Case B - Treatment of Liver Disease II (Cordyceps)
3. Liver fibrosis
Liver fibrosis is a pathological process that develops from chronic liver disease to cirrhosis. Hepatic fibrosis is characterized by hyperplasia and deposition of extracellular interstitial (ECM). Hepatitis virus, schistosomiasis, alcohol, chemical poisons and other liver damage can stimulate the proliferation of connective tissue cells secreted by liver cell inflammatory cells, collagen proliferation and deposition. , leading to liver fibrosis. The gene mainly manifests as over-expression of hepatic fibrosis factor, while the expression of inhibitory factor is relatively low, leading to the activation of hepatic stellate cells, transforming synthesis and secretion of a large number of extracellular matrix, while the expression of enzymes that degrade ECM decreases and the expression of inhibition increases. , resulting in reduced ECM degradation, resulting in massive deposition in the liver. When the deposition is increased to more than 5 times that of the liver, liver fibrosis is formed. The main pathological features are excessive deposition of collagen polysaccharides and glycoproteins in the portal area and hepatic lobules, and capillary vascularization in the vicinity of the fibrosis. In recent years, the experimental and clinical research on anti-liver fibrosis of traditional Chinese medicine has been widely carried out. The traditional Chinese medicine syndrome differentiation and treatment rules such as Huoxue Huayu, Bushen Yijing and so on have provided many valuable experiences for clinical treatment. Studies have found that Cordyceps sinensis and its fermented hyphae can inhibit hepatitis virus, reduce the cause of liver fibrosis, improve the structure and function of sclerosing liver, improve liver cell function, regulate liver extracellular matrix metabolism and regulate cytokines and immune functions. Liver fibrosis has a good preventive effect.
※Wang Yaojun et al. randomly divided 49 patients with hepatic fibrosis into 27 patients in the treatment group and 22 patients in the control group. The control group received oral inosine tablets daily.
Times, 0.4g each time, Gantaile 3 times a day, each time 0.2g; treatment group oral Jinshuibao capsules 3 times a day, each time 1.0g, the course of treatment is March. Results Serum ALT and bilirubin decreased significantly in the treatment group. The levels of serum type III procollagen and laminin decreased, and were significantly lower than those in the control group and before treatment (P<0.01). Collagen deposition of type I, II and IV in liver tissue Reduced, liver lipid storage cell transformation is inhibited. table
Cordyceps sinensis has good anti-fibrosis effect.
※Wang Yaojun et al reported that oral liver tylosin and inosine tablets were used as controls to observe the clinical efficacy of Cordyceps sinensis (Huadong Pharmaceutical) in the treatment of liver fibrosis. After treatment, serum ALT and bilirubin (SB) decreased significantly, albumin (ALB) increased; serum type III procollagen (PCIII) and laminin (LN) levels decreased, and significantly lower than the treatment group and treatment Before (P<0.01), the results are shown in Table 8-35; liver tissue immunohistochemistry and ultramicroscopic observation, the treatment group decreased the collagen deposition of type 1, III and IV, and the liver fat storage cell transformation was inhibited.
※ Gong Huanyu and other patients with chronic hepatitis were randomly divided into the treatment group of 25 cases and the control group of 18 cases, the treatment group in the control group took liver protection drugs
On the basis of giving Bailing capsules, 3 times a day, each time 1.0g, the course of treatment is March. The effects of chronic hepatitis B T cell subsets (CD4, CD8 and CD4-CD8) and fibrosis markers (HA and PCIII) were significantly different before and after treatment (P<0.05), and there were significant differences compared with the control group (P<0.05). P < 0.05), see Table 8-36. It indicated that the fermented hyphae of Cordyceps sinensis has a certain effect on regulating cellular immunity and anti-fibrosis in patients with chronic hepatitis B.
※ Ma Jie et al reported that the toxic effects of anesthetic drugs and surgical inflammatory reactions during surgical treatment can accelerate the fibrosis process in patients with early cirrhosis. Serum hyaluronidase (HA), laminin (LN), N-type collagen (N-C) and type III procollagen (PCIII) are important reference indicators for judging liver fibrosis and cirrhosis. In the early 66 cases of cirrhosis, 36 patients were randomly divided into treatment group and 30 cases in operation group.
