中医药协同治疗自身免疫性肝病重度皮肤瘙痒案例

张磊; 蒋开平

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中医药协同治疗自身免疫性肝病重度皮肤瘙痒案例

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中医药协同治疗自身免疫性肝病重度皮肤瘙痒案例
Chinese medicine synergistic treatment of severe skin pruritus of autoimmune liver disease case
1.广州中医药大学附属佛山中医院肝病科，佛山 528000
DOI：

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张磊, 蒋开平. 中医药协同治疗自身免疫性肝病重度皮肤瘙痒案例[DB/OL].（2023-10-26）[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43053311&Fpath=home&index=0

ZHANG Lei, JIANG Kaiping. Chinese medicine synergistic treatment of severe skin pruritus of autoimmune liver disease case[DB/OL].（2023-10-26）[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43053311&Fpath=home&index=0
张磊, 蒋开平. 中医药协同治疗自身免疫性肝病重度皮肤瘙痒案例[DB/OL].（2023-10-26）[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43053311&Fpath=home&index=0 DOI：

ZHANG Lei, JIANG Kaiping. Chinese medicine synergistic treatment of severe skin pruritus of autoimmune liver disease case[DB/OL].（2023-10-26）[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43053311&Fpath=home&index=0 DOI：

摘要

病史摘要,2,患者中年女性，慢性病程，因“反复乏力、皮肤瘙痒伴肝功能异常半年”就诊。半年前因乏力、皮肤瘙痒于外院皮肤科就诊查肝功能异常，以GGT、ALP升高为主，予抗过敏、护肝治疗症状无缓解，反复发作。2018年5月30日我院Fibroscan：CAP：197 dB/m，LSM：20.9 kPa；肝功能：ALT） 59.1 U/L， AST）67.4 U/L， GGT）377.7 U/L；拟“肝损害查因”收治。症见：神志清，精神倦怠，面色萎黄，焦虑面容，乏力，口干，全身皮肤瘙痒、干燥，可见搔抓痕，无皮疹，上腹胀满不适，胃纳差，厌油腻，睡眠差，小便黄，大便烂，舌暗红，苔薄白，舌下脉络迂曲，脉弦涩。否认饮酒史，否认药物史。辅助检查：2018年5月31日全肝功能：ALT）57.1 U/L；AST）60.4 U/L；GGT）302.7 U/L；TBA）136.65 μmol/L；TBIL）31.92 μmol/L； DBIL）23.83 μmol/L；ALP）635.1 U/L；自身免疫性肝病抗体谱：抗AMA-M2陽性（+）；抗核抗体胞浆颗粒型（1：640）；免疫三项：IgG 17.78 g/L；IgM 3.57 g/L；血清蛋白电泳：γ -球蛋白 27.6%；甲、乙、丙、戊病毒性肝炎阴性；肝活检：（肝穿组织）慢性肝炎，中度，G3S3；肝细胞点灶状坏死、桥接坏死；汇管区中等炎细胞浸润，中度碎屑状坏死（界面性炎），纤维组织增生粗大，纤维间隔形成。中医诊断　肝着（肝郁脾虚，瘀血阻络）西医诊断　自身免疫性肝病----重叠综合征（自身免疫性肝炎-原发性胆汁性胆管炎）干预措施中医治则　疏肝健脾，活血化瘀，祛风止痒；处方：逍遥散+血府逐瘀汤西医治疗　护肝、利胆、抗炎、免疫调节疗效转归乏力、皮肤瘙痒症状缓解，肝功能好转。门诊随访病情控制稳定，后停药反弹

Abstract

Summary of case history　,The patient was a middle-aged female with a chronic course of disease who presented to the hospital due to "repeated fatigue, pruritus and abnormal liver function for six months".Half a year ago, the patient went to the dermatology department of another hospital due to fatigue and itching, and the examination showed abnormal liver function, mainly increased GGT and ALP.The symptoms were not relieved by anti-allergy and liver-protecting treatment,and recurrent.2018-5-30 Our hospital Fibroscan: CAP:197 dB/m, LSM: 20.9 kPa; Liver function: ALT) 59.1 U/L, AST)67.4 U/L, GGT)377.7 U/L; Planned "liver damage check" treatment. Symptoms: clear consciousness, mental burnout, yellow complexion, anxious face, fatigue, dry mouth, skin itching, dry body, visible scratching marks, no rash, upper abdominal distension, poor stomach appetite, greasy, poor sleep, yellow urine, rotten stool, dark red tongue, thin white moss, tortuous veins under the tongue, astringent pulse.Denial of alcohol use, denial of drugs. Auxiliary examination: On May 31, 2018, total liver function: ALT) 57.1 u /L; 60.4 U/L AST); 302.7 U/L GGT); Associates) 136.65 μmol/L; TBIL) 31.92 μmol/L; DBIL) 23.83μmol/L; 635.1 U/L ALP); Autoimmune liver disease antibody spectrum: anti-AMA-M2 positive (+); Cytoplasmic particle type of antinuclear antibody (1:640); IgG 17.78 g/L; IgM 3.57 g/L; Serum protein electrophoresis: γ -globulin 27.6%; Viral hepatitis A, B, C, E negative; chronic hepatitis, moderate, G3S3; Focal necrosis and bridging necrosis of hepatocytes; There was moderate inflammatory cell infiltration, moderate clastic necrosis (interfacial inflammation), thick fibrous tissue hyperplasia, and fibrous septa.,TCM diagnosisliver,　fixity (hepatic depression and spleen deficiency, blood stasis obstruction),Western medicine diagnosis　,autoimmune liver disease --(autoimmune hepatitis - primary biliary cholangitis )overlap syndrome,Therapeutic methods,　Principles of TCM treatment:Soothing liver and strengthening spleen,Promoting blood circulation to remove blood stasis,Dispelling wind and arresting itchingPrescription:Xiaoyao Powder and Xuefu Zhuyu DecoctionWestern medical treatment: Liver protection, Choleretic , Anti-inflammatory, Immunomodulatory,Clinical outcomes,　Fatigue, skin itching symptoms were relieved, liver function improved. During outpatient follow-up, the patient's condition was stable and recovered after self-withdrawal.

关键词

皮肤瘙痒重叠综合征自身免疫性肝炎原发性胆汁性胆管炎

Keywords

itching of the skinoverlap syndromeautoimmune hepatitisprimary biliary cholangitis

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