”Chinese liver, foreigners’ lungs” refers to the high incidence of lung disease in the West and the high incidence of liver disease in China. As a major hepatitis B country, it is common for hepatitis B to eventually develop into cirrhosis. Cirrhosis is usually incurable, so it is especially important to recognize and prevent it.
Today, cirrhosis should be viewed not just as a single end-stage disease, but as a group of systemic diseases that can be staged based on significant clinical symptoms. Cirrhosis can be seen as a dynamic evolutionary process and is mainly classified according to prognosis as
Stage 1.
In the compensatory stage, where esophageal varices have not yet appeared, with a one-year mortality rate of about 1%;
Stage 2.
Still in the compensated stage, but esophageal varices have appeared, with a one-year mortality rate of 3-4%;
Stage 3.
Stage 3: decompensated stage with ascites, with a mortality rate of 20% in one year;
Stage 4.
Loss of compensated stage with ruptured esophagogastric fundic varices and 57% one-year mortality;
Stage 5.
Severe decompensated stage with infection and renal dysfunction, with a one-year mortality rate of up to 67%.
Cirrhosis often leads to death due to serious complications, including portal hypertension, varices and bleeding from ruptured varices, ascites, infection, hepatic encephalopathy, and hepatocellular hepatocellular carcinoma.
It is the classic view that cirrhosis cannot be reversed, much less cured. Unlike liver cancer, which is confined to one part of the liver, cirrhosis is diffuse and cannot be removed as in the treatment of liver cancer. Since cirrhosis cannot be reversed, there is no “cure” drug. To date, the FDA has not approved a single drug for cirrhosis.
Without curative drugs, there are only three directions for cirrhosis treatment: first, etiologic treatment, second, symptomatic supportive treatment, and third, liver transplantation. The first two directions have not changed significantly for decades and have mediocre efficacy. For decompensated cirrhosis, liver transplantation is recognized as an effective treatment, but it is limited by the lack of donors, high costs, and high rates of transplant-related complications and death. Although hepatocyte transplantation facilitates the repair of cirrhosis, it also faces practical problems such as low number of donor hepatocytes, rejection reactions, low cell viability, inability to maintain proliferation in vitro for a long time, and continuous culture.
Early preventive interventions should be advocated for patients with cirrhosis to prevent disease progression and to avoid or delay the onset of clinical decompensative complications. In particular, for many patients with cirrhosis, the new challenge in the 21st century lies in avoiding liver transplantation whenever possible.
Advances in biomedicine in the 21st century have provided new avenues for the treatment of cirrhosis. After years of research, it has been found that there is a class of cell populations in the human body with self-renewal and differentiation potential that can differentiate into liver stem cells and hepatocytes in specific environments and participate in the repair and remodeling of the injured liver, which to some extent can improve liver function in patients with end-stage cirrhosis and provide new ideas for the treatment of this disease.
In recent years, these cells have broad application prospects in the field of cirrhosis treatment, and great progress has been made in both basic and clinical research. The main lesion of cirrhotic patients is in the liver, and the autologous ability to produce these cells is normal, so the use of autologous transplantation solves the problem of source, and the low chance of rejection, stable genetic background, and strong differentiation and proliferation ability make it easy for clinical application.
Since the blood supply of the liver is characterized by the portal vein providing more than 70% of the blood supply to the liver, longer retention time after reaching the hepatic blood sinusoids, good selective distribution, fusion with the recipient liver parenchyma without changing the microstructure of the organ, and high concentration of hepatophilic cytokines in the portal system, the nutrients contained in the intrahepatic microcirculation and blood in the portal vein are beneficial for the survival and growth of the transplanted cell population. The portal venous system has a special structure, starting from the main trunk, one end receives blood from the entire intestine and splenic vein, which is pooled from the splenic sinusoids, and the other end branches to the hepatic sinusoids, so that both ends are capillary in shape, so the usual infusion methods cannot reach the portal vein directly.
Based on the tracking of domestic and foreign research dynamics in this field, combined with the actual construction of the technology platform, Director Deng Yunzong of the Third Affiliated Hospital of Henan College of Traditional Chinese Medicine carried out the transplantation technology of autologous bone marrow cell cluster via portal vein route. With the successful recovery of the patient, it marks the maturity of this technology.