30 cases in the control group. The control group was treated with percutaneous liver puncture, and the surgical group and the treatment group were treated with intraoperative biopsy for morphological examination. The treatment group used Danshen injection and Cordyceps sinensis fermented hyphal preparation during the perioperative period, and continued to take the Cordyceps sinensis mycelium preparation after discharge. The indexes of liver fibrosis in the control group, the surgical group and the treatment group were consistent with the morphological diagnosis, and there was no significant difference (P>0.05). In the control group, the index of liver fibrosis increased after 3 months, but there was no significant difference compared with the admission (P>0.05). The fibrosis index of patients with surgically treated cirrhosis changed significantly, and the difference was very significant before surgery (P <0.01), there was also a significant difference compared with the control group (P<0.05); while the perioperative treatment group showed a significant decrease in liver fibrosis index compared with the surgical group, the difference was extremely significant (P<0.01). See Table 8-37
It indicated that the combination of Danshen and Cordyceps sinensis fermented mycelial preparations had significant preventive effects on liver fibrosis in early cirrhosis.
※Mei Cunjin and other application of cordyceps polysaccharide liposome combined with salvia miltiorrhiza in the treatment of chronic active hepatitis and early liver cirrhosis in 68 cases, respectively
Liver function indicators (ALT, TBiL, A and G) and serum liver fibrosis (HA, PCIII and 3) were measured before treatment and 4 months after treatment.
LN), the results were significantly improved compared with before treatment, and there were significant differences between the indicators before and after treatment (P<0.05 or P<0.01), see Table 8-38. It indicated that the Fuzheng Huayu method consisting of Cordyceps polysaccharide liposome combined with Salvia miltiorrhiza has certain anti-fibrosis effect.
※ Yuan Cuiyun and other applications of ribonucleic acid combined with Cordyceps sinensis in the treatment of chronic hepatitis after liver fibrosis in 28 cases, oral Cordyceps preparation (mainly Cordyceps sinensis) 30ml per day, 30mg of nucleic acid per day, self-control before and after treatment, before and after treatment in January and March respectively Serum hyaluronic acid, type III procollagen sputum, and laminin were measured. Results After treatment, the patients were treated with serum hyaluronic acid and type III procollagen peptides after January and March.
The 3 layers of laminin were significantly lower than before treatment, and the longer the course of treatment was found, the more obvious the change was.
※ Xu Xiangtian and other applications of compound Cordyceps sinensis preparation (Chongcao Huaxian Capsule) for the treatment of patients with liver fibrosis after chronic hepatitis. Post-treatment knot
Compared with the 38 control group taking the Xinganbao capsule (total effective rate 60.52%), the efficacy of 78 treatment groups (total effective rate 83.33%6)
More significant (P <0.05); compared with before treatment, the treatment group after treatment, abdominal distension, fatigue, hepatosplenomegaly and other symptoms and signs are also clear
Significant improvement (P<0.01-0.05).
In traditional medicine in the motherland, post-hepatitis cirrhosis is a range of "sickness" and "expansion", mainly because the liver is attacked by external evils, leaving it without leaving, causing liver damage, obstruction of the liver, blood stasis, and liver loss. The function of the strip and the venting, the liver will pass the spleen, the spleen and the kidney, and eventually lead to liver, spleen and kidney damage. The onset of cirrhosis is insidious and progresses slowly. The main pathology is the proliferation of collagen fibers on the basis of chronic liver injury. Blood stasis, qi deficiency and weakness are the characteristics of the disease. Therefore, traditional Chinese medicine to promote blood circulation and remove phlegm at the same time to correct the deficiency is the basic rule of the disease, while Cordyceps sinensis and some of its mycelial preparations have clear curative effect, which is cirrhosis. The treatment opens up a promising new path.
※ It is reported that Cordyceps 3-5g per day, the treatment of chronic hepatitis not only has the effect of raising albumin, reducing globulin, but also improving the symptoms of cirrhosis. It was also reported that Shanghai Longhua Hospital used Cordyceps sinensis powder to treat more than 30 patients with advanced liver cirrhosis with persistent hepatic inflammation. As a result, all patients had decreased ascites, and some of them had subsided, and all liver function indexes were significantly improved.
※ Kong Qinghui and other applications of Cordyceps sinensis in the treatment of 40 cases of cirrhosis ascites, in the Western medicine diuretic, add albumin based on the addition of Cordyceps sinensis, 2-3 times a day, each time 2-4g. The results showed that after 3 days of treatment, the amount of urine increased and the ascites decreased. After 12 days, the symptoms were significantly improved, and the ascites disappeared after 20 days. The mechanism of action is that Cordyceps sinensis can improve human serum albumin, increase plasma osmotic pressure, reduce plasma extravasation, inhibit the formation of ascites, and promote the absorption of ascites.
