蒋开平

运用“春夏养阳 秋冬养阴”理论干预治疗慢性HBV 感染免疫耐受的探讨

蒋开平

慢性乙型肝炎病毒（HBV）感染免疫耐受的干预治疗正受到临床高度关注。通过分析慢性HBV感染免疫耐受的治疗现状，结合临床实践，提倡从长计议，引入基于“春夏养阳，秋冬养阴”理论的中医综合治疗方案进行整体干预治疗，内容包括：辨证论治基本方药、宗李时珍之说因时选择用药、按药物属性因时选择用药、因时调整治法方药以及因时调摄精神、因时调摄起居、因时调摄形体锻炼、因时调摄饮食等身心调摄项目。通过该方案的综合治疗，部分慢性HBV感染免疫耐受患者，可不同程度出现免疫耐受被打破的现象，若不能有效实现HBeAg血清学转换，还可为继续使用抗病毒西药制剂谋求较好的切入点，从而提高HBV抗治疗的成功率。

春夏养阳；秋冬养阴；乙型肝炎病毒；免疫耐受

Abstract：The intervention treatment of immune tolerance in patients with chronic HBV infection are being clinical attened. By analyzing the status quo of the treatment in immune tolerance patients with chronic HBV infection, combined with clinical practice, the author introduced a integrated therapy program based on the “supporting Yang in spring and summer, supporting Yin in autumn and winter” theory of TCM, in which there were basic recipe based on the theory of TCM, the medicine experience of Li Shi Zhen's , the selection of medication in different season according to drug-like properties,the adjustment of treatment or recipe in different season and the the physical and psychological adjustment in different season ---- the spirit , the living ,the physical exercise,the diet and so on. Treated by the program, some patients with chronic HBV infection can occur a broken phenomenon of immune tolerance to a certain extent. If the serum conversion of HBeAg can not be effectively achieved in these patients, a better opportunity for anti-HBV treatment of western drugs may be seeked so as to enhance the success rate of anti-HBV treatment .

Key words：Supporting Yang in spring and summer；Supporting Yin in autumn and winter；Hepatitis B virus（HBV）；Immune tolerance

免疫耐受是乙型肝炎慢性化的最主要机制，其形成既有宿主因素、也有病毒因素[1]。慢性HBV感染免疫耐受的主要群体为 HBeAg阳性慢性 HBV携带者和部分HBeAg阳性慢性乙型肝炎患者。这类患者由于对抗HBV治疗西药制剂（干扰素或核苷类似物）的应答较差，长期使用具有难以规避副作用、耐药、成本效益差等不利因素，故不主张治疗者占据多数，仅须长期随访观察，待血清ALT水平升高或肝活检发现活动性炎症时才开始治疗[2]。一些探索性治疗虽时有报道，但整体疗效仍相当有限[3]。目前，我们必须面对的现实是：该类患者不仅肝组织学正常者较少，且长期处于高病毒载量状态，而高病毒载量状态又与慢性肝病不良预后（肝功能失代偿、肝硬化、肝癌）关系密切[4]。……