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胆宁片等3种药物预防ERCP术后胆总管结石复发的效果比较
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| 篇名： | 胆宁片等3种药物预防ERCP术后胆总管结石复发的效果比较 |
| TITLE： | Comparison of the efficacy of 3 kinds of drugs such as Danning tablet on preventing the recurrence of choledo-cholithiasis after endoscopic retrograde cholangiopancreatography |
| 摘要： | 目的 比较胆宁片、牛磺熊去氧胆酸和熊去氧胆酸预防内镜逆行胰胆管造影（ERCP）术后患者胆总管结石复发的效果。方法回顾性分析南通市第一人民医院2017年1月－2020年1月153例行ERCP胆总管取石术患者的临床资料，根据患者术后接受药物治疗的不同分为3组，即胆宁片组（A组，49例）、牛磺熊去氧胆酸组（B组，44例）和熊去氧胆酸组（C组，60例）。以上各组药物均为单用，分别于术后2周开始使用，疗程均为180d。比较3组患者ERCP术后6个月的胆汁成分指标[血清总胆红素（Tbil）、直接胆红素（Dbil）、碱性磷酸酶（ALP）、谷氨酰转移酶（GGT）]，脂代谢指标[血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）]水平，临床症状（腹痛、腹胀、恶心、纳差）发生情况及术后6、12、18、24个月胆总管结石复发情况。结果与术前比较，3组患者术后6个月的血清Tbil、Dbil、ALP、GGT、TC、TG、LDL水平均显著降低（P＜0.05），血清HDL水平均显著升高（P＜0.05），发生腹痛、腹胀、恶心、纳差的患者占比均显著降低（P＜0.05）。A、B组患者的Tbil水平显著低于C组（P＜0.05），A组患者的Dbil、ALP水平均显著低于B、C组（P＜0.05），但3组患者的GGT水平比较差异无统计学意义（P＞0.05）；相较于A、C组，B组患者的4个脂代谢指标水平均得到显著改善（P＜0.05）；A组发生腹痛、腹胀、纳差的患者占比明显低于B、C组（P＜0.05），但3组发生恶心症状的患者占比差异无统计学意义（P＞0.05）。术后6、12、18个月时，3组患者的胆总管结石复发率比较，差异均无统计学意义（P＞0.05）；术后24个月时，A组患者的胆总管结石复发率（2.04%）显著低于B组（15.91%）和C组（15.00%）（P＜0.05）。结论ERCP术后应用胆宁片相较于应用牛磺熊去氧胆酸和熊去氧胆酸，更有利于减少胆汁酸分泌、预防胆结石复发、改善临床症状，但牛磺熊去氧胆酸较其他2种药物更能明显加速患者脂代谢。 |
| ABSTRACT： | OBJECTIVE To compare the efficacy of Danning tablet， taurosodeoxycholic acid and ursodeoxycholic acid in preventing the recurrence of choledocholithiasis after endoscopic retrograde cholangiopancreatography （ERCP）. METHODS The clinical data of 153 patients who underwent ERCP choledocholithotomy from January 2017 to January 2020 in Nantong First People’s Hospital were retrospectively analyzed. According to the different drug treatment received after surgery， patients were divided into three groups， namely， Danning tablet group （group A， 49 cases）， tauroursodeoxycholic acid group （group B， 44 cases） and ursodeoxycholic acid group （group C， 60 cases）. The above groups of drugs are all single-use， starting from 2 weeks after surgery for a course of 180 days. The effects of bile component indicators [total bilirubin （Tbil）， direct bilirubin （Dbil）， alkaline phosphatase （ALP）， glutamyltransferase （GGT）]， lipid metabolism indicators [total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein （LDL）， high-density lipoprotein （HDL）]， the occurrence of clinical symptoms （abdominal pain， bloating， nausea， and poor appetite） at 6 months after ERCP， and the recurrence of choledocholithiasis at 6， 12， 18 and 24 months after surgery were compared among 3 groups. RESULTS Compared with before surgery， the serum levels of Tbil， Dbil， ALP， GGT， TC， TG and LDL were significantly reduced （P＜0.05）， while serum HDL levels were significantly increased （P＜0.05） in the three groups at 6 months after surgery. The proportion of patients who experienced abdominal pain， bloating， nausea， and poor appetite at 6 months after surgery was significantly reduced （P＜0.05）. The Tbil levels of groups A and B were significantly lower than those of group C （P＜0.05）， while the Dbil and ALP levels of group A were significantly lower than those of groups B and C （P＜0.05）； however， there was no statistically significant difference in GGT levels among the 3 groups （P＞0.05）. Compared with groups A and C， the levels of four lipid metabolism indicators in group B were significantly improved （P＜0.05）； the proportion of patients with abdominal pain， bloating， and poor appetite in group A was significantly lower than groups B and C （P＜0.05）， but there was no statistically significant difference in the proportion of patients with nausea among the 3 groups （P＞0.05）. At 6，12 and 18 months after surgery， there was no statistically significant difference in the rate of choledocholithiasis recurrence among the 3 groups （P＞0.05）； at 24 months after surgery， the rate of choledocholithiasis recurrence in group A （2.04%） was significantly lower than group B （15.91%） and group C （15.00%） （P＜0.05）. CONCLUSIONS Compared with tauroursodeoxycholic acid and ursodeoxycholic acid， the application of Danning tablet after ERCP is more beneficial to reduce the secretion of bile acid， prevent the recurrence of gallstones， and improve clinical symptoms， but tauroursodeoxycholic acid can significantly accelerate the lipid metabolism of patients compared with the other two drugs. |
| 期刊： | 2023年第34卷第15期 |
| 作者： | 施颖琦；沈美琴；仇建伟 |
| AUTHORS： | SHI Yingqi，SHEN Meiqin，QIU Jianwei |
| 关键字： | 胆宁片；牛磺熊去氧胆酸；熊去氧胆酸；内镜逆行胰胆管造影；胆总管结石；复发 |
| KEYWORDS： | Danning tablets； tauroursodeoxycholic acid； ursodeoxycholic acid； endoscopic retrograde cholangiopancreatography； |
| 阅读数： | 64 次 |
| 本月下载数： | 9 次 |
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