熊去氧胆酸联合清热利湿化石方预防ERCP术后胆总管结石复发的效果及对胆固醇代谢、胆汁成分的调节作用  

Clinical Efficacy of Ursodeoxycholic Acid Combined with Heat-clearing and Dampness-expelling and Stone-removing Decoction in Prevention of the Recurrence of Choledocholithiasis Patients after ERCP and Its Regulatory Effects on Cholesterol Metabolism and Bile Composition

作　　者：吴静 廖振林[1] 卓振山[1] 商倩[1] 聂皓 牛建海 WU Jing;LIAO Zhen-lin;ZHUO Zhen-shan;SHANG Qian;NIE Hao;NIU Jian-hai(Department of Gastroenterology,the First Hospital of Baoding City,Baoding,Hebei 071000,China)

机构地区：[1]保定市第一医院消化内科,河北保定071000

出　　处：《临床误诊误治》2022年第4期31-35,共5页Clinical Misdiagnosis & Mistherapy

基　　金：保定市科学技术局项目(1941ZF027)。

摘　　要：目的探讨熊去氧胆酸联合清热利湿化石方预防内镜逆行胰胆管造影(ERCP)术后胆总管结石复发效果及对胆固醇代谢、胆汁成分的调节作用。方法选择2019年1月—2020年10月收治的120例行ERCP术治疗胆总管结石,根据ERCP术后治疗方法不同分为中药组和对照组,每组60例。对照组给予熊去氧胆酸,中药组给予熊去氧胆酸联合清热利湿化石方。比较两组不同时间点胆汁和血清胆固醇(CHO)、总胆汁酸(TBA)、总胆红素(TBil)、非结合胆红素(UCB)、磷脂(PL)、胆盐(BS)水平,以及胆囊壁厚度、胆囊收缩率、结石复发和不良反应发生情况。结果两组术中、术后7、14 d胆汁中CHO、TBil、UCB依次呈降低趋势,TBA、PL、BS依次呈升高趋势(P<0.05);中药组术后7、14 d胆汁中CHO、TBil、UCB低于对照组,TBA、PL、BS高于对照组(P<0.05)。两组术前、术后1、3个月血清CHO、TBil、UCB依次呈降低趋势,TBA、PL依次呈升高趋势(P<0.05);中药组术后1、3个月血清CHO、TBil、UCB低于对照组,TBA、PL高于对照组(P<0.05)。两组术后1、3个月胆囊壁厚度较术前降低,胆囊收缩率较术前升高(P<0.05);中药组术后1、3个月胆囊壁厚度低于对照组,胆囊收缩率高于对照组(P<0.05)。中药组术后6、12个月复发率低于对照组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论熊去氧胆酸联合清热利湿化石方可改善胆固醇代谢、胆汁成分,增强胆囊功能,预防ERCP术后胆总管结石复发,且安全可靠。Objective To investigate clinical efficacy of Ursodeoxycholic Acid combined with Heat-clearing and Dampness-expelling and Stone-removing Decoction in prevention of recurrence of choledocholithiasis patients after endoscopic retrograde cholangiopancreatography(ERCP)and the regulatory effects on cholesterol metabolism and bile composition.Methods A total of 120 choledocholithiasis patients undergoing ERCP who had been admitted between January 2019 and October 2020 were selected and divided into traditional Chinese medicine(TCM)group(n=60)and control group(n=60)according to different therapeutic methods after ERCP.Control group was given Ursodeoxycholic Acid,while TCM group was given Ursodeoxycholic Acid combined with Heat-clearing and Dampness-expelling and Stone-removing Decoction.Levels of cholesterol(CHO),total bile acid(TBA),total bilirubin(TBil),unconjugated bilirubin(UCB),phospholipid(PL)and bile salt(BS)in bile and serum as well as the thickness of gallbladder wall,gallbladder contraction rate,stone recurrence and incidence rate of adverse reactions were compared at different time points between two groups.Results During the operation and after operation for 7 and 14 d,CHO,TBil,and UCB contents in bile showed decreasing trends in turn,while TBA,PL,and BS contents showed increasing trends in turn in two groups(P<0.05).After operation for 7 and 14 d,in TCM group,contents of CHO,TBil and UCB in bile were significantly lower,while contents of TBA,PL and BS were significantly higher than those in control group(P<0.05).Before operation and after operation for 1 and 3 months,serum levels of CHO,TBil and UCB showed decreasing trends in turn,while TBA and PL levels showed increasing trends in turn in two groups(P<0.05).After operation for 1 and 3 months,in TCM group,serum levels of CHO,TBil and UCB were significantly lower,while levels of TBA and PL were significantly higher than those in control group(P<0.05).After operation for 1 and 3 months,thickness values of the gallbladder wall were significantly decreased,whi

关 键 词：胆总管结石 熊去氧胆酸 清热利湿化石方 内镜逆行胰胆管造影 复发 胆固醇 胆汁 

分 类 号：R575.7[医药卫生—消化系统]