乙型肝炎肝衰竭的中西医结合治疗策略

Clinical research progress in integrated traditional Chinese and Western medicine therapy for HBV-related liver failure

乙型肝炎相关慢加急性肝衰竭(ACLF)和慢性肝衰竭(CLF)是目前国内肝衰竭的主要临床类型,临床证候复杂多变,变证多,兼夹证多,治疗难度大。近年来,在肝衰竭病因病机、证候规律以及中西医结合治疗研究领域取得了一些新进展。人们对肝衰竭病因病机的认识逐步趋于一致,基本的病因病机可以用"湿、热、毒、瘀、虚"来高度概括;临床研究更注重循证医学证据,结合中国国情开展临床研究;个体化复杂干预的中西医结合治疗方案,可以有效控制并发症,降低肝衰竭患者的病死率,改善临床症状,提高患者的生命质量与生存质量;其在调控免疫、有效控制内毒素血症方面的作用机制初步得以揭示。

Currently,hepatitis B virus （HBV）-related acute-on-chronic liver failure （ACLF）and chronic liver failure （CLF）are the main clinical types of liver failure.This disease has complex,changeable,and accompanying syndromes,so the treatment is very difficult. In recent years,some progress has been made in the etiology and pathogenesis of liver failure,associated traditional Chinese medicine syn-dromes,and integrated traditional Chinese and Western medicine therapy.Consensus has gradually been reached on the etiology and patho-genesis of liver failure,which can be summarized as＆quot;dampness,heat,toxin,stasis,and deficiency＆quot;.Evidence-based medicine is empha-sized in the clinical study,which should be conducted in combination with Chinese conditions.Integrated traditional Chinese and Western medicine therapy for individualized intervention can effectively control complications,reduce the mortality of patients with liver failure,relive the clinical symptoms,and improve their quality of life.The preliminary mechanism has been revealed in regulating immunity and effectively controlling endotoxemia.