清胆汤联合胆道减压内引流对急性重症胆管炎大鼠肝功能和炎症因子的影响

Effect of Qingdan Decoction Combined with Biliary Decompression on the Liver Function and Inflammatory Factors in Acute Cholangitis Severe Type Rats

目的探讨清胆汤联合胆道减压内引流对急性重症胆管炎(ACST)大鼠的作用及其机制。方法 48只SD大鼠开腹手术制备ACST模型,并随机分为ACST组、清胆汤组、减压组、清胆汤+减压组各12只。造模后6h清胆汤组给予清胆汤灌胃,减压组行胆道减压内引流术并给予生理盐水灌胃,清胆汤+减压组行胆道减压内引流术并给予清胆汤,造模后48h取材。计算各组大鼠死亡率,检测各组大鼠血常规、肝功能、血清内毒素(LPS)、肿瘤坏死因子-α((TNF-α)水平,光镜下观察肝脏病理变化。结果 ACST组死亡率最高,与其相比清胆汤组死亡率差异无统计学意义(P>0.05),而减压组及清胆汤+减压组则显著降低(P<0.01)。减压组和清胆汤+减压组大鼠与ACST组比较,血常规和肝功能各指标均明显好转(P<0.05或P<0.01);清胆汤组肝功能各指标明显高于减压组和清胆汤+减压组(P<0.01)。与ACST组比较,其他各组LPS、TNF-α水平均显著降低(P<0.05或P<0.01),且清胆汤+减压组LPS水平低于减压组(P<0.05)。结论清胆汤联合胆道减压内引流能显著降低ACST大鼠死亡率、改善肝功能,可能与降低血清LPS、TNF-α有关。

ABSTRACT Objective To observe the efficacy and mechanism of Qingdan Decoction （Gallbladder-Clearing Decoction） com- bined with biliary decompression for acute cholangitis severe type （ACST）. Methods The ACST models were established with laparotomy preparation on 48 SD rats. The rat models were randomized into the ACST group, Qingdan Decoction group, decompression group and Qingdan Decoction＋decompression group, with 12 in each. Six hours after modeling, the Qingdan Decoction group was given intragastric administration of Qingdan Decoction, the decompression group was given biliary decompression and drainage and intragastric administration of saline, and the Qingdan Decoction＋decompression group was given bil iary decompression and drainage and Qingdan Decoction. The tissues were drawn after 48 hours. The mortality of rats was calculated. The blood count, liver function, lipopolysaceharide （LPS） and tumor necrosis factor-α （TNF-α） was detected. The pathological changes of the liver were observed by light microscope. Results The mortality in the ACST group was the high- est, but with no significant difference between Qingdan Decoction group （P〈0.05）. The mortality in the decompression group and Qingdan Decoction＋decompression group was significantly lower （P〈0.01）. Comparing with the ACST group, the blood count and liver function in the decompression group and Qingdan Decoction＋ decompression group was significantly improved （P〈0.05 or P〈0.01）. The liver function indicators in the Qingdan Decoction group were significantly higher than those in the decompression group and Qingdan Decoction＋ decompression group （P〈0.01）. Comparing with the ACST group, the lev- els of LPS and TNF-α were significantly decreased in the other groups （P〈0.05 or P〈0.01）, and the decrease was more sig- nificant in Qingdan Decoction＋decompression group than that in the decompression group （P〈0.05）. Conclusion Qingdan Decoction combined with biliary decompression can obviously lower the mortality and improve the liver function of rat with ACST. The mechanism might be related with the decrease of the level of serum LPS and TNF-α.