舒肝宁注射液联合急诊ERCP治疗急性梗阻性化脓性胆管炎疗效及对血清和胆汁炎性因子的影响

Effect of Shuganing injection combined with emergency treatment by endoscopic retrograde cholangiopancreatography on acute obstructive suppurative cholangitis and its influence on serum and bile inflammatory factors

目的观察舒肝宁注射液联合急诊经内镜逆行胰胆管造影(ERCP)治疗急性梗阻性化脓性胆管炎(AOSC)的疗效及对血清和胆汁炎性因子的影响。方法将90例AOSC患者随机分为观察组45例和对照组45例,对照组给予急诊ERCP治疗,观察组在对照组治疗基础上于术后当天给予舒肝宁注射液治疗,疗程为7 d;观察2组治疗前后临床症状、肝功能、血常规、胆汁病原菌变化情况,检测2组治疗前后血清和胆汁炎性因子含量。结果治疗后2组发热、腹痛、腹胀、恶心呕吐、黄疸评分及症状总评分均显著降低(P均<0.05),且观察组上述评分均显著低于对照组(P均<0.05);2组治疗后肝功能指标(ALT、AST、TBil、CHE)、血常规指标(WBC、NEU、CRP)均显著改善(P均<0.05),且观察组上述指标改善情况均显著优于对照组(P均<0.05);治疗后观察组胆汁病原菌培养株数、阳性率均显著低于对照组(P均<0.05);治疗后2组血清和胆汁中IL-6、TNF-α水平均显著降低(P均<0.05),IL-10水平显著升高(P均<0.05),且观察组上述指标改善情况优于对照组(P均<0.05)。结论在急诊经ERCP治疗基础上,采用舒肝宁注射液治疗能够显著缓解AOSC患者临床症状,抑制病原菌,保护受损的肝功能,其机制可能与促进血清和胆汁中抗炎-促炎细胞因子的平衡有关。

Objective It is to observe the efficacy of Shuganing injection combined with emergency endoscopic retrograde cholangiopancreatography（ ERCP） in the treatment of acute obstructive suppurative cholangitis（ AOSC） and its effect on serum and bile inflammatory factors. Methods Ninety patients with AOSC were randomly divided into observation group（45 cases） and control group（45 cases）. The control group was given emergency ERCP treatment. The observation group was treated with Shuganing injection for 7 days on the basis of the control group on the same day after the treatment.The changes of clinical symptoms,liver function,blood routine,biliary pathogens were observed,the contents of serum and bile inflammatory factors were detected before and after treatment in the two groups. Results The scores of fever,abdominal pain,bloating,nausea,vomiting,jaundice and total symptom scores were significantly decreased after treatment in both groups（ P 〈 0. 05）,the above scores in the observation group were lower than those in the control group（ P 〈 0. 05）.Liver function indexes（ ALT,AST,TBil,CHE）,blood routine indexes（ WBC,NEU,CRP） were significantly improved（P 〈 0. 05） after treatment,the above indicators in the observation group were better than those in the control group（P 〈0. 05）. The number and positive rate of bile pathogens in the observation group were lower than those in the control group after treatment. The levels of serum and bile IL-6 and TNF-α was decreased significantly while that of IL-10 was increased after treatment in both groups（ P 〈 0. 05）,the improvements of the above indicators in the observation group were better than those in the control group（ P 〈 0. 05）. Conclusion Treatment of Shuganing injection on the basis of ERCP in emergencies can significantly relieve the clinical symptoms of AOSC patients,inhibit pathogens,and protect the damaged liver function. The mechanism may be related to the promotion of balance of anti-inflammatory and pro-inflammatory cytokines in serum and bile.