内镜介入治疗急性化脓性胆管炎对YKL-40,MCP-1和HMGBl的影响  

Serum levels of chitin enzyme protein-40,monocyte chemotactic factor-1 and high mobility group box-1 protein in patients with acute suppurative cholangitis receiving endoscopic therapy

作　　者：殷晓星[1] 周琨[1] 马保金[1] 

机构地区：[1]复旦大学附属华山医院静安分院普外科,上海200040

出　　处：《同济大学学报（医学版）》2016年第3期97-100,106,共5页Journal of Tongji University(Medical Science)

摘　　要：目的观察内镜介入和开腹手术治疗急性化脓性胆管炎(acute purulent cholangitis,APC)的疗效及其对机体甲壳质酶蛋白-40(YKL-40),单核细胞趋化因子(monocyte chemotactic protein-1,MCP-1)和高迁移率族蛋白(high mobility group box-1 protein,HMGB1)的影响。方法选择2012年1月至2014年12月在我院就诊的ACST108例,根据手术方式分为观察组(65例)和对照组(43例),观察组予以内镜介入治疗,对照组行传统开腹手术。观察两组操作成功率,并发症,腹痛、体温、黄疸、胃肠功能变化和住院时间,以及两组治疗前后丙氨酸转氨酶(ALT)、谷草转氨酶(AST)、高敏C反应蛋白(hs-CRP)、总胆红素(TBil)、YKL-40、MCP-1和HMGBl变化。结果观察组操作成功率明显高于对照组(P<0.01),并发症发生率和腹痛缓解、体温正常、黄疸减轻、胃肠功能恢复和住院时间均小于对照组(P<0.01);两组治疗后ALT、AST、hs-CRP、TBil、YKL-40、MCP-1和HMGBl明显降低(P<0.01),但观察组降低水平更明显(P<0.01)。结论内镜治疗ACST具有创伤小、黄疸消退快、并发症少、降低机体炎症反应好等优点,如病例选择适当可作为ACST的首选疗法。Objective To investigate the efficacy of endoscopic therapy and open surgery in treatment of acute purulent cholangitis（APC）,and their impacts on chitin enzyme protein-40（YKL-40）,M onocyte chemotactic protein-1（M CP）-1 and high mobility group box-1 protein（HM GBl）.Methods One hundred and eight patients with ACST admitted from January 2012 to December 2014 were included in the study,including 65 patients treated with endoscopic therapy（endoscopic group）and 43 patients treated with open surgery（control group）.The success rate,complications,time of abdominal pain,temperature returned to normal,jaundice disappearing,gastrointestinal function recovery and hospital stay were observed,and serum levels of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,high-sensitivity C-reactive protein（hs-CRP）,total bilirubin（TBil）,YKL-40,MCP-1 and HMGBl were measured.Results The success rate of endoscopic group was higher than that of control group（P〈0.01）,incidence of complications and time of abdominal pain,temperature returned to normal,jaundice disappearance,gastrointestinal function recovery and hospital stay were less than those of control group（P〈0.01）.Serum levels of ALT,AST,hs-CRP,TBil,YKL-40,M CP-1 and HM GBl were significantly decreased after treatment in both groups（P〈0.01）,while the decrease degree of above parameters in endoscopic group were more markedly than that in control group（P〈0.01）.Conclusion Endoscopic therapy has advantages of smaller trauma,faster jaundice disappearance,fewer complications and decreased inflammatory response,compared with open surgery in treatment of ACST patients.

关 键 词：内镜治疗 急性化脓性胆管炎 甲壳质酶蛋白-40 单核细胞趋化因子-1 高迁移率族蛋白B1 

分 类 号：R575.7[医药卫生—消化系统]