加味大柴胡汤预防胆总管结石ERCP术后胰腺炎的临床研究

Clinical Study on Modified Major Bupleurum Decoction in the Prevention of Pancreatitis after ERCP for Choledocholithiasis

目的探讨加味大柴胡汤预防胆总管结石内镜逆行胰胆管造影术(ERCP)后胰腺炎的效果。方法选取2020年10月—2022年1月80例行ERCP手术的胆总管结石患者,根据ERCP术后胰腺炎防治方法不同分为观察组和对照组各40例。对照组术前术后予吲哚美辛纳肛,观察组在对照组基础上联合加味大柴胡汤灌肠。统计2组胰腺炎发生率、症状改善时间、住院时间及不良反应,比较治疗前后中医证候积分、JAK2/STAT3信号通路蛋白、肠道屏障功能指标水平。结果术后24 h,观察组胰腺炎发生率为2.50%低于对照组的17.50%(P<0.05)。术后24 h 2组腹胀、腹痛积分及JAK2、STAT3、D-乳酸、内毒素、二胺氧化酶水平均低于术前,且观察组低于对照组(P<0.05,P<0.01)。观察组症状改善时间、住院时间较对照组短(P<0.01)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论加味大柴胡汤可有效防治ERCP术后胰腺炎,改善肠道屏障功能,缩短住院时间,且安全性高,作用机制可能与下调JAK2/STAT3信号通路蛋白有关。

Objective To investigate the effect of modified Major Bupleurum decoction in preventing pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP)for choledocholithiasis.Methods In total,80 patients with choledocholithiasis who underwent ERCP from October 2020 to January 2022 were selected and divided into observation group(n=40)and control group(n=40)according to different methods of preventing pancreatitis after ERCP.The control group was given Indomethacin Suppositories before and after surgery,and the observation group was given modified Major Bupleurum decoction for enema on the basis of the control group.The incidence of pancreatitis,time to symptom improvement,length of hospital stay and adverse reactions of the two groups were analyzed.TCM syndrome scores,JAK2/STAT3 signaling pathway protein levels and intestinal barrier function indexes before and after treatment were compared.Results At 24 h after operation,the incidence of pancreatitis in observation group was 2.50%,which was lower than that in control group(17.50%)(P<0.05).At 24 h after surgery,abdominal distension and abdominal pain scores and the levels of JAK2,STAT3,D-lactic acid,endotoxin and diamine oxidase in the two groups were lower than those before surgery,and lower in the observation group than in the control group(P<0.05,P<0.01).Time to symptom improvement and length of hospital stay were shorter in the observation group than in the control group(P<0.01).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Modified Major Bupleurum decoction can effectively prevent and treat pancreatitis after ERCP,improve intestinal barrier function and shorten the length of hospital stay,with good safety.The mechanism of action may be related to the down-regulation of JAK2/STAT3 signaling pathway protein.