门静脉血栓(PVT)是肝硬化的常见并发症,主要与血流缓慢、局部血管损伤和血液高凝状态有关.本文就肝硬化PVT的危险因素、中医证候特点及中西医治疗手段等方面进行综述.

陈新瑜从事中西医结合临床工作近30年,重庆市中医院名中医,师从全国名老中医罗本清,其防治原发性肝癌骨转移有丰富的临床经验,陈新瑜老师重视扶正固本、未病先防,擅长以疏肝理气、健脾补肾为治法,补肾又当以补肾阴为主,温肾阳为辅,临证中常以四逆散合四君子汤合左归丸加减为基本方联合抗癌中药,并根据辨证选用行气、活血化瘀、化痰及温经散寒的方剂组成复方,灵活应用,随症加减,多获良效.

Objective To explore the effects and mechanism of saikosaponin D (SSD) on immune hepatic fibrosis induced by porcine serum in rats through network pharmacology analysis and animal experimental verification. Methods The potential targets for SSD and autoimmune hepatic diseases were obtained based on network pharmacology analysis, and the protein interaction network was constructed using STRING database and Cytoscape software. Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis was subsequently performed with DAVID database. Then the rat model of immune hepatic fibrosis was prepared and further intervened with SSD. Serum levels of ALT, AST, TNF-α, IL-1β and IL-18 were measured by ELISA. The pathological changes of rat liver were observed using HE staining; and Western blotting was conducted to detect the ptotein expression of NLRP3, ASC, Caspase-1, GSDMD, Toll-like receptor 4 (TLR4), myeloid differentiation primary response 88 (Myd88), p65 and p-p65 in rat liver tissues. Results A total of 177 potential targets of SSD and autoimmune hepatic diseases were collected. Enrichment analysis showed that the immune system-related pathways were mainly NOD-like receptor signaling pathway, and the enrichment of potential targets in this signaling pathway was obtained. As compared with the model group, high-dose SSD significantly reduced the serum levels of ALT and AST in rats (P < 0.05), and remarkably improved hepatic fibrosis and alleviated liver injury in rats. ELISA indicated notable declines in TNF-α, IL-1β and IL-18 levels in rats after intervention of medium- and high-dose SSD (P < 0.05). Western blotting also suggested that SSD greatly down-regulated the protein levels of NLRP3, ASC, Caspase-1, GSDMD, TLR4, Myd88 and p65, and inhibited the phosphorylation of p65. Conclusion SSD reduces the release of inflammatory factors in serum and alleviates the injury of liver cells in rats with immune hepatic fibrosis, which may be related to the regulation of TLR4/NF-κB and NLRP3 inflammasome signaling pathways.

陈新瑜主任中医师系全国第三批师带徒学术继承人,师从重庆市名老中医罗本清主任医师,从事肝胆疾病研究多年,临床治疗慢性肝病经验丰富.本文总结其治疗慢性乙型病毒性肝炎合并非酒精性脂肪性肝病的经验,陈新瑜认为脏腑气血关系的病理变化贯穿于本病始终,以"血气不和"为基本病机;临床重视病因学治疗,注重恢复脏腑气血正常关系,以气血理论为指导,提出"调和气血,祛邪安脏"的总治则,根据病情程度分阶段、有层次用药,同时注重顾护正气,保护脏腑机能.

陈新瑜教授从事中西医结合临床工作近30年,是中西医结合治疗慢性肝病的知名专家,湖南中医药大学教授,重庆市中医院名中医,其临床治疗原发性肝癌肺转移有丰富的经验和独到之处,陈新瑜教授强调扶正为根本,扶正固本当贯穿疾病治疗始终,以疏肝理气、健脾补肺、益气养阴为治法,以四逆散合六君子汤加减为基本方,并选用部分温阳化积散结与抗肿瘤的中药组成复方,灵活应用,随症加减,多获良效.

OBJECTIVE To explore the effect of Xiao Chaihu decoction on liver function and HBV-DNA copies of patients with hepatitis B virus (HBV) infection .METHODS A total of 96 patients with HBV infection who were hospitalized in hepatopathy department and treated in outpatient department from Apr 2012 to Nov 2015 were en-rolled in the study and divided into the control group and the experimental group ,with 48 cases in each group .The control group was treated with conventional antiviral therapy ,liver protection and reduction of enzymes ,while the experimental group was given additional Xiao Chaihu decoction on basis of the above treatment ,both groups were treated for 4 weeks as a course .The liver function ,HBV-DNA copies ,hepatic fibrosis indexes and T lymphocytes subsets were determined before and after the treatment ,and the clinical curative effect and incidence of adverse re-actions were observed and compared between the two groups of patients .RESULTS The levels of serum AST , ALT ,TBiL and HBV-DNA copies of the two groups of patients were lower after the treatment than before the treatment ,the levels of serum HA , Ⅳ C ,PC Ⅲ and LN of the two groups of patients were lower after the treat-ment than before the treatment ,the levels of serum CD4 + and CD4 + /CD8 + were higher after the treatment than before the treatment ,and the CD8 + level was lower after the treatment than before the treatment (P < 0 .05) .The levels of serum AST ,ALT ,TBiL and HBV-DNA of the experimental group were lower than those of the control group after the treatment ;the levels of serum HA ,Ⅳ C ,PC Ⅲ and LN of the experimental group were lower than those of the control group after the treatment ,the levels of serum CD4 + and CD4 + /CD8 + of the experimental group were higher than those of the control group after the treatment ,and the CD8 + level of the experimental group was lower than that of the control group (P < 0 .05) .The response rate of the control group was 77 .08％ , lower than 91 .67％ of the experimental group (P < 0 .05) .CONCLUSION Xiao Chaihu decoction may raise the cur-ative effect of the patients with HBV infection ,remarkably improve the liver function and reduce the hepatic fibro-sis and HBV-DNA copies ,with the safety satisfied ,and it is effective for the treatment of the patients .

Objective:To observe the clinical efficacy of Gansui Baijiezi capsule and western medicine on hepatic hydrothorax.Methods:The 50 patients were randomly divided into two groups,25 in each.The patients were treated by western medicine in control group,and Gansui Baijiezi capsule as well as western medicine in treatment group.The efficacy was compared between the two groups.Results:The effective rate was 88.0％ in the control group and 96.0％ and in the treatment group,and the difference was not significant (P＞0.05).The serum albumin (Alb),alanine aminotransferase (ALT),aspartate aminotransferase (AST),bilirubin (TBIL) were better than before in the two groups (P＜0.05) and the treatment group showed better improvement than the control group (P＜0.05).The difference on clinical symptoms improvement time (cough,dyspnea,not supine,malaise and fatigue) was significant (P＜0.05).Conclusion:Gansui Baijiezi capsule and western medicine can provide obvious curative effect on hepatic hydrothorax.