慢加急性肝衰竭的证候演变及证治思路

张茜茜; 黄玉; 孙克伟

doi:10.12449/JCH250602

慢加急性肝衰竭的证候演变及证治思路

DOI: 10.12449/JCH250602

湖南中医药大学第一附属医院肝病中心，长沙 410007

基金项目:

国家科技重大专项 (2008ZX10005-007);

国家中医药管理局高水平中医药重点学科建设项目 (zyyzdxk-2023146);

国家中医临床研究基地业务建设科研专项 (JDZX2012061);

国家自然科学基金面上项目 (81973833);

国家自然科学基金面上项目 (81673959);

国家中医药管理局科研基金 (JDZX2012061);

湖南省自然科学基金面上项目 (2025JJ50697);

湖南省自然科学基金面上项目 (2020JJ4475)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：张茜茜负责撰写论文；黄玉负责查阅文献；孙克伟负责拟定文章思路，修改并最终定稿。

详细信息

通信作者:
孙克伟， keweisun550@163.com （ORCID： 0000-0002-9734-3717）

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出版历程
- 收稿日期: 2025-04-04
- 录用日期: 2025-05-02
- 出版日期: 2025-06-25

Syndrome evolution of acute-on-chronic liver failure and ideas for diagnosis and treatment

Department of Hepatology，The First Hospital of Hunan University of Chinese Medicine，Changsha 410007，China

Research funding:

National Science and Technology Major Project (2008ZX10005-007);

High Level Key Discipline Construction Project of Traditional Chinese Medicine by the State Administration of Traditional Chinese Medicine (zyyzdxk-2023146);

National Traditional Chinese Medicine Clinical Research Base Business Contruction Research Special Project (JDZX2012061);

General Project of National Natural Science Foundation of China (81973833);

General Project of National Natural Science Foundation of China (81673959);

Scientific Research Fund of State Administration of Traditional Chinese Medicine (JDZX2012061);

General Project of Natural Science Foundation of Hunan Province (2025JJ50697);

General Project of Natural Science Foundation of Hunan Province (2020JJ4475)

More Information

Corresponding author: SUN Kewei， keweisun550@163.com （ORCID： 0000-0002-9734-3717）

摘要

摘要: 慢加急性肝衰竭（ACLF）是一种具有短期高病死率的急危重症，目前治疗多以消除诱因、器官支持及预防并发症为主。肝移植虽为最有效的治疗方式，但临床应用受限，而中医药在治疗ACLF方面显示出显著的优势和特色。中医学将ACLF归属于“黄疸”等疾病范畴，与传统黄疸多实证、热证不同，ACLF疾病谱变化导致其证候呈现由阳黄向阴黄转化的趋势。本文结合ACLF的西医发病机制与中医学理论，深入探讨ACLF的中医病机本质规律，分析其证候演变规律，并基于湿热、瘀热、脾虚三因辨治模式，综述中医药的临床疗效与机制研究进展，同时评估健脾温阳药在ACLF临床应用中的安全性，为中医药治疗ACLF提供思路、方法和依据。
- 慢加急性肝功能衰竭 /
- 证候 /
- 湿热 /
- 瘀热 /
- 脾虚
Abstract: Acute-on-chronic liver failure （ACLF） is an acute and critical illness with a high short-term mortality rate， and current therapies mainly focus on elimination of causes， organ support， and prevention of complications. Although liver transplantation is the most effective treatment modality， its clinical application is limited， and traditional Chinese medicine has shown significant advantages and characteristics in the treatment of ACLF. In traditional Chinese medicine， ACLF is classified into the same category as diseases such as “jaundice”， and unlike traditional jaundice which is mostly characterized by excess and heat syndromes， the syndrome of ACLF has gradually transformed from Yang jaundice to Yin jaundice due to the changing disease spectrum of ACLF. With reference to the pathogenesis of ACLF in Western medicine and traditional Chinese medicine theories， this article discusses the essential pathogenesis of ACLF in traditional Chinese medicine， explores the evolution of ACLF syndromes， and reviews the research advances in the clinical efficacy and mechanisms of traditional Chinese medicine based on the three-factor differentiation-based treatment of damp-heat， blood stasis-heat， and spleen deficiency， as well as the safety of spleen-strengthening and Yang-warming drugs in the clinical treatment of ACLF， in order to provide ideas， methods， and evidence for the application of traditional Chinese medicine in ACLF.
- Acute-On-Chronic Liver Failure /
- Symptom Complex /
- Dampness Heat /
- Stagnant Heat /
- Spleen Deficiency

HTML全文

图 1 不同的诊断标准下ACLF病程中的不同阶段

Figure 1. Different diagnostic criteria can be considered as different stages in the course of ACLF

下载: 全尺寸图片幻灯片

图 2 ACLF“瘀热-湿热-脾虚”虚实夹杂三因发病模式

Figure 2. Acute-on-chronic liver failure “stasis-heat-dampness-spleen deficiency” deficiency-excess mixed three-cause pathogenesis model

下载: 全尺寸图片幻灯片

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