治共识。本文首先分析AIH合并MASLD现有的诊疗难题,归纳二者的主要鉴别要点,初步提出AIH合并MASLD的临床诊疗流程图;继而指出AIH合并MASLD属于中医学合病范畴,其主要病机为肝郁脾虚肾亏、湿热痰浊瘀血阻滞,基本治则为疏肝健脾益肾、清热化痰活血,“党参、茯苓、白术、女贞子、枸杞子、川芎、赤芍、黄芩、薏苡仁、陈皮、半夏、浙贝母”为基础方剂,针对个体体质及病程特点辨证加减,灵活配伍以改善临床症状及患者预后。提出临床诊疗过程中应重视AIH合并MASLD这一合并症,积极开展中西医结合临床诊治研究,以改善患者预后。The morbidity of metabolic dysfunction-associated steatotic liver disease(MASLD)is the highest among liver diseases,and the combination of autoimmune hepatitis(AIH)and MASLD is commonly seen clinically.Although the clinical manifestations of these two liver diseases are similar,there are significant differences in pathologic mechanism and diagnosis and treatment,and there is a lack of consensus on the research and diagnosis and treatment of these two liver diseases because of the complexity of the condition and the difficulty of the treatment after the concurrency.This paper firstly analyzes the existing difficulties in diagnosis and treatment of AIH combined with MASLD,summarizes the main identification points of the two,and initially put forward the clinical diagnosis and treatment flowchart;then,it points out that AIH combined with MASLD belongs to the category of combined diseases in Chinese medicine,and the main pathogenesis is depression of liver,deficiency of spleen and kidney,obstruction of dampness,heat,phlegm,stasis and blood stagnation,and the basic treatment principles are to dredge liver,strengthen the spleen and benefit the kidney,and to clear away heat and resolve phlegm and activate blood circulation.Codonopsis,Poria,Atractylodes macrocephala,Ligustri lucidi fructus,Lycii fructus,Chuanxiong rhizome,Paeoniae radix rubra,Scutellariae radix,Coicis semen,Citri reticulatae pericarpium,Pinelliae rhizome,Fritillariae thunbergii bulbus are used as the basic formula,and it is tailored to the characteristics of the individual's physique and the course of the disease,and can be flexibly combined with the formula to improve the clinical symptoms and the patient's prognosis.Finally,it is suggested that in the clinical diagnosis and treatment,AIH combined with MASLD should be emphasized,and the clinical research on diagnosis and treatment on AIH combined with MASLD should be actively carried out so as to improve patients'prognosis.

关 键 词：自身免疫性肝炎 代谢相关脂肪性肝病 合并症 诊断 治疗 

分 类 号：R575[医药卫生—消化系统]