※Wang Yaojun et al. used oral Gantaile as a control to observe the clinical efficacy of Cordyceps sinensis (Huadong Pharmaceutical) in the treatment of decompensated cirrhosis.
Changes in liver function and symptoms after 1 month of treatment are shown in Table 8-40 in Table 8-39. In addition, the ascites regression time was based on the examination of non-mobility dullness or / and B-type ultrasound examination of the dark area of the liquid, the treatment group was (11.8 ± 5.6) d (P < 0.01), the control group was (25.8 ± 9.2) d (1 case has not been returned, not counted). Changes in serum HbsAg: 15 cases in the treatment group were positive after treatment, and 4 cases were negative. Interestingly, 4 cases of patients with HCV infection (serum anti-BCV positive or weak positive) were negative; 4 cases in the control group were positive. Turning negative, the difference between the two groups was significant (P<0.05).
※ Cao Lisen et al. used on the basis of conventional comprehensive therapy, plus Xinganbao capsule in the treatment of liver cirrhosis in the late stage of hepatitis. The treatment group was treated with 22 cases of Xinganbao capsule. The dosage was 11 cases per day, 4.5g, and the other 11 cases were 3.0g per day. It is taken in 3 times, and it is a course of treatment in March. Results The control group was effective in 2 cases (9%), effective in 10 cases (45.5%), ineffective in 10 cases (45.5%), and the total effective rate was 54.5%; the treatment group was markedly effective in 13 cases (59%) and effective in 7 cases (32%). 2 cases were ineffective (9%), and the total effective rate was 91% (P<0.001). The ascites disappeared in the control group (51.8±12.2) d, the effective rate was 64.3%; the treatment group (38.4±12.1) d (P<0.01), the ascites disappearance rate was 90.5%. There was no significant difference in the rate of AT and total bilirubin in the two groups, but in the improvement of albumin level and correction of the ratio of white-globulin ratio, the effective rate of the treatment group was 86.4%, and that of the control group was 62.5%.
※Chen Yongning randomized 79 patients with cirrhosis into 45 patients in the treatment group and 34 patients in the control group. The treatment group received Jinshuibao capsules 3 times a day for 3 times each time. The control group received Western medicine for 4 weeks. . Clinical efficacy was determined by clinical symptoms, liver function and ascites. Results After treatment, the treatment group was effective in 21 cases, effective in 20 cases, and ineffective in 4 cases. The total effective rate was 91.11%. The control group was effective in 10 cases, effective in 11 cases, and ineffective in 13 cases. The total effective rate was 61.76%. Significant (P <0.01).
※ Liu Cheng et al reported that Cordyceps sinensis fermented mycelium capsule (Jiangsu Nantong Biochemical Pharmaceutical Factory) treated 22 cases of liver cirrhosis in late stage, the dose was 6-9g per day, and the course of treatment was 3 months. After treatment, both mental and appetite improved to varying degrees, and most of the symptoms of bloating disappeared. Among the 17 patients with ascites, 12 cases of ascites disappeared and 5 cases decreased. In 17 cases, plasma albumin increased after treatment, of which increased by 0.5g% or more. For example (50%), the highest increase was 1.2g%; protein electrophoresis analysis showed that albumin increased significantly after treatment (P<0.01), while τ-globulin decreased significantly (P<0.05).
※ Liu Cheng et al. reported the effect of Cordyceps sinensis fermented hyphae on monocytes in patients with posthepatitic cirrhosis. Single patient with cirrhosis after hepatitis
The nucleated cells (PBMC) were used to induce interferon (IFN) in vitro. It was found that the fermentation mycelium of Cordyceps sinensis had no inducing effect, but it could enhance the effect of ConA on the induction of IFN. Different concentrations of Cordyceps sinensis The silk action is inconsistent, with 5mg/ml and 10mg/ml being the strongest, too high or too low. At the same time, the authors carried out the fermentation of hyphae of Cordyceps sinensis on the IFN-induced IFN test in rats, which showed that the serum induced by Cordyceps sinensis or the serum containing Cordyceps sinensis could significantly enhance the effect of ConA induced IFN.
