大柴胡汤加味预防胆管塑料内支架再阻塞的临床研究

Dachaihu decoction in preventing of obstruction of biliary plastic stent

目的评价大柴胡汤对预防胆管塑料内支架再阻塞的疗效和安全性。方法 68例因胆道疾病而放置胆道塑料内支架(ERBD)患者随机分为大柴胡汤剂组(40例,男:女=18:22)和对照组(28例,男:女=13:15),3个月后收集内支架,观察支架阻塞情况。采用免疫定量分析支架内膜抗核周因子抗体(APF)含量;红外光谱检测胆红素钙、胆固醇和碳酸钙盐含量;细菌学培养分析支架内细菌成分。结果(1)大柴胡汤组和对照组APF蛋白定量分析分别为(16.579±8.62)ng/ml和(10.46±3.25)ng/ml,两组差异有统计学意义(P<0.05);(2)对照组支架内生物膜的胆红素和碳酸钙含量均明显高于大柴胡汤剂组(P<0.01);(3)相比未阻塞的支架,大多阻塞的支架包含多种的细菌种群。结论胆道感染多由肠道细菌逆行感染引起,阻塞支架内生物膜的主要成份是胆红素钙和部分碳酸钙。而大柴胡汤通过影响APF,有助于减缓胆道支架蛋白生物膜的形成,而保持胆道通畅。

Objective TO evaluate efficacy and safety of Dachaihu Decoction in prevention of obstruction of biliary plastic stent. Methods Sixty eight cases patients with plastic biliary stents were randomly assigned into Dachaihu decoction group （n=40） and control group （n=28）. The obstruction of stent was examined 3 months after treatment; the anti-perinuclear factor （APF） levels were measured by ELISA; bacterium culture and stone composition were also analyzed. The results were compared between two groups. Results The APF levels were （10.39± 2.17）ng/ml in control group and （17.29 ± 9.52）ng/ml in Dachaihu de- coction group（P〈0.05）. The contents of bilirubin calcium and calcium carbonate in stents of control group were higher than those in Dachaihu group （P〈0.01）. Only one type of bacterium were found in Dachaihu group. Conclusion Dachaihu decoction may prevent obstruction of biliary stent though inhibition of biofilm formation in stent, which may be associated with the up-regulation of anti-perinuclear factors.