中西醫(yī)結(jié)合在慢加急性肝衰竭全病程管理中的特色和優(yōu)勢

通信作者：，wangxianbo638@163.com（ORCID：0000-0002-3593-5741）

關(guān)鍵詞：慢加急性肝功能衰竭；中西醫(yī)結(jié)合療法；多學(xué)科診療

基金項目：國家自然科學(xué)基金（82474419，82474426）；北京市衛(wèi)生健康委員會-研究型病房卓越臨床研究計劃（BRWEP2024W102170107）；北京市醫(yī)院管理中心創(chuàng)新夢工場經(jīng)費(fèi)資助（202335）

Characteristics and advantages of integrated traditional Chinese and Western medicine therapy in whole-course management of acute-on-chronic liver failure

GAO Fangyuan，F(xiàn)ENG Ying，WANG Xianbo

Center of Integrative Medicine，Beijing Ditan Hospital，Capital Medical University，Beijing 1Ooo15，China

Corresponding author：WANG Xianbo，wangxianbo638@163.com（ORCID： 0000-0002-3593-5741）

Abstract：Acute-on-chronic liverfailure（ACLF）isacomplexclinical syndrome characterized byacute deteriorationof liver functioncaused bydiferent factorson the basisof chronic liverdisease，accompanied by liver failureand/or extrahepatic organ failure，and itoften hasa high short-term mortalityrate.With the increasing evidenceof evidence-based medicine， multipleguidelinesandconsensus statements havebeenreleased，suchas Guidelines forclinicaldiagnosisandtreatmentof acute-on-chronic liver failure intraditional Chinese medicine，Expertconsensus on thediagnosisand treatmentofacute-onchronicliverfailurewithintegratedtraditionalChineseandWesternmedicine，andGuidelines fortheintegrated traditional Chineseand Westernmedicinediagnosisandtreatmentofacute-on-chronic liverfailure，and integrated traditional Chinese and Western medicine therapies for ACLF have been constantly standardizedand perfected.This article explores the characteristicsandadvantagesof integrated traditional Chinese andWestern medicine therapyin the whole-course management of ACLF from theaspectsof early warning and prevention，treatment in theacute stage，managementof complications，andrehabilitationcare，inorder to enhancetheunderstandingof traditional Chinese and Western medicine treatment strategies among clinicians.

KeyWords：Acute-On-ChonicLiverFilure；IntegratedChineseTraditionalandWesteMedicineTherapy;Multi-DisciplinaryTeam

Research funding：NationalNaturalScienceFoundationofChina（82474419，82474426）；BeijingMunicipal HealthCommisionExcelent Clinical ResearchProgram for Research Wards（BRWEP2024W102170107）；Beijing HospitalsAuthority Innovation Studio of Young Staff Funding Support （202335）

慢加急性肝衰竭（ACLF）具有發(fā)病急驟、進(jìn)展迅速、并發(fā)癥多、病死率高等特點(diǎn)，中西醫(yī)結(jié)合作為我國獨(dú)特的醫(yī)療模式，在ACLF這類復(fù)雜危重癥的全病程管理中展現(xiàn)出顯著特色與優(yōu)勢。本文將系統(tǒng)闡述中西醫(yī)協(xié)同在ACLF不同病程階段的整合干預(yù)策略，為構(gòu)建ACLF多學(xué)科協(xié)作診療體系提供新的思路

1ACLF的早期預(yù)警

ACLF發(fā)病迅速、病情兇險、并發(fā)癥多、預(yù)后差。若能對ACLF早期預(yù)警，并給予積極干預(yù)，則有機(jī)會控制疾病的發(fā)生和發(fā)展，對降低ACLF的發(fā)病率和病死率具有重要臨床意義。

1.1ACLF早期中醫(yī)癥候群余思邈等1對多中心、大樣本HBV相關(guān)ACLF（HBV-ACLF）患者不同分型及分期的證素、證型分布規(guī)律開展因子分析和聚類分析研究，結(jié)果顯示，肝衰竭早期患者病性證素分布以熱（ 39.4% ，359/912）濕 （27.5%，251/912） 多見，證型主要以肝膽濕熱證1 74.6% ，461/618）為主；主要癥候群包括身目發(fā)黃，口渴喜涼飲、口中黏膩、口苦、口臭，腹脹、惡心嘔吐，急躁易怒、脅肋脹痛，小便黃或短少，大便穢臭或黏滯不爽或秘結(jié)，苔厚或膩，脈滑或弦。正如《金匱要略方論·黃疸病脈證并治》所云：“黃家所得，從濕得之”，《諸病源候論》謂之：“熱毒所加，故卒然發(fā)黃”，濕熱毒邪是HBV-ACLF發(fā)病的首要病因。若肝損傷患者出現(xiàn)上述癥候表現(xiàn)，應(yīng)警惕ACLF的發(fā)生。

1.2預(yù)警ACLF發(fā)生風(fēng)險的常用評分系統(tǒng)和工具近10年，我國研究團(tuán)隊陸續(xù)開發(fā)了多項ACLF早期預(yù)警系統(tǒng)，包括基于臨床病歷數(shù)據(jù)和新型生物標(biāo)志物的預(yù)測模型?！?br>