内镜结合中药治疗急性胆道感染的临床研究

Clinical Study on Treatment of Acute Biliary Tract Infection with Biliary Drainage via Endoscope Combined with Chinese Drug Medication

目的观察经内镜鼻胆管引流结合中药治疗急性胆道感染的临床疗效及对补体C3、C-反应蛋白(CRP)和白介素6(IL-6)的影响。方法将16例急性胆道感染患者(A组)分为两组,中西医结合组(C组,9例)采用经内镜胆道引流加中药治疗,常规治疗组(D组,7例)采用手术胆道引流,并将同期单纯胆囊结石患者18例(B组)作对照组,观察临床疗效并检测各组患者治疗前后补体C3、CRP和IL-6水平。结果治疗前:A组与B组比较补体C3降低,CRP及IL-6均出现显著增高(P<0·05或P<0·01)。治疗后:C组一般临床状况改善,肠道功能恢复时间缩短;补体C3逐渐上升,CRP和IL-6均明显下降,与D组比较有明显差异(P<0·05或P<0·01)。结论内镜结合中药治疗急性胆道感染疗效显著,辨证运用中药能降低血中促炎细胞因子水平,促进免疫损伤的恢复。

Objective To observe the curative effects of biliary drainage via endoscope （ENBD） combined with Chinese drug medication on acute biliary tract infection （ABTI） and the influence of treatment on complement 3 （C3）, C-reactive protein （CRP） and interleukin-6 （IL-6）, Methods Sixteen patients with ABTI were randomly assigned to two groups： the 9 patients in the combined treatment group （CTG） treated with ENBI） combined with Chinese medicine and the 7 patients in routine treatment group （RTG） treated with ENBD alone. Another 18 patients with simple gallbladder stone were taken as the control group （CG）. The curative effect was observed and the serum concentrations of C3, CRP and IL-6 were determined before and after treatment. Results Before treatment, the concentrations of CRP and IL-6 were significantly higher and C3 lower in all ABTI patients than those in patients with simple gallbladder stone （P 〈 0.05 or P 〈 0.01 ）. After treatment, the general condition of patients was improved, the recovery time of intestinal tract function was shortened and the concentrations of C3, CRP and IL-6 significantly decreased in CTG, with the effects better than those in RTG respectively （P〈0.01 or P〈0.05）. Conclusion ENBD combined with Chinese drug medication shows favorable curative effects on ABTI. Treatment with Chinese medicine according to syndrome differentiation could decrease blood level of pro-inflammatory cytokines and promote recovery of the injured immune function.