The technique involves percutaneous transhepatic portal vein puncture and placement of a tube under imaging guidance, importing autologous bone marrow cell populations obtained from the portal vein, which are then colonized in the liver, and applying their targeted differentiation ability to achieve regeneration of liver cells and reconstruction of liver function, immune function, and skeletal structure. The clinical manifestations include reduction of serum ghrelin, ghrelin, and total bilirubin levels, improvement of albumin synthesis capacity, and reduction of ascites production. In conjunction with the autologous bone marrow cell cluster intrahepatic transplantation technique, a comprehensive treatment plan combining Chinese and Western medicine can be designed for different patients using the portal vein access that has been set up to substantially improve the overall treatment effect.
The establishment of traditional portal vein infusion access requires open surgery to establish, which is more traumatic. Director Deng Yunzong pioneered the minimally invasive technique of transdermal transhepatic puncture to establish portal vein access, which realizes the minimally invasive and comfortable treatment process. Patients treated by this technique can eat and move freely after only 3-6 hours of bed rest.
These techniques have been applied clinically in the treatment of cirrhosis, and more promising results have been achieved. Available results show that 80% of patients have reduced ascites, larger liver size, improved Child score, and increased activity of liver progenitor cells that can continue to differentiate into hepatocytes within 6 months.
Intrahepatic transplantation of autologous bone marrow cell populations for cirrhosis also needs to be combined with other effective therapeutic measures, such as antiviral therapy, hepatoprotective therapy, etc.; because cell infusion alone may not completely improve the pathological structure of the liver. Chinese medicine has a long history of treating cirrhosis and is vital in the overall treatment of liver disease.
The Chinese medical term for cirrhosis is “accumulation”, and the Chinese medical terms for “stagnation”, “deficiency”, “accumulation” and “accumulation” range from The names of the disease mechanism such as “bulging” and “blood” also reveal the nature of the disease.
Traditional Chinese medicine treatment includes internal administration of tonics for clearing heat and detoxifying toxins, regulating Qi and resolving dampness, activating blood circulation and eliminating blood stasis, nourishing Yin and softening the liver, benefiting Qi and helping Yang to benefit water, as well as external treatments such as external application of Chinese medicine, acupuncture point injection, Chinese medicine reserved enema, acupuncture, and irradiation of meridian points.
Umbilical application is one of the external treatment methods of TCM, which has a long history. Based on the principle of “regulating qi, activating blood circulation, resolving blood stasis, clearing heat and detoxification, nourishing yin and benefiting qi”, the umbilical patch is composed of Chinese herbs such as Lycopodium, Saxifrage, Dilong and Han Fangji. It can enhance the movement of the digestive tract, promote intestinal peristalsis, accelerate the elimination of endotoxins, and play a vital role in relieving clinical symptoms.
The effect of acupuncture on the meridian points is obvious in supporting the righteousness and expelling the evil, and the efficacy of the acupuncture point injection plus the drugs can complement each other. The use of Astragalus injection 2ml of bilateral foot sanli injection has significantly improved the patient’s sleep, appetite, fatigue and other symptoms, and has increased the response rate of antiviral, which fully reflects the TCM treatment concept of “supporting the righteous and dispelling the evil”.
Chinese herbal enemas have a long history and originate from the “diarrhea method” of the eight methods of Chinese medicine treatment. Chinese medicine enema is based on “cleansing the intestines and cleansing the internal organs”, and can be supplemented with blood activation and elimination of blood stasis, detoxification and dampness, etc., with more accurate therapeutic effect. On the basis of the diagnosis and treatment of Chinese medicine combined with modern pharmacological research, the Chinese medicine enema prescriptions “varying from evidence to evidence and from person to person” are introduced, which complement each other. It has been proved that Chinese medicine enema has little side effects, low price, easy to use, and can effectively avoid the occurrence of drug resistance caused by the use of antibiotics. Thus, herbal enemas have unique advantages in the treatment of enteric-derived endotoxemia in liver disease.
The combination of Chinese and Western medicine and liver function reconstruction technology under the guidance of comfortable medical strategy brings benefits to the increasing number of patients with liver cirrhosis.