红霉素及复方氨基酸对胆石症患者胆囊收缩功能的协同作用

Synergy of erythromycin and CoAA on the function of gallbladder contraction in patients with cholelithiasis

目的：胆囊收缩功能减退，胆汁留是胆石形成的重要因素。本文旨在研究促进胆囊排空药物复方氨基酸（ＣｏＡＡ）和红霉素的联合应用及其作用机制。方法：对８０例胆石症患者分别应用硫糖铝＋生理盐水（Ｎ．Ｓ）、硫糖铝＋ＣｏＡＡ、丙谷胺＋ＣｏＡＡ、红霉素＋Ｎ．Ｓ．、红霉素＋ＣｏＡＡ，比较其用药后胆囊最大排空率〔ＭＧＥＲ），并分别测定后二组患者空腹及用药后的血浆胃动素（ｍｏｔｉｌｉｎ）水平。结果：ＣｏＡＡ组ＭＧＥＲ为４３．１３％土８．６９％，该胆囊收缩作用可用胆囊收缩素（ＣＣＫ）受体阻滞剂丙谷胺加以部分阻断；红霉素组ＭＧＩＥＲ为３３．５４％士３．５４％，且同步血浆ｍｏｔｉｌｉｎ浓度提高；ＣｏＡＡ＋红霉素组ＭＧＥＲ为５１．６６％土４．６９％，与单独用药组相比有明显提高（Ｐ＜０．００１），且作用时间延长。结论：对于纠正胆石症患者胆囊排空障碍及预防长期静脉高营养患者的胆汁留，ＣｏＡＡ和红霉素联合应用比单独用药更为有效。其作用机制同ＣＣＫ和ｍｏｔｉｌｉｎ的释放有关。

Objective:Decrease of gallbladder contraction and bile retention are two important factors involved in gallstone formation. Combined use of compound amino acids (CoAA) and erythromycin can promote gallbladder emptying, the mechanism is discussed briefly. Methods: Sucrafate-N.S., Sucrafate-CoAA, Proglumide-CoAA, Erythromycin-N.S., Erythromycin-CoAA were given respectively to 80 patients with cholelithiasis, and their maximum gallbladder emptying rate (MGER) was compared by measuring gallbladder volume ultrasonographically. Plasma motilin level was measured respectively in fasting and post-administration in the Erythromycin-N.S. and Erythromycin-CoAA groups. Results: CoAA group's MGER was 43.13%± 8.69%。The gallbladder contraction effect of CoAA could be blocked partially by cholecytokinin (CCK) receptor blocker-Proglumide. Erythromycin group's MGER was 33.54%± 3.54% , and plasma motilin concentration increased simultaneously. CoAA and erythromycin group's MGER was 5l.66%± 4.69%, which increased more markedly than those groups using CoAA or Erythromycin only (p<0.001).The time of action prolonged as well. Conclusion: For correcting gallbladder emptying impairment and preventing bile retention, it is suggested that combined use of Erythromycin ─CoAA is more effective than either one alone. The mechanism of action is related to release of CCK and motilin.