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

施颖琦; 沈美琴; 仇建伟

doi:10.6039/j.issn.1001-0408.2023.15.16

您当前的位置：

首页 >

文章列表页 >

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

药物与临床 | 更新时间：2023-08-10

- 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
- Comparison of the efficacy of 3 kinds of drugs such as Danning tablet on preventing the recurrence of choledocholithiasis after endoscopic retrograde cholangiopancreatography
- 中国药房 2023年34卷第15期页码：1874-1878
- 作者机构：
  
  南通市第一人民医院消化内科，江苏南通　226000
- 作者简介：
  
  副主任医师，硕士。研究方向：炎症性肠病、胆总管结石、消化道早癌。E-mail：shiyq2012@163.com
- 基金信息：
  
  江苏省重点研发计划项目(JS2021SD122)
- DOI：10.6039/j.issn.1001-0408.2023.15.16
  中图分类号： R969.4;R975+.5
- 纸质出版日期：2023-08-15，
  
  收稿日期：2022-12-29，
  
  修回日期：2023-07-21，
扫描看全文
施颖琦,沈美琴,仇建伟.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 ^Δ[J].中国药房,2023,34(15):1874-1878.

SHI Yingqi,SHEN Meiqin,QIU Jianwei.Comparison of the efficacy of 3 kinds of drugs such as Danning tablet on preventing the recurrence of choledocholithiasis after endoscopic retrograde cholangiopancreatography[J].ZHONGGUO YAOFANG,2023,34(15):1874-1878.
施颖琦,沈美琴,仇建伟.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 ^Δ[J].中国药房,2023,34(15):1874-1878. DOI： 10.6039/j.issn.1001-0408.2023.15.16.

SHI Yingqi,SHEN Meiqin,QIU Jianwei.Comparison of the efficacy of 3 kinds of drugs such as Danning tablet on preventing the recurrence of choledocholithiasis after endoscopic retrograde cholangiopancreatography[J].ZHONGGUO YAOFANG,2023,34(15):1874-1878. DOI： 10.6039/j.issn.1001-0408.2023.15.16.

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180 d。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（

＜0.05），血清HDL水平均显著升高（

＜0.05），发生腹痛、腹胀、恶心、纳差的患者占比均显著降低（

＜0.05）。A、B组患者的Tbil水平显著低于C组（

＜0.05），A组患者的Dbil、ALP水平均显著低于B、C组（

＜0.05），但3组患者的GGT水平比较差异无统计学意义（

＞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（

＜0.05）；A组发生腹痛、腹胀、纳差的患者占比明显低于B、C组（

＜0.05），但3组发生恶心症状的患者占比差异无统计学意义（

＞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（

＞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%）（

＜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 （

＜0.05）， while serum HDL levels were significantly increased （

＜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 （

＜0.05）. The Tbil levels of groups A and B were significantly lower than those of group C （

＜0.05）， while the Dbil and ALP levels of group A were significantly lower than those of groups B and C （

＜0.05）； however， there was no statistically significant difference in GGT levels among the 3 groups （

＞0.05）. Compared with groups A and C， the levels of four lipid metabolism indicators in group B were significantly improved （

＜0.05）； the proportion of patients with abdominal pain， bloating， and poor appetite in group A was significantly lower than groups B and C （

＜0.05）， but there was no statistically significant difference in the proportion of patients with nausea among the 3 groups （

＞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 （

＞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%）（

＜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.

关键词

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

tauroursodeoxycholic acidursodeoxycholic acidendoscopic retrograde cholangiopancreatographycholedocholithiasisrecurrence

references

WU J Q，WANG G Z. Retention time of endoscopic nasobiliary drainage and symptomatic choledocholithiasis recurrence after endoscopic retrograde cholangiopancrea- tography：a single-center，retrospective study in Fuyang，China[J]. Surg Laparosc Endosc Percutan Tech，2022，32（4）：481-487.

CIANCI P，RESTINI E. Management of cholelithiasis with choledocholithiasis：endoscopic and surgical approaches[J]. World J Gastroenterol，2021，27（28）：4536-4554.

TRACY B M，POULOSE B K，PATERSON C W，et al. National adherence to the ASGE-SAGES guidelines for managing suspected choledocholithiasis：an EAST multicenter study[J]. J Trauma Acute Care Surg，2022，92（2）：305-312.

