中西医结合治疗胆管消失型PBC 1例
A Aase of PBC with Disappearance of Bile Duct Treated by Combination of Traditional Chinese and Western Medicine
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1.杭州市西溪医院,杭州 310023
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徐艳琳,周毅骏,荀运浩,等.中西医结合治疗胆管消失型PBC 1例[DB/OL].(2023-11-13)[2023-11-13].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43867764&Fpath=home&index=0&lang=zh
XU Yanlin,ZHOU Yijun,XUN Yunhao,et al.A Aase of PBC with Disappearance of Bile Duct Treated by Combination of Traditional Chinese and Western Medicine[J].,
徐艳琳,周毅骏,荀运浩,等.中西医结合治疗胆管消失型PBC 1例[DB/OL].(2023-11-13)[2023-11-13].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43867764&Fpath=home&index=0&lang=zh DOI:
XU Yanlin,ZHOU Yijun,XUN Yunhao,et al.A Aase of PBC with Disappearance of Bile Duct Treated by Combination of Traditional Chinese and Western Medicine[J]., DOI:.
病史摘要,2,患者,女,56岁。2021年6月10日因“眼干、口干1年余。”就诊。患者1年余前诊断干眼症后转诊至风湿免疫科,因ALP、GGT显著升高,自身抗体谱抗SSA、AMA-M2阳性,考虑干燥综合征、原发性胆汁性胆管炎,予标准剂量熊去氧胆酸胶囊750 mg/d口服改善胆汁淤积治疗。服药期间患者间断复查ALP、GGT始终高于正常,考虑为UDCA应答欠佳,就诊于我院,肝穿明确诊断为胆管消失型PBC后予中西医结合治疗。四诊信息:神气不足,面色萎黄有黧黑斑,两颧发红,形瘦体惫,腰腿痠软,心中憺憺,心烦少寐,口干微苦,双目干涩,时有耳鸣。胃纳不馨,大便偏干,小便短少。舌黯红、苔少有裂纹,脉细、稍数。中医诊断 虚劳-肝肾阴虚证。西医诊断 原发性胆汁性胆管炎(胆管消失型)。干预措施 中医治疗运用过建春教授治疗PBC“藏象—病—证”理论,基于“肝络”概念,以一贯煎加减贯穿始终,根据症候演变,分别施以滋肾填精、柔肝和胃,养血活血、疏风止痒,疏肝和胃,活血化纤等法。西医治疗:长期口服熊去氧胆酸胶囊(250 mg/片)3片/天。疗效转归 经中西医结合治疗后,患者口干、眼干、疲乏感等诸症均有好转,ALP、GGT指标逐步下降,肝脏组织学得到改善。
Summary of case history, Patient, female, 56 years old. On June 10, 2021, she sought medical attention due to dry eyes and mouth for over a year. She was diagnosed with dry eye more than a year ago and referred to the Department of Rheumatology and Immunology. Due to significant elevation of ALP and GGT, as well as positive anti SSA and AMA-M2 in autoantibodies, she was diagnosed with Sjogren's syndrome and primary biliary cholangitis, and was treated with a standard dose of ursodeoxycholic acid capsule 750mg/d orally to improve cholestasis. During the medication period, her intermittent follow-up ALP and GGT were consistently higher than normal. It was considered that the UDCA response was poor, so she sought medical attention at our hospital. After liver biopsy confirmed the diagnosis of PBC with disappearance of bile ducts, she was treated with a combination of traditional Chinese and western medicine. Symptoms and signs: Lack of energy, pale complexion with swarthy black spots, red cheekbones, thin and tired body, weak waist and legs, heart palpitations, restlessness and lack of sleep, slightly bitter dry mouth, dry eyes, and occasional tinnitus. Poor appetite, dry stools, and short voidings of scant urine. The tongue was dull red, with few cracks on the tongue coating,and the pulse was thin and fast.,TCM diagnosis, Consumptive disease. Liver and kidney Yin deficiency syndrome.,Western medicine diagnosis, Primary biliary cholangitis (Vanishing type of bile duct) .,Therapeutic methods, Traditional Chinese medicine treatment: Using Professor GUO Jianchun's theory of "visceral symptoms-disease-syndrome" in the treatment of PBC, based on the concept of "liver collaterals", the method of consistently decocting, adding and subtracting was applied throughout the entire process. According to the evolution of symptoms, methods such as nourishing the kidney and filling the essence, softening the liver and stomach, nourishing blood and promoting blood circulation, dispersing wind and relieving itching, soothing the liver and stomach, and promoting blood circulation and resolving fibrosis were applied. Western medicine treatment: long-term oral administration of ursodeoxycholic acid capsules (250 mg/tablet) 3 tablets/day.,Clinical outcomes, After treatment with a combination of traditional Chinese and western medicine, the patient's symptoms such as dry mouth, dry eyes, and fatigue improved. ALP and GGT indicators gradually decreased, and liver histology improved.
原发性胆汁性胆管炎经验过建春教授
Primary biliary cholangitisexperienceProfessor GUO Jianchun
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