加减益肝化石汤阻止取石术后胆石复发作用的观察及对胆汁成石基因的影响

Yiganhuashi decoction changes B-UGT,CYP7A1 and prevents the recurrence of common duct stones

[目的]观察益肝化石汤预防胆总管结石患者经内镜逆行胰胆管造影(encoscopicretrograde cholangio-pancreatography,ERCP)+十二指肠乳头切开取石术后胆石复发的疗效,及其对胆汁成石基因血胆红素尿苷二磷酸葡萄糖醛酸基转移酶(B-UGT)与胆固醇7α羟化酶(CYP7A1)的影响。[方法]入选对象700例,均为ERCP乳头切开取石成功患者。研究分为两部分:①将600例随机分为A、B组,每组300例。A组口服中药益肝化石汤100ml,2次/d,每月服用不少于6～7剂,每年服药不少于70剂;B组未服任何药物。2组同时进行随访,随访时间6～60(平均48)个月,每半年或出现腹痛症状时经腹部B超、CT、磁共振胰胆管造影复查;以失访和治疗依从性差为截尾,采用Kaplan-Meier法进行复发概率分析2组结石复发率。②将100例随机分成C、D组各50例。C组在常规治疗基础上,加服益肝化石汤;D组仅给予常规治疗。检测并比较2组服药前、服药后第7天、1个月血B-UGT、CYP7A1mRNA的表达。[结果]①A组有19例复发,B组有33例复发,2组术后结石累计复发概率分别是6.3%和11.0%,2组比较,差异有统计学意义(P<0.05)。②成石基因检测显示,C组治疗后血中B-UGT、CYP7A1mRNA蛋白表达较治疗前明显升高(P<0.05),D组治疗前后两基因及蛋白表达无变化。[结论]益肝化石汤辨证施治可有效预防ERCP取石术后患者的胆石症复发,其机制可能是通过上调B-UGT、CYP7A1mRNA表达,抑制成石性胆汁的形成。

[Objective]To observe the prevention effect on the recurrence of common duct stones in pa- tients with post-ERCP/EST by Yiganhuashi decoction and the effect on B-UGT,CYP7A1. [Methods]①Six hundred patients diagnosed as choledocholith whose calculus were removed with mechanical lithotripsy and reticular baske were randomly divided into two groups, experimental group（n=300）given Yiganhuashi de- coction 100 ml, bid, for at least 6 days per month, the control group（n=300）given nothing. All patients were followed-up 6 to 60 months（average of 48 months）, and abdominal B ultrasound, CT, MRCP were re- viewed every six months. ②The same one hundred patients were randomly divided into two groups, the control group（n= 50） and the Yiganhuashi decoction（n= 50）. The patients of control group were treatedwith the normal anti-inflammatory therapy. The other group was treated with the Yiganhuashi decoc- tion. The expression of B-UGT, CYP7A1 in the blood was detected by RT-PCR and Western blot at the first, seventh and thirtieth day after the therapy. [Results]①Nineteen cases of recurrence were found in the experimental group, however, thirty-three cases in control group, and the probability of postoperative stone cumulative recurrence were 6.3% and 11 % respectively. Statistically significant difference was found be- tween two groups （X2 = 4. 361, P = 0.037）. ②The high expression of B-UGT, CYP7A1 was found in experi- ment group（P（0. 05）. However,there were no changes in the control group. [Conelusion]Yiganhuashi de- coction is effective in preventing recurrence after ERCP/EST stone extraction in patients with common duct stones by regulating the expression B-UGT,CYPTA1.