JAN Y，HUSSAIN M，AMAN Z，et al. Primary closure vs T-tube drainage following open choledochotomy for CBD（common bile duct）stones[J]. Cureus，2023，15（3）：e35846.

FISHMAN D S，BARTH B，MAN-WAI TSAI C，et al. A prospective multicenter analysis from the pediatric ERCP database initiative：predictors of choledocholithiasis at ERCP in pediatric patients[J]. Gastrointest Endosc，2021，94（2）：311-317.e1.

MA Y J，LI J M，JU Z C，et al. Danning Tablets alleviate high fat diet-induced obesity and fatty liver in mice via modulating SREBP pathway[J]. J Ethnopharmacol，2021，279：114320.

SHEN Y Y，LU C J，SONG Z B，et al. Ursodeoxycholic acid reduces antitumor immunosuppression by inducing CHIP-mediated TGF-β degradation[J]. Nat Commun，2022，13（1）：3419.

HOU Y H，LUAN J Y，HUANG T D，et al. Tauroursodeoxycholic acid alleviates secondary injury in spinal cord injury mice by reducing oxidative stress，apoptosis，and inflammatory response[J]. J Neuroinflammation，2021，18（1）：216.

顾崇琪，宋吉涛，陈晶. ERCP术后复发性胆总管结石的诊治现状[J]. 现代消化及介入诊疗，2021，26（5）：657-661.

KONSTANTAKIS C，TRIANTOS C，THEOPISTOS V，et al. Recurrence of choledocholithiasis following endoscopic bile duct clearance：long term results and factors associated with recurrent bile duct stones[J]. World J Gastroin- test Endosc，2017，9（1）：26-33.

Abdurakhmanovich K O，UGLI G S O. Ultrasonic diagnosis methods for choledocholithiasis[J]. Cent Asian J Med Nat Sci，2022，3（2）：43-47.

GUO T，WANG L，XIE P，et al. Surgical methods of treatment for cholecystolithiasis combined with choledocholithiasis：six years’ experience of a single institution[J]. Surg Endosc，2022，36（7）：4903-4911.

WANG X，WANG X P，SUN H，et al. Endoscopic papillary large balloon dilation reduces further recurrence in patients with recurrent common bile duct stones：a randomized controlled trial[J]. Am J Gastroenterol，2022，117（5）：740-747.

徐雯，王正峰，王海平，等. 经内镜逆行胰胆管造影术后胆总管结石复发危险因素分析及其预测模型的应用价值[J]. 中华消化外科杂志，2021，20（8）：890-897.

LIN T，LI L，LIANG C J，et al. Network pharmacology-based investigation of the therapeutic mechanisms of action of danning tablets in nonalcoholic fatty liver disease[J]. Evid Based Complement Alternat Med，2021，2021：3495360.

卢泳宇，刘昌江，黄帅. 水飞蓟宾葡甲胺联合胆宁片治疗酒精性肝炎患者疗效及其对血脂和氧化应激指标的影响[J]. 实用肝脏病杂志，2020，23（5）：662-665.

NAMISAKI T，FUJINAGA Y，MORIYA K，et al. The association of histological progression with biochemical response to ursodeoxycholic acid in primary biliary cholangitis[J]. Hepatol Res，2021，51（1）：31-38.

JOHN B V，KHAKOO N S，SCHWARTZ K B，et al. Ursodeoxycholic acid response is associated with reduced mortality in primary biliary cholangitis with compensated cirrhosis[J]. Am J Gastroenterol，2021，116（9）：1913-1923.

LU Q F，JIANG Z Y，WANG Q H，et al. The effect of tauroursodeoxycholic acid（TUDCA）and gut microbiota on murine gallbladder stone formation[J]. Ann Hepatol，2021，23：100289.

陆启帆，蒋兆彦，王启晗，等. 牛磺熊去氧胆酸预防高脂饮食小鼠胆囊结石的研究[J]. 外科理论与实践，2019，24（6）：522-529.

黄永刚，顾卯林，郭吕，等. 胆宁片预防胆囊切除术后综合征临床分析[J]. 实用中医药杂志，2020，36（9）：1215.

朱星屹，刘京山，张晓彤，等. 胆宁片预防内镜保胆取石术后胆囊结石复发的研究[J]. 中国内镜杂志，2022，28（5）：33-39.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

5-氟尿嘧啶与异维甲酸联合用药治疗妇科尖锐湿疣的疗效观察

低剂量环磷酰胺联合复方黄柏液对尖锐湿疣患者CO2激光术后复发的影响