熊去氧胆酸预防胆道塑料支架再阻塞的临床研究

A clinical study on the prevention of obstruction of biliary stent with ursodeoxycholic acid

目的分析熊去氧胆酸（UDCA）在预防胆道塑料支架再阻塞中的作用和疗效。方法前瞻性研究，将胆道疾病十二指肠塑料支架引流术患者随机分成UDCA组和对照组，收集2组患者术后3个月的支架，肉眼判断支架阻塞睛况，采集支架内胆泥，测定内膜抗核周因子（APF）含量，分析胆红素钙、胆固醇和碳酸钙盐含量，并进行细菌学培养。结果共收集88例患者的支架，UDCA组（43例）和对照组（45例）支架阻塞率分别为8．9％和58．1％，差异有统计学意义（P〈0．05）。UDCA组APF蛋白高于对照组[（17．29±9．52）μmol／L比（10．39±2．17）μmo]／L，P〈0．05]；而胆泥中的胆红素钙、碳酸钙含量[（13．90±3．80）％、（12．60±5．69）％]均明显低于对照组[（30．92±7．07）％、（16．52±4．11）％，P均〈0．05]；细菌培养多为单一细菌，其中40．0％培养出大肠埃希杆菌（75％产B-葡萄糖醛酸苷酶），低于对照组的72．1％。结论UDCA可能通过提高APF含量，抑制细菌繁殖，从而降低胆道塑料支架再阻塞率。

Objective To evaluate efficacy and safety of ursodeoxycholic acid（UDCA） for prevention of obstruction of biliary plastic stent. Methods A total of 88 patients with plastic biliary stents at our hospital were divided into UDCA group and the control group. Stents were collected 3 months after the operation for argile biliare in the stent. The contents of APF, calcium bilirubin and calcium carbonate were analyzed by biochemistry, and bacterium culture was conducted. Results The obstruction rate of UDCA group （ n = 43 ） and control group （ n = 45 ） were 8. 9% and 58.1% respectively with significant differences （ P 〈 0. 05 ）. There were significant differences in the protein level of APF between the UDCA group （ 17.29 ± 9. 52 ） μm/L and the control group （ 10. 39 ＋ 2. 17 ） μm/L （ P 〈 0. 05 ）. Calcium bilirubin [ （ 13.90 ± 3.80 ） vs. （ 30. 92 ± 7.07 ） ] and calcium carbonate [ （ 12. 60 ± 5.69 ） vs. （ 16. 52 ± 4. 11 ） ] were less than those of the control group （ P 〈 0. 05 ）. Only one type of bacterium was found, and Escheriehia coli were cultured in 40. 0% samples,a lower incidence compared with the control（72. 1% ）. Conclusion UDCA would lessen biofilm and smooth stent surface by promoting secretion of endogenous bile acid and increasing APF, and keep the biliary patency.