※Liu Cheng et al. observed the clinical effect of the peach extract and Cordyceps sinensis on cirrhosis after hepatitis, and the results were mostly different.
Improvements in the degree of appetite, increased mental health, increased physical strength, reduced or disappeared bloating. Among them, the anterior portal vein diameter, splenic vein diameter and spleen volume of the observation group were (15.10±3.38) mm, (10.85±2.45) mm, and (663±38), respectively, which were reduced by (0.43=0.13) mm (n). =40, P<0.01), (0.71±0.19) m (n=34, P<0.001), (16146) cm3 (n=34, P<01); and changes in immunological indicators before and after treatment indicated that the observation group was immunized The indicators have improved significantly, see Table 8-41.
Laparoscopic observation of 5 cases in the observation group: the liver was observed to have different degrees of swelling before treatment, the color was dark red or purple, the texture was medium or hard, and the surface was
Diffuse nodules and fibrous tissue, blunt edge, mild edema of the falciform ligament in 2 cases, retinal or mesenteric vasodilation or varicose veins. After treatment 3
The liver stiffness was restored to varying degrees, the color turned red or dark red, the fibrosis of the liver surface was slightly reduced, the edema of the sacral ligament disappeared, and the degree of varicose veins in the 2 cases was alleviated.
Light microscopic observation (hepatic histopathological examination): Different degrees of hepatocyte degeneration, regeneration and lymphocyte-based treatment before treatment
Inflammatory cells infiltrated, 2 cases of hepatocyte punctate necrosis; due to the finely divided specimens, the sections were too small, 5 specimens showed no intact pseudolobules, only fibroblasts, fibroblasts and collagen fibers, reticular fibers proliferated, forming fibrous septa 4 cases of Kupffer cell hypertrophy. After treatment
Degeneration and regeneration were almost the same as before treatment. Two cases of lymphocyte infiltration disappeared, Kupffer cell hypertrophy was more obvious, 4 cases of fiber spacing decreased, and 2 cases of hepatic sinus significantly enlarged.
Electron microscopic observation: The electron density of hepatic cytoplasm decreased before treatment, and the rough endoplasmic reticulum had degranulation, pool expansion, and a small amount of mitochondrial swelling.
Inflated, irregular shape, reduced or disappeared sputum, irregular nuclei, active hepatocyte regeneration, widening of hepatocyte gap in most cases, more collagen fibers and hyperplasia of microvilli, granules reduced, in hepatocytes A bundle of collagen fibers can also be found in the necrotic area and the capillary bile duct. Dicken's gap is enlarged. In 2 cases, a small amount of lipid droplets are found in the cytoplasm of the fat storage cells, collagen fibers are present around the cells, and Kupffer cells are slightly larger, and cytoplasm is present. There are phagosomes inside, and lymphocytes and monocytes infiltrate. After treatment, the cytoplasmic electron density of the 4 cases returned to normal. The rough endoplasmic degranulation and mitochondrial swelling were improved to some extent. The nucleus rules or rules, the hepatocyte gap becomes normal, and the collagen fibers are only visible in the capillary bile duct. Multiple hepatic sinus expansion, Kupffer cell hypertrophy, more phagosomes inside, 1 case of lipid storage cells containing more lipid droplets in the Divine gap, no collagen fibers around, inflammatory cell infiltration is rare.
※ Xu Lieming et al. further observed 54 cases of post-hepatitis cirrhosis treated with Prunus persica L. and 6 cases of laparoscopic and liver biopsy before and after treatment, and anti-drug resistance from pathological and immunohistochemical perspectives. The role of reversal of hepatic sinus capillary vascularization during liver fibrosis was explored. Laparoscopic observation: Before treatment, the left and right lobe of the 6 patients had different degrees of swelling, the texture was moderate or hard, the color was dark red or purple, and the surface had diffuse nodular bulge; 5 cases were small nodule type. 1 case was mixed with large and small nodules; the liver edge was slightly blunt or obtusely rounded; 3 cases of hepatic sacral ligaments were mildly edematous; 5 cases showed swollen spleen, dark red color, fibrin exudation on the surface, 1 The spleen has been resected; all cases of large reticular vessels and mesenteric vessels have dilated or varicose veins; 2 cases have ascites. After treatment, the liver hardness was reduced in 3 cases, the color turned red or dark red, and the edema of the sacral ligament disappeared.