熊去氧胆酸在预防胆管结石再发中的临床研究

Clinical study of ursodeoxycholic acid in the prevention of bile duct stones recurrence

摘要:

目的 前瞻性分析熊去氧胆酸（UDCA）在预防胆道支架内结石生成的作用和疗效。方法 共119例患者随机分成UDCA组和对照组，并收集胆道疾病患者十二指肠内引流术（ERBD）后塑料内支架，肉眼判断支架阻塞或堵塞。采用免疫定量分析支架内膜抗核周因子（APF）含量，细菌培养分析支架内细菌学，红外光谱分析胆红素钙、胆固醇和碳酸钙盐含量。结果 对照组和UDCA组APF蛋白定量分析数值分别为（10.17±2.38）和（17.55±9.39）ng/mL，两组发生支架堵塞率分别为58.3%和10.0%，两组差异有显著性（P <0.01）。使用UDCA组支架内生物膜的胆红素钙和碳酸钙含量均明显低于对照组（P <0.01）。阻塞支架包含多种胆道感染的细菌种群，多由肠道细菌逆行感染引起的。结论 UDCA可能通过促进内源性胆汁酸的分泌，增加APF含量，来减缓胆道支架蛋白生物膜的形成，而减少胆石生成保持胆道通畅。

Abstract:

【Objective】 To evaluate efficacy and safety of ursodeoxycholic acid in prevention of bile duct stones recurrence. 【Methods】 119 cases collected from patients in our hospital with plastic biliary stents were divided into two groups ursodeoxycholic acid group and control group. To observe content of antiperinuclear factor, bacterium culture and stone composition were analyzed by biochemistry, compared between two groups.【Results】 The protein level of antiperinuclear factor was (10.17±2.38) ng/mL in control group, (17.55±9.39) ng/mL in ursodeoxycholic acid group, the different was significant (P <0.05). Calcium bilirubin and calcium carbonate were the major elements in control group, while not bilirubin and calcium carbonate but antiperinuclear factor were the major elements in ursodeoxycholic acid group, the different was significant (P <0.01). Only one type of bacterium was found in no-obstruction stents. The bacterial infection of control tract was caused by enteric retrograde. 【Conclusion】 Calcium bilirubin and calcium carbonate are the major elements in bile duct stone, and ursodeoxycholic acid would participate in lessening biofilm and smooth stent surface by promoting secretion of endogenous bile acid and increasing bile flow, then keep the biliary patency.