熊去氧胆酸治疗肝胆管结石行肝切除术后合并毛细胆管炎患者的临床疗效

Clinical effect of ursodeoxycholic acid in the treatment of hepatolithiasis patients complicated with cholangitis after hepatectomy

目的探讨熊去氧胆酸治疗治疗肝胆管结石行肝切除术后合并毛细胆管炎患者的临床疗效及安全性。方法选取2016年1月至2018年1月中南大学湘雅医学院附属株洲医院收治的9例肝胆管结石行肝切除术后合并毛细胆管炎的患者为研究对象,所有患者均给予熊去氧胆酸治疗[10 mg/(kg·d),早晚分2次口服,连续治疗3个月],观察治疗前后患者的临床症状(乏力、皮肤瘙痒、食欲减退、腹胀、黄疸等)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、血清总胆红素(total bilirubin,TBil)、直接胆红素(direct bilirubin,DBil)、γ-谷氨酰转肽酶(glutamyl transpeptidase,γ-GT)、碱性磷酸酶(alkaline phosphatase,ALP)、血液流变学指标(血低切黏度、血浆黏度及血小板聚集率)及药物不良反应。结果治疗前患者ALT、AST、TBil、DBil、γ-GT、ALP、全血低切黏度、血浆黏度、血小板聚集率分别为(62.3±12.2)U/L、(65.8±10.6)U/L、(23.6±2.3)μmol/L、(17.6±2.1)μmol/L、(78.9±12.6)U/L、(174.3±22.9)U/L、(14.3±1.1)mPa·s、(1.56±0.11)mPa·s、(49.5±10.2)%,治疗后上述指标分别为(34.3±6.2)U/L、(25.6±2.5)U/L、(10.2±1.1)μmol/L、(5.69±0.25)μmol/L、(39.5±9.8)U/L、(102.6±12.8)U/L、(9.0±0.25)mPa·s、(1.25±0.12)mPa·s、(39.9±10.1)%,差异均有统计学意义(P均<0.001)。治疗前患者乏力、皮肤瘙痒、食欲减退、腹胀、黄疸等症状发生例数分别为8例、7例、8例、8例、9例,治疗后上述症状发生例数分别为2例、2例、2例、3例、2例,差异均有统计学意义(P均<0.05)。治疗总有效例数为8例,仅1例发生头晕。结论熊去氧胆酸治疗肝胆管结石行肝切除术后合并毛细胆管炎可有效改善患者临床症状,改善肝功能及血液流变学。

Objective To investigate the clinical efficacy and safety of ursodeoxycholic acid in the treatment of hepatolithiasis complicated with cholangitis after hepatectomy. Methods Total of 9 cases of hepatolithiasis complicated with cholangitis after hepatectomy in the Affiliated Zhuzhou Hospital of XiangYa School of Medicine, Central South University from January 2016 to January 2018 were enrolled. All patients were treated with ursodeoxycholic acid 10 mg/(kg·d), oral administration twice in the morning and evening for three months. The clinical symptoms(weakness, itch of skin, anorexia, abdominal distension and jaundice), alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBil), direct bilirubin(DBil), glutamyl transpeptidase(γ-GT), alkaline phosphatase(ALP), indexes of hemorheology(whole blood low shear viscosity, plasma viscosity and platelet aggregation rate) and adverse reactions were compared before and after treatment. Results Before treatment, ALT, AST, TBil, DBil, γ-GT, ALP, whole blood low shear viscosity, plasma viscosity and platelet aggregation rate were(62.3 ± 12.2) U/L,(65.8 ± 10.6) U/L,(23.6 ± 2.3) μmol/L,(17.6 ± 2.1) μmol/L,(78.9 ± 12.6) U/L,(174.3 ± 22.9) U/L,(14.3 ± 1.1) mPa·s,(1.56 ± 0.11) mPa·s and(49.5 ± 10.2)%, respectively;after treatment, the above indexes were(34.3 ± 6.2) U/L,(25.6 ± 2.5) U/L,(10.2 ± 1.1) μmol/L,(5.69 ± 0.25) μmol/L,(39.5 ± 9.8) U/L,(102.6 ± 12.8) U/L,(9.0 ± 0.25) mPa·s,(1.25 ± 0.12) mPa·s and(39.9 ± 10.1)%, respectively, the differences were statistically different(all P < 0.001). Before treatment, the number of weakness, itch of skin, anorexia, abdominal distension and jaundice were 8 cases, 7 cases, 8 cases, 8 cases and 9 cases), respectively, after treatment, the number of the above symptoms were 2 cases, 2 cases, 2 cases, 3 cases and 2 cases, respectively, the differences were statistically different(all P < 0.05). The total effective number were 8 cases, only one case occurred dizziness after treatment. Conclusion Ursodeoxycholic acid can effectively improve the clinical symptoms, liver function and hemorheology of cholangitis patients complicated with cholangitis after hepatectomy.